Exploring Barriers: How to Overcome Roadblocks Impeding the Provision of Postabortion Care to Young People in Togo.

Abstract

Family planning counseling and provision of a variety of contraceptive methods during postabortion care (PAC) can increase voluntary contraceptive use and prevent unintended pregnancies, helping to reduce maternal morbidity and mortality. Youth in Togo, however, face many barriers to accessing contraceptives during PAC including provider bias, parental consent policies, stigma, and pressure on young people to have children. This article describes the lessons learned from follow-up with providers who were trained on PAC to build their willingness and skills in offering youth-friendly PAC. With assistance from the Evidence to Action (E2A) Project, Togo's Division for Maternal and Infant Health and Family Planning (DSMI/PF) systematically applied IntraHealth International's Optimizing Performance and Quality (OPQ) approach to improve the quality of PAC at 5 health facilities from 2014 to 2016. OPQ identified gaps and helped establish solutions to shortcomings that hinder youth's access to contraceptive choice during PAC. To address these shortcomings, staff trained providers to improve their knowledge, attitudes, and skills with regard to (1) medical eligibility criteria for contraceptive use to remove age as justification for denying contraceptives; (2) AFPAC to increase the ability to consider gender-based violence and to encourage client-focused and age-sensitive counseling; and (3) monitoring through disaggregation of data by age, method, and parity for data-driven planning and delivery of AFPAC. Providers reported improved attitudes and empathy toward young PAC clients, efforts to screen for exposure to sexual and gender-based violence, and willingness to explore reproductive health needs and assist clients in choosing contraceptive methods. Previously, no youth PAC clients chose contraceptives during PAC or returned to the facility for routine follow-up. After providers received OPQ training, they treated 775 PAC clients in 5 health facilities between June and December 2016; 351 were ages 14-24, of whom 142 (40.5%) chose a modern contraceptive. The most common method selected by youth was oral contraceptive pills (44%), followed by implants (41%) and injectables (15%). Of the 142 youth PAC clients who chose a method, 86 (58.5%) returned for the 7-day follow-up. Training providers to offer AFPAC along with the application of OPQ to improve the quality of PAC increases voluntary contraceptive uptake, including implants, among youth who make up a substantial portion of all PAC clients. Incorporating AFPAC in family planning/reproductive health policies, norms, protocols, and PAC training, as Togo's DSMI/PF did, is an important element to ensuring institutionalization of the practice.