Systematic review of experiences and effects of integrating post-abortion family planning services into existing health system worldwide

Objective To systematic review and analyze the practices and effects of integrating post-abortion family planning （PAFP） services into existing health system worldwide in order to inform the future interventions to deliver PAFP in China. Methods A systematic search for relevant published and unpublished literature was conducted. Based on a set of criteria, citation and full text were screened, related data were extracted. Findings of included studies were reviewed and analyzed using a textual narrative approach to synthesis. Results A total of 28 studies were included in the synthesis. The studies were published between 1995 and 2008 and covered 20 countries. Some countries were in the stage of piloting post-abortion care （PAC）/PAFP intervention, while others were either from piloting to scaling up or examined how well a pilot PAC/PAFP intervention and resulting improvements were able to be maintained over the long term in the same intervention site. Most studies examined initiatives that were implemented at public sectors from tertiary, secondary to primary health facilities, while a few were imple- mented at private sectors. Efforts of integrating PAFP into existing health system from health system perspectives such as funding the programs, training of trainer （TOT） training or on the job training of physicians and mid-level service provider, expan- sion the range of contraceptive methods available including a few free distribution of contraceptives, improving data collection including cost analysis in a few countries,service guidelines provided to health professionals, supportive supervision at program sites to ensure quality of care, and leadership from government to strengthen PAC/ PAFP service by revising or developing a new national policy. Effects of those intervention programs included that 2 studies decreased abortion rates, 7 studies improved modern contraceptive use, 1 study improved women＇s knowledge on sexual ＆ reproductive health, and 5 studies reported women＇s high satisfaction rate with receiving PAC/PAFP services. Conclusion Each study was conducted within a cultural legal social and religious framework. There might be no single set of best practices that can be put forward as a model to integrate PAFP into existing health system in China. These areas should be taken into account in our future intervention including government＇s optimization and complement to the regulations related to abortion, contraception and PAFP, capacity building for service provider, continuous efforts to improve the quality of PAFP service, and accessibility of multiple contraceptive methods for married as well as unmarried youth.

针对流动人口开展流产后计划生育服务的必要性研究

目的了解北京市寻求人工流产的年轻流动妇女避孕、流产相关情况以及流产后获得计划生育服务的现状,探讨对流动人口开展流产后计划生育服务的必要性。方法采用自行设计的调查问卷,对1008名25岁以下的人工流产妇女进行横断面调查。对其中624名流动人口的数据进行对比分析。结果流动人口中77.1%为未婚,≤19岁占11.1%,初中以下文化程度占22.9%,工作不稳定占23.2%,月收入≤1000元占46.5%,16.5%的人经历过高危流产;本次流产原因是未避孕及不知道避孕方法的比例分别为64.1%和11.8%,与户籍妇女相比均有统计学意义(P<0.05)。流产后没有接受任何避孕宣教服务的占35.1%,没有接受计划生育咨询服务的占84.1%,5.47%的人表示医生向其提供了避孕药具,10.42%的人表示医生向其建议转诊(获得药具或宣教)。结论与户籍妇女相比,流动人口中人工流产妇女的年龄相对较小,文化程度较低,工作不稳定、收入低,避孕知识欠缺,避孕方法使用率低,高危流产比例高,而现有流产后计划生育服务提供的数量和内容有限,应针对其特点加强流产后计划生育服务。

Post Abortion Women’s Perceptions of Utilizing Long Acting Reversible Contraceptive Methods in Uganda. A Qualitative Study

Background: About one-third of all pregnancies that occur in low income countries are unintended. An estimated 1.2 million unwanted pregnancies occur in Uganda annually. The majority of the unwanted pregnancies end in unsafe abortion which is one of the five direct causes of maternal mortality. Abortion related complications are responsible for 26% of all maternal deaths in Uganda. Abortion complications can be avoided if women appropriately use contraception to avoid unwanted pregnancy. However, in Uganda the contraceptive prevalence is low at 30% and less than 4% of women rely on long acting reversible contraceptives. Aim: We aimed to explore post-abortion women’s perceptions of using of long acting reversible contraception (LARC). Methods: A qualitative research design was used for data collection and analysis. Thirty in-depth interviews with post abortion women in Mulago hospital were carried out using an interview guide. Interviews were transcribed and coded using nodes and subsequently through query, we derived themes. Results: Emergent themes regarding women perceptions of using LARC methods were myths and misinformation, fear of side effects, women’s lived experiences, relatives’ influence, health providers’ perceptions, lack of knowledge and women desire for spacing children for a long time. Conclusion and recommendations: The majority of women were skeptical about using LARC. There is a need to educate women to dispel myths, misinformation and quality counseling to address the benefits and side effects of LARC. There is also a need to revamp the knowledge and skills of the healthcare providers regarding LARC methods.

A Review of the Development and Effect of Contraceptive Counseling After Abortion

Objective To introduce the background and development of post-abortion services such as contraceptive counseling at home and abroad,and its important role for women so as to provide a reference for the further popularization of this service in China.Methods Chinese and English databases such as CNKI,WanFang Database,VIP,PubMed,and Web of Science were searched to find relevant studies on the implementation of post-abortion service,including post-abortion family planning and post-abortion contraceptive counseling in China.And then the literature on the implementation effect of post-abortion contraceptive counseling and related services was reviewed in China.Results and Conclusion The post-abortion contraceptive counseling service can effectively improve the reproductive health of the patients with induced abortion and the level of knowledge about contraception and birth control,so as to change the contraceptive behavior and adverse psychological state of the patients.Besides.it can guide patients to use more long-term and effective contraceptive measures,thereby reducing the occurrence of unintended pregnancy and repeated abortion.Standardized contraceptive counseling and related services can also improve patient satisfaction.According to the development and implementation effect of post-abortion service and post-abortion contraceptive counseling at home and abroad,it is necessary to further promote post-abortion contraceptive counseling service in the future.Much consideration should be given to carrying out a health technical assessment of the standardized post-abortion contraceptive counseling service as well as its implementation costs.Therefore,medical institutions will have a reference to carry out standardized post-abortion contraceptive counseling service.