Postabortion Care Workshop Proceedings: Workshop Presentations

Maternal & Neonatal Health

Issues in Establishing Postabortion Care Services in Low-Resource Settings: Workshop Presentations

Why a PAC Strategy?

Anita Ghosh, MA
JHPIEGO Corporation

Introduction

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The PAC community has made amazing strides over the past 5 years. Worldwide advocacy efforts gained momentum following the international conferences in Cairo and Beijing. These conferences highlighted the need to support improved PAC as an essential intervention to reduce maternal mortality and morbidity. Standards for care have been adopted and competency-based training materials have been developed by a consortium of CAs dedicated to improving PAC services. USAID and other donors are supporting PAC programs in many countries worldwide.

PAC Achievements Since 1994

Advocacy/sensitization of stakeholders
Guidelines adopted
Competency-based training materials developed by PAC Consortium
Services implemented in numerous countries

Programming Achievements

Thanks to programming and research efforts, many achievements have been documented. The following points are just a sampling of what has been learned to date:

Cost-Effective, High Quality Services. We know that PAC is a strategy by which high quality services can be provided using a low-tech approach. Sophisticated equipment and materials are not required. Existing services are often underutilized and improvements can be made to integrate PAC services at reasonable costs. Standards of quality can be developed and applied.

High FP Acceptance. Programs to date have documented high FP acceptance among women who have been treated for postabortion complications. Typically, women seeking emergency treatment are not practicing FP. Few are counseled or offered a FP method at the time of treatment. Most women, however, are receptive to FP services following treatment for abortion complications.

Program Planning Models Established. Program planning models have been developed and are currently being used to guide the introduction of services in many countries worldwide. Country programs are learning from one another and are continually refining these models.

Resources Available. Numerous resources have been developed from print materials to videos to key spokespersons throughout the world, a number of whom are represented at this workshop. These resources cover a range of topics from advocacy to technical issues.

Visibility of PAC. In addition to the international visibility mentioned earlier, PAC is gaining visibility on national and local levels. For example, few people would have thought that the words "postabortion care" could appear on the front page of the daily newspaper in Ouagadougou, Burkina Faso. But thanks to the advocacy efforts of the Burkina Faso Chapter of the Reproductive Health Research Network (CRESAR in French), this is exactly what happened when services were launched at the two main teaching hospitals in the country (see Figure 1).

Figure 1. Front Page of Newspaper in Burkina Faso Mentioning PAC

CRESAR Supports Quality Postabortion Care

Why a PAC Strategy?

If we know that PAC is an approach that is safe, cost-effective and contributes to improved maternal care, why are we here? Programs have been moving forward and technical resources are available. There has been some level of both informal and formal sharing of country experiences. Examples include study tours, meetings and provision of technical assistance across countries. In West Africa, service providers from Ghana assisted their colleagues in Burkina Faso to introduce PAC services. The Burkinabè have since provided technical assistance to colleagues in Senegal and Guinea. The technical resources available in the region continue to grow.

Also, we could argue that each country context has its own set of social, political and cultural norms that need to be considered—one strategy could not address such specificities.

When we examine the current situation, however, we find that:

Many services that started as pilot/demonstration projects have remained as such.
Hospitals/capital cities are over-represented as project sites.
Long-term vision is considered during the initial planning, but many program managers are struggling with how to develop systems to reach long-term goals.
Each country context is unique, but there are some commonalities across country programs in needs and programmatic considerations.

Finally, The Hague Forum held in February 1999 highlighted that unsafe abortion remains a major cause of maternal mortality, even though a growing number of countries have acknowledged unsafe abortion as a serious public health concern.