Postabortion Care in Humanitarian Emergencies: Improving Treatment and Reducing Recurrence

Autor: Meghan C Gallagher, Claire Eldred, Ribka Amsalu, Catherine N. Morris, Sarah Ashraf, Mariam Aldogani, Emily Monaghan, Janet Meyers, Abdikani Hirsi Shire
Rok vydání: 2019
Předmět:
medicine.medical_specialty
Capacity Building
Yemen
endocrine system diseases
Service delivery framework
Somalia
medicine.medical_treatment
education
Aftercare
Context (language use)
Abortion
Health Services Accessibility
Dilatation and Curettage
03 medical and health sciences
Dilation and curettage
0302 clinical medicine
Pregnancy
Unsafe abortion
health services administration
medicine
Humans
030212 general & internal medicine
Quality of Health Care
Abortifacient Agents
Nonsteroidal
030219 obstetrics & reproductive medicine
Mobilization
business.industry
fungi
Community Participation
food and beverages
Abortion
Induced
General Medicine
Relief Work
medicine.disease
Quality Improvement
humanities
Programmatic Review & Analysis
Equipment and Supplies
Vacuum Curettage
Community mobilization
Family Planning Services
Family medicine
Democratic Republic of the Congo
Female
Emergencies
business
Misoprostol
Zdroj: Global Health: Science and Practice
ISSN: 2169-575X
DOI: 10.9745/ghsp-d-18-00400
Popis: Despite the challenging environment of humanitarian emergencies, with focused programmatic attention, demand for quality postabortion care can be created and services delivered while voluntary contraceptive uptake for PAC clients can simultaneously increase substantially, even in settings where the use of contraception after abortion is often stigmatized. Greater representation of long-acting methods, as a proportion of the methods PAC clients chose, occurred in all 3 countries’ method mix, but at different rates.
Background: Unsafe abortion contributes to maternal mortality worldwide and disproportionately affects the most disadvantaged women and girls; thus, improving the treatment of complications of abortion is essential. Shifting PAC treatment from sharp dilation and curettage (D&C) to the use of aspiration techniques, notably manual vacuum aspiration (MVA), and medical treatment with misoprostol improves health outcomes. Equally critical is ensuring that women have access to voluntary contraception after an abortion to prevent future unintended pregnancies. In humanitarian settings, access to voluntary family planning to disrupt the cycle of unsafe abortion is even more critical because access to quality services cannot be guaranteed due to security risks, migration, and devastation of infrastructure. Save the Children applied a multipronged postabortion care (PAC) approach in the Democratic Republic of the Congo (DRC), Somalia, and Yemen that focused on capacity building; assurance of supplies and infrastructure; community collaboration and mobilization; and monitoring and evaluation. Methods: Program-level data were extracted for each of the 3 countries from the inception of their program through 2017. The sources of information included monthly service delivery reports that tracked key PAC indicators as well as qualitative data from evaluations of community mobilization activities. Results: The number of PAC clients increased in all countries. In the DRC in 2012, 19% of PAC clients requiring treatment received D&C; in 2017 the percentage was reduced to 3%. In 2013, 25% of all PAC clients in Yemen were treated with D&C; this percentage was reduced to 3% in 2017. The proportion of women choosing contraception after an abortion increased. In 2012, only 42% of all PAC clients in the DRC chose a contraceptive method; by 2017, the proportion had increased to 70%. Somalia had substantial increases in PAC demand, with the percentage of all PAC clients electing contraception increasing from 64% in 2012 to 82% in 2017. In Yemen, where the health system has been constrained due to severe conflict, the percentage of PAC clients choosing voluntary contraception rose from 17% in 2013 to 38% in 2017. Uptake and demand for PAC was mobilized through targeted community outreach in each context. Conclusion: These data demonstrate that providers can effectively shift away from D&C as treatment for PAC and that contraceptive uptake by PAC clients can increase substantially, even in settings where the use of contraception after abortion is often stigmatized.
Databáze: OpenAIRE
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