Post-abortion Family Planning Research Articles

O190 Postabortion family planning – A cost effective best practice for reducing maternal mortality and morbidity

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S147-S147 Free communication (oral) presentations O190 Postabortion family planning – A cost effective best practice for reducing maternal mortality and morbidity C. Curtis, C. CurtisSearch for more papers by this author C. Curtis, C. CurtisSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)60562-2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S147-S147 RelatedInformation

PARADIGM SHIFT: MOVING TOWARD ACCESS IN EVERY OFFICE

Dehlendorf and Grumbach should be commended for their recent piece on medical liability insurance for abortion care in family medicine.1 Their work highlights that family medicine physicians are uniquely positioned to provide early abortion care to their patients. Medication abortion and first-trimester aspiration abortion are skills that family medicine physicians can easily incorporate into their practices as a service to their patients. As mentioned by Dehlendorf and Grumbach, it is estimated that 44% of women have an abortion sometime during their life.2 This fact makes early abortion relevant to all primary care physicians, but especially to family medicine physicians, who have clinical training in obstetrics and gynecology. Additionally, in the more rural parts of the United States, family medicine physicians are often the only physicians in town. In the 87% of US counties that do not have an abortion provider, family medicine physicians could be the answer to this unmet need.3 Anthony McWilliams, left, and “L” Lawrence Warren, right, participate in the 2nd Annual Stand Up and Represent National Black Gay Pride march in the West End section of Atlanta, GA, on September 2, 2002. Photograph by Ric Feld. Printed with permission of AP Images. Currently, only 2% of abortions are provided in private doctors' offices.3 The majority are performed in specialty abortion clinics. Patients are often referred to these specialty clinics from the gynecologist or primary care doctor who diagnosed their pregnancy. This is the current model of abortion care in this country. Imagine however, if first-trimester abortions were available in the majority of primary care practices. The paradigm of abortion care in the United States could be fundamentally altered, and the negative stigma of abortion could be lessened. Family medicine physicians have other advantages beyond their physical proximity and training skills: the ability to provide continuity of care and make use of the acquired trust of their patients. In times of crisis, primary care physicians have a unique opportunity to intervene to effect positive change as a result of the relationship they have built with their patients.4 Delivering abortion care in the primary care setting has the potential to improve postabortion family planning and contraceptive services, such as patient selection of intrauterine devices or other highly effective contraceptive methods. Better contraception means fewer repeat abortions, and that is a goal that almost everyone can agree on.5

Impact of post-abortion family planning services on contraceptive use and abortion rate among young women in China: a cluster randomised trial

Objectives To compare two post-abortion family planning (FP) service packages on contraceptive use and repeat abortion rate among young women in three cities in China.Methods In this cluster-randomized trial, one FP service package included provision of limited information and referral to existing FP services, and the other, more comprehensive, package consisted – in addition to the above simple package – of individual counselling, free provision of contraceptive materials, and involvement of the male partner. Eight matched pairs of hospitals were certified by centralized randomization. Women undergoing abortion were followed up for six months, and data were collected in two rounds, before and after the intervention.Results We followed a total of 2336 women younger than 25 years (555 before and 555 after the simple intervention package; 634 before and 592 after the comprehensive intervention package). Both packages increased use of any contraceptive method, but the comprehensive approach also increased use of more effective methods. Odds ratios for consistent and correct use of condoms were 2.32 (95% confidence interval 1.55–3.46) and 2.78 (1.81–4.26), respectively, compared with the simple package. The rates of unwanted pregnancies and repeat abortions were somewhat reduced for both packages, with no significant statistical difference between them.Conclusion Couples who received the comprehensive post-abortion FP service appear to use more effective contraceptive methods and show better compliance.

Second Trimester Abortion in Viet Nam: Changing to Recommended Methods and Improving Service Delivery

In Viet Nam, abortion has been legal up to 22 weeks of pregnancy since the 1960s. There are about one million induced abortions every year. First trimester abortion is provided at central, provincial, district and commune level, while second trimester abortion is provided only at central and provincial level. For second trimester abortion, dilatation and evacuation (D&E) has been introduced at some central and provincial hospitals, and medical abortion protocols have been included in the draft National Standards and Guidelines currently being updated. However, Kovac's, an unsafe method, is still often used at many provincial hospitals. While access to first trimester abortion services is not difficult, there are still many barriers to second trimester abortion, especially for young, unmarried women. In order to prevent unwanted pregnancies, increase access to safe abortion and improve quality of care, the Vietnamese Ministry of Health is working with others to establish national policies and developing effective models for women-friendly comprehensive abortion care, including post-abortion family planning. This paper, based on published information, interviews and observations by the second author of service delivery in 2006–2008, provides an overview of second trimester abortion services in Viet Nam and ongoing plans for improving them.

Attitudes and practices of private medical providers towards family planning and abortion services in Nigeria

The study was designed to investigate the attitudes and practices of private medical practitioners towards abortion, postabortion care and postabortion family planning in Nigeria. Three hundred and twenty-three private practitioners who were proprietors of private clinics in three states of the country were interviewed with a structured questionnaire that elicited information on their knowledge and experiences of abortion and postabortion care in the cities. Twenty-four percent of the doctors reported that they routinely terminate unwanted pregnancies when requested to do so by women, while 82% reported that they frequently treat women who experience complications of unsafe abortion. Over 45% reported that they use manual vacuum aspiration (MVA) for the management of abortion in the first trimester, while 25% use dilatation and curettage (D and C). Nearly 28% reported the use of MVA followed by D and C in the first trimester. Fifty-seven percent reported their lack of expertise in managing second-trimester abortions, while those admitting that they manage second-trimester abortions reported nonstandard methods and procedures. In addition, there was evidence of inadequate counseling of women, lack of institutional protocols and poor use of postabortion family planning by the doctors. These results suggest the need for a program of retraining of private practitioners on the principles and practices of safe abortion, postabortion care and family planning in Nigeria and the integration of these topics into medical training curricula in the country.

Knowledge, Attitude and Practice of Private Medical Practitioners in Calabar towards Post-Abortion Care

This study examined the knowledge, attitude and practice of private medical practitioners in Calabar on abortion, post-abortion case and post-abortion family planning. Forty eight private practitioners who were proprietors of private clinics in the city were interviewed using a structured questionnaire. The results showed that 22.9% of the doctors routinely terminate unwanted pregnancies when requested to do so by women, while 83.3% of them treat women who experience complications of unsafe abortion. The major reasons given by some of the doctors for not terminating unwanted pregnancies were religious, moral and ethical considerations rather than respect for the Nigerian abortion law. Only 18.2% of the doctors use standard procedures such as manual vacuum aspiration (MVA) for the management of patients with abortion and abortion complications. A good number of them did not routinely practice integrated post-abortion family planning and STDs management. There is need for a comprehensive programme of retraining of private medical practitioners in Calabar on the principles and practices of safe abortion, post-abortion care and family planning. These aspects of reproductive health need to be integrated into the medical training curricula in Nigeria. It is believed that this approach would help reduce the present high rate of abortion-related morbidity and mortality in Nigeria.

Knowledge, attitude and practice of private medical practitioners in Calabar towards post-abortion care.

This study examined the knowledge, attitude and practice of private medical practitioners in Calabar on abortion, post-abortion case and post-abortion family planning. Forty eight private practitioners who were proprietors of private clinics in the city were interviewed using a structured questionnaire. The results showed that 22.9% of the doctors routinely terminate unwanted pregnancies when requested to do so by women, while 83.3% of them treat women who experience complications of unsafe abortion. The major reasons given by some of the doctors for not terminating unwanted pregnancies were religious, moral and ethical considerations rather than respect for the Nigerian abortion law. Only 18.2% of the doctors use standard procedures such as manual vacuum aspiration (MVA) for the management of patients with abortion and abortion complications. A good number of them did not routinely practice integrated post-abortion family planning and STDs management. There is need for a comprehensive programme of retraining of private medical practitioners in Calabar on the principles and practices of safe abortion, post-abortion care and family planning. These aspects of reproductive health need to be integrated into the medical training curricula in Nigeria. It is believed that this approach would help reduce the present high rate of abortion-related morbidity and mortality in Nigeria.

Bridging the Gap: Integrating Family Planning with Abortion Services in Turkey

In Turkey the inadequacy of family planning services leads many women to have repeat abortions which constitutes a major public health issue. In response the postabortion family planning program established linkages between abortion and family planning services. This paper reviews a decade of experience in postabortion family planning services which were delivered through three related phases: 1) a pilot program in a single public maternity hospital 2) an expansion of the program into 10 public facilities and 3) further expansion into 12 private-sector and two public-sector hospitals in Istanbul. Overall the experience in Turkey shows that women turn to abortion because of lack of contraception options. In an analysis of abortion trends it is noted that the postabortion family planning program efforts implemented throughout the 1990s contributed to the decline in abortion both by increasing the use of contraceptives among women who had had an abortion and by tilting the method mix toward more effective methods. The commitment of decision-makers was a particularly important criterion in the success of postabortion interventions. At the national level the program required support from management at the Ministry of Health and at the Social Insurance Organization. The most important challenge for the postabortion family planning program in Turkey was reaching the private sector.

Contraceptive practices of women after abortion in Turkey

Objectives The aim of this study was to determine the postabortion contraception choices of women and the subsequent reduction in pregnancy rate. The changes in method of contraception during the1-year follow-up period were also assessed.Methods Ninety women decided to practice family planning methods following an abortion procedure. The family planning choices of the postabortion familyplanning group were determined by active immediate family planning counselling. The control group, which consisted of 23 women who had had an abortion and wanted to become pregnant again, were followed-upfor 1 year to determine their pregnancy rate. The pregnancy rates and methods used were determined during a 12-month follow-up period.Results Following counselling, 79.64% of the patients signedfor immediate family planning practice. In the postabortion family planning group, one out of 90 patients (1.1%, Pearl index 1.29) practising contraception with a condom became pregnant. However, ten outof 23 (43.5%, Pearl index 54.2) patients in the control group became pregnant during the 1-year follow-up period (p < 0.05). In the postabortion family planning group, intrauterine devices (IUDs)(n = 43), injectable monthly contraceptives (n = 24) and tubal ligation (n = 9) were the most commonly preferred methods, with 47%, 27% and 10% of the women using these methods, respectively.At the end of the 12-month period, the drop-out rate among women using the injectable monthly contraceptives was significantly higher (13 patients, 54%) compared to other methods (p < 0.05). Inone case out of 43 using an IUD (2.38%), the IUD was expelled during follow-up.Conclusion The use of postabortion family planning significantly decreased the postabortion pregnancy rate. Theuse of an IUD was the preferred immediate method of choice. Use of injectable monthly contraceptives was the method with the highest drop-out rate. The expulsion rate of postabortion IUDs was acceptablein our practice. The pregnancy rate in the control group was lower than the physiological fecundity would predict. This may suggest that, although couples plan to get pregnant, they do not concentrate onthe ideal conditions for conception or they do, in fact, practice some form of family planning.

Contraceptive intentions of women seeking induced abortion in the city of Jos, Nigeria

This is a prospective study involving 120 women who requested abortion for an unplanned and unwanted pregnancy. We sought to determine their contraceptive intentions and use. The characteristics of these women revealed that the majority were young, single schoolgirls with 68.5% of them being nulliparous. Over 90% had had their first sexual experience before the age of 20 years. Although, 113 (94%) were aware of the availability of contraceptive services only 70 (62%) of these had ever used a method and the majority of the contraceptive methods selected were ineffective. Although 97 (80.8%) had a positive intention towards post-abortion family planning, only 18 (18.5%) eventually agreed and were offered a method after the termination of pregnancy. The study revealed a high risk group of unplanned and unwanted pregnancy in Jos but low contraceptive use despite the high positive intentions expressed by this cohort of patients. Effective post-abortion contraception counselling should be incoporated into family planning in Nigeria in order that clients who express positive intentions to the use of family planning actually use the method thereby reducing the incidence of repeated induced abortions and its social and medical consequences.

Book Reviews

Australian and New Zealand Journal of Obstetrics and GynaecologyVolume 39, Issue 2 p. 278-280 Book Reviews First published: 19 March 2008 https://doi.org/10.1111/j.1479-828X.1999.tb03396.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Book review in this Article Post-abortion Family Planning: a practical guide for programme managers. Author: Division of Reproductive Health (Technical Support). Publisher: Division of Reproductive Health (Technical Support) Family & Reproductive Health World Health Organization Geneva. Preparation and Revision for the DRCOG. Second edition. Authors: Janice Rymer, Gregory Davis, Adam Rodin and Michael ChaDman. Basic Sciences for Obstetrics and Gynaecology MCQs. Author: Tim Chard. Fetal Awareness. Author: Report of a Working Party. Fetal Abnormalities. Guidelines for Screening, Diagnosis and Management. Author: Joint Working Party of RCOG and RCPCH. Medical Methods for Termination of Pregnancy. Author: WHO Technical Support Series. Screening for Down Syndrome in the First Trimester. Edited by: JG Grudzinkas & RHJ Ward. Hysterectomy and Vaginal Repair-Fourth Edition. Authors: Sally Hasslett and Molly Jennings. OSCEs in Obstetrics and Gynaecology. Authors: Rymer J, Ahmed H. Volume39, Issue2May 1999Pages 278-280 RelatedInformation

Unsafe abortion and post abortion family planning in Africa: The Mauritius conference International Planned Parenthood Federation Africa Region, 1994

Unsafe abortion and post abortion family planning in Africa: The Mauritius conference International Planned Parenthood Federation Africa Region, 1994

Meeting women's needs for post-abortion family planning: Framing the questions

Although women who undergo abortion are at risk of subsequent unwanted pregnancies abortion services in developing countries are rarely linked to family planning services. This neglect of post-abortion contraceptive services reflects both the low priority allotted to womens reproductive health needs and national and international policies that restrict abortion-related programming. Even when abortion providers refer women to a family planning center the clinic is often inaccessible or insufficiently supplied with modern contraceptives. preferable is a model involving on-site delivery of initial counseling and contraceptive provision after abortion coupled with referral to and contraceptive provision after abortion coupled with referral to community sources for continuity of care and resupply. Since women who are not adequately counseled are at high risk of method discontinuation all family planning options must be clearly presented. In all cases respectful treatment of abortion patients and understanding of the situation that led them to seek abortion will improve the acceptability of services. In the majority of cases unwanted pregnancies occur because family planning services are unavailable inaccessible ineffective or culturally unacceptable to women. The inclusion of women in the design of post-abortion services can help to identify the obstacles to family planning use. Fortunately there is growing concern about the effects of unsafe clandestine abortion (up to 200000 maternal deaths each year) and the momentum for change exists. Ways must be found however to reach women who induce abortions clandestinely and never enter the health care system.

Post-abortion family planning: reversing a legacy of neglect

UN policies have been narrowly focused and have created within the international community the disintegration of family planning and postabortion family planning services. Local policy markers were thus encouraged to circumvent the difficult policy issues surrounding abortion. The result was unsafe abortion as the leading cause of maternal mortality and morbidity. Health professionals must resist the pressures to segregate abortion from reproductive health. The destructive effect is evident in the lives lost, the chronic disability or injury. and the deterioration of families. Death, disability, and injury is preventable in the case of abortion. The current political climate has changed and there is more support throughout the world for dealing with unsafe abortion. Efforts were made in the formation of a 25-member technical working group in Bellagio, Italy, in February 1993 to focus attention on reintegrating abortion and family planning. Conference participants represented a range of professions related to reproductive health needs. The group consensus was that abortion care facilities and family planning programs must be responsive to provision of family planning services to abortion patients. Family planning centers must serve all women and provide referral when abortion services are not part of the program. Abortion care providers must be aware of family planning and create links with providers of family planning. High-quality services are the goal that can be achieved by designing programs to meet the need of individuals rather than an arbitrary set of standards. Post-abortion family planning can be improved despite restrictive laws and must not be ignored until laws have changed. Political and managerial will is required in order to improve access to a full range of reproductive health services for women. It is an ethically responsible mandate to facilitate access to safe, appropriate contraceptive information and services following abortion.