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September 3, 2019

Expanding Voluntary Postabortion Family Planning

The Global Health: Science and Practice (GHSP) journal recently published a special supplement on “Saving Women’s Lives Through Emergency Obstetric Care and Voluntary Family Planning” that focusses on postabortion care (PAC). The supplement offers original research, analysis, and commentaries from around the world exploring methods for improving the quality of PAC, reducing maternal and child mortality through effective PAC, and expanding postabortion family planning counseling and contraceptive services.

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Members of the EngenderHealth team, including Colin Baynes, Rehema Kahando, Justin Kahwa, Grace Lusiola, Japheth Ominde, and Erick Yegon, co-authored three papers in the supplement, sharing learnings and insights from Tanzania. The papers cover quality of PAC, women’s satisfaction with PAC, and cost-effectiveness of PAC. Key findings from those papers include:

  • Gaps in PAC availability and quality in Tanzania “spanned multiple domains, including human resource capacity and availability of supplies and contraceptives.” To ensure providers are able to deliver high-quality PAC, the authors of “The Quality of Postabortion Care in Tanzania: Service Provider Perspectives and Results From a Service Readiness Assessment” recommend: “Technical assistance approaches that blend training, clinical quality improvement, systems strengthening, and social interventions that address demand-side barriers.” (Yegon et al., 2019)
  • “Tanzanian women expressed greater satisfaction with PAC received at district hospitals and health centers…than at regional hospitals.” At the smaller facilities, women “experienced shorter waiting times, more family planning counseling, and threefold greater uptake of voluntary family planning.” The authors of “Women’s Satisfaction With and Perceptions of the Quality of Postabortion Care at Public-Sector Facilities in Mainland Tanzania and in Zanzibar” conclude: Continued decentralization to lower-level health facilities “would likely enhance client satisfaction with postabortion care.” (Baynes et al., 2019)
  • Because the burden and cost of PAC in Tanzania is high, “health policy should strengthen voluntary family planning programs and the availability of a variety of contraceptive methods to PAC clients,” with a focus on PAC at lower-level facilities, “including health centers and dispensaries, which can provide safe, accessible, and appropriate PAC at the lowest cost including surgical or medical options.” The authors of “The Unit and Scale-Up Cost of Postabortion Care in Tanzania” find that “Investing more resources in voluntary family planning and PAC treatment of routine complications at the primary level would likely reduce health system costs.” (Baynes et al., 2019)

This GHSP supplement comes at an important time. Twenty-five years ago, at the landmark International Conference on Population and Development (ICDP) in Cairo, 179 governments committed to a set of standards, including:

“In all cases, women should have access to quality services for the management of complications arising from abortion. Post-abortion counselling, education and family-planning services should be offered promptly to protect women’s health and to help to avoid repeat abortions.”

As leaders from all sectors prepare to gather later this year at the Nairobi Summit to mark the 25th anniversary of ICPD and to renew the focus on women’s health and rights, the authors of the GHSP supplement rightly review what the evidence tells us about PAC and postabortion family planning. They find that PAC clients still face multiple barriers in accessing effective voluntary family planning in an environment of choice, respect, and support. They also find indicators of improvement and paths to greater success. As Guest Editor: Douglas Huber, MD, MSc, writes, “Now is the time to make voluntary postabortion family planning accessible as an essential component of PAC.” We couldn’t agree more.

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