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 Methods A systematic search for relevant published and unpublished literature was conducted.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.

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.

流产后关爱服务在基层医院人工流产患者中的应用

目的:探讨人工流产实施流产后关爱(Post-Abortion Care,PAC)健康教育后的实施效果。方法:将医院妇科住院人工流产患者1910例分为两组,每组各955例。对照组给予人流术前术后常规处理,研究组给予PAC流产后健康教育服务。比较两组的临床效果。结果:研究组对人工流产后避孕知识于流产相关知识掌握、落实避孕措施、对服务的满意度较对照组明显增高。1年内的重复流产率较对照组明显降低。两组比较差异均具有统计学意义(P<0.05)。结论:实施PAC健康教育对促进女性生殖健康、避免重复流产率、提高生活质量有重要意义。

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.

Research Priorities for Preventing Unsafe Abortions in the WHO Africa Region

Background: Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. Methods: We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. Results: Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. Conclusions: Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.

流产后关爱服务在产后避孕现状中的研究进展

产后避孕是产妇在胎盘娩出后的特定时间内为防止意外妊娠而采取的重要措施,是推行计划生育、加强妇女保健工作的重要组成部分,也是此项工作的薄弱环节。由于大多数女性对产后避孕重要性认知不够,在产后不能及时使用有效的避孕方法,致使产后高危妊娠及人工流产发生率居高不下。因此,研究流产后关爱服务在产后避孕中的现状和目前所面临的问题至关重要。流产后关爱服务作为一种标准化流程,可以有效提高产后女性避孕意识。有相关研究表明,流产后关爱服务对降低产后女性重复流产率、及时落实避孕措施、提升其生活质量有重要作用。现就对流产后关爱服务在产后避孕现状中的研究进展作一综述。

Integration of Post Abortion Care Package in the Activity of 56 Health Facilities by the Burkina Faso Society of Obstetricians and Gynecologists (SOGOB)

Introduction: This article is an analysis of post-abortion care in 56 health facilities after their capacity building by the Burkina Faso Society of Obstetricians and Gynecologists (SOGOB). Patients and Methods: In 2012, with funds from Safe Abortion Action Fund, the SOGOB trained care providers and equipped 56 health facilities for post abortion care. Statistical data on the management of incomplete abortions after the capacity building were analyzed. The significance level was set at 0.05. Results: There were 6316 cases of abortion that have been managed in 56 health facilities. The evacuation of the uterine contents for incomplete abortion has been provided to 6167 patients. Manual vacuum aspiration (MVA) and misoprostol were used respectively in 69.4% and 26.9% of cases to evacuate uterine content. Post-treatment complications were 1.8% for MVA and 0.9% for misoprostol (p = 0.004). MVA’s complication rate in the health facilities of the 1st level of care (1.7%) was not different from the third level of care (1.2%) with p = 0.21. A modern method of contraception was provided after abortion to 65.7% of the patients. In addition to the post abortion care, 7.3% of the patients received other reproductive health services. The community was involved in the development process of post abortion care in the facilities of the first level of care. Conclusion: The support of health facilities by SOGOB has provided post abortion care to thousands of women with little complications. Given the good results, an extension to other health facilities is desirable.