Providing Comprehensive Abortion Care

Location:

Introduction:

According to the World Health Organization, 25 million unsafe abortions (45% of all abortions) occurred every year between 2010 and 2014. The overwhelming majority of unsafe abortions occurred in developing countries in Africa, Asia, and Latin America. In one crisis-affected country in Asia, this humanitarian organization has made great strides in increasing access to contraceptive and post abortion care services. Despite this progress, the number of unsafe abortions remained high, putting women’s health and lives at risk.

Project Description:

The organization recognized the need for greater access to safe abortion care (SAC) and decided to introduce comprehensive abortion services (CAC) into its programming. In doing so, CACComprehensive abortion care was integrated into the services already offered by nurses and midwives in government health facilities and support was provided to improve the quality of abortion services offered by private providers. Values clarification and attitude transformation (VCAT) activities were important first steps to fostering an environment conducive to high quality, unbiased care. The organization conducted on-the-job training on misoprostol and manual vacuum aspiration for CACComprehensive abortion care and provided all necessary supplies and equipment. In order to maintain client privacy and confidentiality, a system was devised to record SACSafe abortion care clients in the post-abortion care (PAC) register with a confidential mark. Women were informed of CACComprehensive abortion care services during one-on-one community outreach sessions to maintain a low profile within the community. When working with private providers, the organization developed a Memorandum of Understanding, facilitated competency-based trainings on contraception, MVAManual vacuum aspiration, and infection prevention, and provided all necessary supplies and equipment in exchange for the price reduction of contraceptive and CACComprehensive abortion care services.

Results:

In the first year of the initiative, 3,411 women and girls received CACComprehensive abortion care services. Of these, 3,086 were PACPost-abortion care clients and 325 were SACSafe abortion care clients. From July to December of 2017, the 59 public facilities supported by the organization received 206 SACSafe abortion care and 1,064 PACPost-abortion care clients. At the 11 supported private providers, 25 SACSafe abortion care and 715 PACPost-abortion care clients accessed services. As a result of facilitated trainings, these private providers are now using MVAManual vacuum aspiration and misoprostol in lieu of dilation and curettage (D&C) for CACComprehensive abortion care clients.

Lessons Learned:

VCATValues clarification and attitudes transformation workshops are key to improving attitudes among health providers as well as organizational staff. Maintaining a low profile, ensuring client confidentiality, working with nurses and midwives, and conducting one-on-one CACComprehensive abortion care information sessions were particularly helpful strategies for integrating SACSafe abortion care at the government facilities. Implementing CACComprehensive abortion care through a network of private providers has proved challenging due to their reluctance in recording and sharing data and higher costs for services remains a barrier for women and girls. Measuring the quality of care of private providers is also challenging without direct observation.