A Comprehensive Approach
To Postabortion Care

Why is comprehensive postabortion care important?

Unsafe abortion can result in infection, hemorrhage, internal injury, psychological trauma, long-term morbidity, and even, for approximately 70,000 women annually, death. Women who have experienced unsafe abortion need care to treat such complications and to prevent them in future. Because of the stigma associated with abortion, and because women who experience incomplete abortion do not always recognize the urgency of their condition, women need the support of communities, as well as community-level referrals, to access timely quality care. Community support is now considered essential to quality postabortion care (PAC), but few models exist for building this support.

Women in need of postabortion care also need family planning (FP) counseling and services so they can avoid future unwanted pregnancies and repeat abortions, and to adequately space a next desired pregnancy. Too often, however, PAC services focus only on emergency treatment, failing to provide clients with the FP options they need to prevent repeat abortion.

How can ESD help establish comprehensive postabortion care?

ESD follows USAID’s model for comprehensive care, which includes three core components: (1) emergency treatment; (2) provision of RH/FP services; and (3) community mobilization. Through ESD’s consortium members and predecessor project CATALYST, ESD has broad experience designing and implementing the community-mobilization component, as well as extensive experience integrating FP/RH services and strengthening emergency treatment—for example, in Bolivia, Cambodia, Egypt, Nepal, Peru, and Romania. ESD is prepared to replicate and scale up these models by:

Conducting advocacy workshops: ESD holds regional workshops and follow-up meetings to encourage policy support for PAC. Depending on the country, workshops focus one developing national PAC service delivery guidelines, including PAC in national health insurance coverage, including PAC in preservice training, devoting resources to the implementation of comprehensive PAC, including FP counseling and services at PAC service sites, allowing lower-level providers such as midwives to conduct manual vacuum aspiration for PAC, or supporting a focus on youth-friendly PAC services.

Establishing, strengthening, and scaling up PAC programs: ESD assists partners to integrate good-quality PAC programs within existing secondary and tertiary OB/GYN and emergency room units, and primary health care services. FP counseling and services are essential components of PAC, so ESD helps partners ensure that postabortion clients have on-site access to FP information, referrals and, when possible, services.

CATALYST helped the public sector establish and scale up PAC to more than 300 facilities in Peru, 165 in Bolivia, and 12 in Egypt. ESD will replicate this approach, which involved conducting needs assessments, sharing information about best practices, and contributing to the development of national PAC service delivery guidelines.  Training materials and systems were developed and used to train trainers and staff, PAC supervision systems were established, and evaluative research determined the extent to which providers follow protocols and assessed client satisfaction. ESD is an active member of the PAC Consortium, able to immediately disseminate state-of-the-art guidelines and best practices.  New guidelines address the needs of young women, who account for roughly 40 percent of those experiencing unsafe abortion. To help institutionalize PAC, ESD also builds the capacity of health centers to identify postabortion emergencies, stabilize clients, and refer clients to hospitals.

Building community support for PAC: The international community has only recently identified community support as an essential component of PAC, so few models for encouraging this support exist. With unique experience, ESD is well positioned to provide leadership in this area. Its predecessor project piloted a model for involving communities in Bolivia; success led to the adaptation, replication, and scale up of the approach in both Egypt and Peru. The Latin-American model uses a community-action approach to define and address PAC-related concerns, while the Egyptian model uses a message-dissemination approach, preparing local leaders to act as PAC champions and educators. Both approaches remove the stigma associated with PAC, and help community members recognize postabortion danger signs and understand the importance of FP to prevent future unwanted pregnancies. Community PAC was replicated by a USAID program in Kenya and scaled up by CATALYST—for example, in Egypt from an initial five communities to an additional 49 communities. A third model, implemented in Cambodia and Romania, focuses on ways to improve community referral for PAC, relying on traditional birth attendants, village health committees, traditional healers, monks, local authorities, and others. ESD can adapt and scale up these or other community PAC models.