Post-abortion care

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Post-abortion care (PAC) is treatment and counseling for post-abortion women. It includes curative care, such as treating abortion complications, as well as preventative care, such as providing birth control to prevent future unwanted pregnancies. [1] Post-abortion care reduces morbidity and mortality associated with abortion. [2]

Contents

Prevalence

Approximately 75 million women require post-abortion care annually following induced and spontaneous abortion (miscarriage). [3] All countries have committed to reducing pregnancy-related mortality by providing treatment for abortion complications, regardless if the abortion was illegally obtained. [1] However, an analysis of ten countries (Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda) found that in seven of ten, less than 10% of primary facilities could provide basic post-abortion care. No primary healthcare facilities in Namibia provided post-abortion care; Malawi, with greatest prevalence, offered post-abortion care at 29% of primary facilities. [2]

Elements

The curative care aspect of PAC includes treating incomplete abortions by removing any fetal or maternal tissues remaining in the uterus. This can include using vacuum aspiration (suction) or curettage (scraping). Aspiration results in shorter procedure times, less pain, and less blood loss than curettage. The drug misoprostol is an alternative to manual removal and is another option for treating incomplete abortion. [3]

For preventative care, women are provided family planning counseling and services, as most women seeking PAC were not using modern contraceptives at the time of conception. A study in Zimbabwe found that family planning counseling was associated with a significant reduction in unwanted pregnancies and repeat abortions in the year after they received post-abortion care. Infrequently, sexual health screenings such as HIV testing are provided as part of post-abortion care, though sexually transmitted infection screening is low and has been identified as an unmet need of PAC. [3]

History

The term "post-abortion care" was first defined in the 1991 by the non-governmental organization (NGO) Ipas. [4] In 1993, Ipas joined Jhpiego, EngenderHealth, Pathfinder International, and International Planned Parenthood Federation, in creating the Postabortion Care Consortium. [5]

In 1994, a post-abortion care model was articulated by the Postabortion Care Consortium, with three key elements, regardless of the legality of abortion in a given country: 1) emergency treatment for abortion-related complications; 2) postabortion family planning counseling and services; and 3) linkage between emergency care and other reproductive health services, such as management of sexually transmitted diseases. [6] The PAC model was adopted by United States Agency for International Development (USAID) in 1994. [3] In 2002, two elements were added relating to counseling and community involvement. [7] The first research compendium on post-abortion care was published in 2007 by USAID, What Works, A Policy and Program Guide to the Evidence on Postabortion Care. [3]

Related Research Articles

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion" and occurs in approximately 30% to 40% of pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion.

Dilationand curettage (D&C) refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a gynecologic procedure used for diagnostic and therapeutic purposes, and is the most commonly used method for first-trimester miscarriage or abortion.

The Mexico City policy, sometimes referred to by its critics as the global gag rule, is a United States government policy that blocked U.S. federal funding for non-governmental organizations (NGOs) that provided abortion counseling or referrals, advocated to decriminalize abortion, or expanded abortion services. When in effect, the Mexico City policy is a U.S. government policy that requires foreign non-governmental organizations to certify that they will not "perform or actively promote abortion as a method of family planning" with non-U.S. funds as a condition for receiving U.S. global family planning assistance and, as of January 23, 2017, any other U.S. global health assistance, including U.S. global HIV and maternal and child health (MCH) assistance.

Maternal death Aspect of human reproduction and medicine

Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant woman due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while she is pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.

Women's health differs from that of men in many unique ways. Women's health is an example of population health, where health is defined by the World Health Organization as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Often treated as simply women's reproductive health, many groups argue for a broader definition pertaining to the overall health of women, better expressed as "The health of women". These differences are further exacerbated in developing countries where women, whose health includes both their risks and experiences, are further disadvantaged.

Vacuum aspiration

Vacuum or suction aspiration is a procedure that uses a vacuum source to remove an embryo or fetus through the cervix. The procedure is performed to induce abortion, as a treatment for incomplete miscarriage or retained pregnancy tissue, or to obtain a sample of uterine lining. It is generally safe, and serious complications rarely occur.

Self-induced abortion Abortion performed by a pregnant person themselves outside the recognized medical system

A self-induced abortion is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortions induced outside of a clinical setting with legal, sometimes over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, potentially more dangerous methods. Such practices may present a threat to the health of women.

Unsafe abortion

An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. An unsafe abortion is a life-threatening procedure. It includes self-induced abortions, abortions in unhygienic conditions, and abortions performed by a medical practitioner who does not provide appropriate post-abortion attention. About 25 million unsafe abortions occur a year, of which most occur in the developing world.

Sexual and reproductive health State of the reproductive system without evidence of disease, disorders, or deficiencies

Sexual and reproductive health (SRH) is a field of research, healthcare, and social activism that explores the health of an individual's reproductive system and sexual wellbeing during all stages of their life.

Abortion in the Philippines is illegal.

Abortion in India has been legal under various circumstances for the last 50 years with the introduction of Medical Termination of Pregnancy (MTP) Act in 1971. The Act was amended in 2003 to enable women's accessibility to safe and legal abortion services.

Abortion in Trinidad and Tobago Abortion is a very serious issue in the nation of Trinidad and Tobago. These laws are very different from those in the United States, and have been in place for approximately 90 years. An abortion is one of the most common surgical procedures in Trinidad and Tobago, and most occur during the first 12 weeks of pregnancy.

Unintended pregnancies are pregnancies that are mistimed, unplanned or unwanted at the time of conception.

Family planning in India Efforts to curb unintended pregnancies

Family planning in India is based on efforts largely sponsored by the Indian government. From 1965 to 2009, contraceptive usage has more than tripled and the fertility rate has more than halved, but the national fertility rate in absolute numbers remains high, causing concern for long-term population growth. India adds up to 1,000,000 people to its population every 20 days. Extensive family planning has become a priority in an effort to curb the projected population of two billion by the end of the twenty-first century.

Septic abortion describes any type of abortion, due to an upper genital tract bacterial infection including the inflammation of the endometrium during or after 20 weeks of gestation. The genital tract during this period is particularly vulnerable to infection, and sepsis in most cases is caused by a combination of factors both due to facility conditions and/or individual predispositions. The infection often starts in the placenta and fetus, with a potential complication of also affecting the uterus, that can result in sepsis spreading to surrounding organs, or pelvic infections.

Ipas (organization)

Ipas is an international, non-governmental organization that increases access to safe abortions and contraception. To this end the organization informs women how to obtain safe and legal abortions and trains relevant partners in Africa, Asia, and Latin America on how to provide and advocate for these.

Abortion in Uganda is illegal unless performed by a licensed medical doctor in a situation where the woman's life is deemed to be at risk.

Abortion is a controversial topic in Nigeria. Abortion in Nigeria is governed by two laws that differ depending on geographical location. Northern Nigeria is governed by The Penal Code and southern Nigeria is governed by The Criminal Code. The only legal way to have an abortion in Nigeria is if having the child is going to put the mother's life in danger. However, sex-selective abortion has long had acceptance in Nigeria.

Abortion in Kenya

Abortion in Kenya is prohibited with the exception of certain circumstances including danger to the life and health of the expectant mother, and rape. Unsafe abortions are a major cause of deaths and health complications for women in Kenya.

Melissa Upreti is a Nepalese lawyer and human rights expert who was the founding attorney and regional director of the Center for Reproductive Rights' Asia program. She is the Senior Director of Program and Global Advocacy at the Center for Women's Global Leadership at Rutgers University and a member of the United Nations Working Group on Discrimination against Women and Girls.

References

  1. 1 2 Owolabi, Onikepe O.; Biddlecom, Ann; Whitehead, Hannah S. (2019). "Health systems' capacity to provide post-abortion care: A multicountry analysis using signal functions". The Lancet Global Health. 7 (1): e110–e118. doi:10.1016/S2214-109X(18)30404-2. PMC   6478445 . PMID   30503402.
  2. 1 2 Temmerman, M. (2019). "Missed opportunities in women's health: Post-abortion care". The Lancet. Global Health. 7 (1): e12–e13. doi: 10.1016/S2214-109X(18)30542-4 . PMID   30503403.
  3. 1 2 3 4 5 Huber, Douglas; Curtis, Carolyn; Irani, Laili; Pappa, Sara; Arrington, Lauren (2016). "Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components". Global Health: Science and Practice. 4 (3): 481–494. doi:10.9745/GHSP-D-16-00052. PMC   5042702 . PMID   27571343.
  4. ↑ Adams, Patrick (9 March 2021). "In Hospitals Across Africa, A Lack Of Post-Abortion Care". NPR. Retrieved 9 March 2021.
  5. ↑ Corbett, M. R.; Turner, K. L. (2003). "Essential elements of postabortion care: Origins, evolution and future directions". International Family Planning Perspectives. 29 (3): 106–11. doi:10.1363/ifpp.29.106.03. PMID   14519586.
  6. ↑ Rasch, Vibeke (2011). "Unsafe abortion and postabortion care - an overview". Acta Obstetricia et Gynecologica Scandinavica. 90 (7): 692–700. doi: 10.1111/j.1600-0412.2011.01165.x . PMID   21542813.
  7. ↑ "USAID PAC Model, Results Framework, and Global and Country Indicators" (PDF). Postabortion Care.
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