Abstract
Unsafe abortion is responsible for at least 9% of all maternal deaths worldwide; however, in humanitarian emergencies where health systems are weak and reproductive health services are often unavailable or disrupted, this figure is higher. In Puntland, Somalia, Save the Children International (SCI) implemented postabortion care (PAC) services to address the issue of high maternal morbidity and mortality due to unsafe abortion. Abortion is explicitly permitted by Somali law to save the life of a woman, but remains a sensitive topic due to religious and social conservatism that exists in the region. Using a multipronged approach focusing on capacity building, assurance of supplies and infrastructure, and community collaboration and mobilisation, the demand for PAC services increased as did the proportion of women who adopted a method of family planning post-abortion. From January 2013 to December 2015, a total of 1111 clients received PAC services at the four SCI-supported health facilities. The number of PAC clients increased from a monthly average of 20 in 2013 to 38 in 2015. During the same period, 98% (1090) of PAC clients were counselled for postabortion contraception, of which 955 (88%) accepted a contraceptive method before leaving the facility, with 30% opting for long-acting reversible contraception. These results show that comprehensive PAC services can be implemented in politically unstable, culturally conservative settings where abortion and modern contraception are sensitive and stigmatised matters among communities, health workers, and policy makers. However, like all humanitarian settings, large unmet needs exist for PAC services in Somalia.
Highlights
830 women die every day from preventable causes related to pregnancy and child birth; of these, almost all (99%) occur in low- and middle-income countries.[1]
98% (1090) of postabortion care (PAC) clients were counselled for postabortion contraception, of which 955 (88%) accepted a contraceptive method before leaving the facility, with 30% opting for long-acting reversible contraception
Like all humanitarian settings, large unmet needs exist for PAC services in Somalia
Summary
830 women die every day from preventable causes related to pregnancy and child birth; of these, almost all (99%) occur in low- and middle-income countries.[1]. The three-component model, attributed to USAID, includes emergency treatment for complications of abortion, including infection, sepsis, haemorrhage, shock, and reproductive tract injuries; family planning counselling and provision of contraceptive methods for the prevention of further unplanned or mistimed pregnancies that may lead to repeat induced abortions; and community awareness and mobilisation around the critical nature of PAC, allowing for important linkages to other. The existing government capacity and systems are weak and access to basic services, including health care, is limited. Somalia has one of the highest total fertility rates in the world (TFR = 6.4) coupled with very low modern contraceptive prevalence (mCPR = 1%), high unmet need for family planning (29.2%), and limited access to PAC.[19,20] With a 1 in 18 lifetime risk of a woman dying during pregnancy or childbirth, it remains one of the few places with the highest risk for mothers.[21]
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