Related Health Topics: MAQ Bulletin, Issue 3

West African Countries Introduce Improved Postabortion Care into Maternity Services

Although abortion is illegal in all of the Francophone West Africa countries, induced abortions are not uncommon and are a major contributor to maternal mortality and morbidity. Currently, the standard technique for treatment of bleeding complications associated with incomplete abortion is sharp curettage. This procedure entails use of an operating theater and administration of heavy sedation or general anesthesia, which promotes increased risk of surgical complications, generally requires the patient to stay for at least one night in the hospital and increases the cost of care. In addition, family planning (FP) counseling for postabortion care (PAC) clients is not systematically provided in most hospitals and access to FP services for these women may be difficult.

As an alternative, postabortion care using manual vacuum aspiration (MVA) under local anesthesia to treat bleeding complications—and including FP counseling and services—has been established in many countries throughout the world and has proved to be a safe and cost-effective approach to managing clients with postabortion complications. PAC services using MVA are currently being introduced into university teaching hospitals in Burkina Faso, Guinea and Senegal.

To be successful, the introduction of PAC services requires support, careful planning and coordination among service providers, administrators and policymakers. Although still in its initial stages in West Africa, the PAC initiative is empowering service providers and continues to gain support in the countries where it is being introduced. And most important, improved access to quality PAC services is helping to reduce one of the major causes of maternal mortality in the region—complications from incomplete abortion.

Nine Key Activities in the Establishment of Quality, Comprehensive PAC Services

Advocacy and consensus-building from key stakeholders—the Ministry of Health, hospital administrators and maternity heads—is absolutely necessary. Initially, meetings are held among these stakeholders to discuss issues and gain consensus and support for the PAC initiative.

A needs assessment is conducted to collect information on present procedures for treating abortion complications as well as on current infection prevention (IP) and FP practices. Data from the needs assessment contribute to the development of training sessions and improved PAC services.

An infection prevention workshop is held for core staff who are in a position to improve IP practices in the maternity. The workshop prepares these staff members to spearhead the PAC initiative by obtaining essential IP materials and upgrading provider IP skills and practices.

A contraceptive technology update is conducted to bring health professionals up to date on appropriate FP methods for PAC clients.

Service delivery guidelines are drafted or updated by these health professionals to include a special focus on providing quality postpartum and postabortion FP services.

A medical staff orientation is held for maternity and hospital staff as well as for staff from neighboring maternities who refer patients for treatment. At this meeting staff are given an opportunity to review important information regarding the problem of incomplete abortion and the elements of comprehensive PAC. They are also informed of the new service that will be provided.

Technical assistance is provided to set up PAC units and develop case management protocols based on the new service delivery guidelines. Patient flow, organization of emergency services, FP counseling and services are all taken into account to organize a model service. Discussions are held to determine who is responsible for the MVA materials and instruments. Also, progress in implementing recommended IP practices is assessed and remaining problems addressed.

A PAC provider team training workshop is held to give the PAC teams (physicians and nurses) the counseling and clinical skills necessary to provide quality care using MVA. A consultant spends 2 to 3 days at each maternity to help initiate PAC services.

Followup visits are made to each of the maternities to determine to what extent each of the sites is offering quality PAC services and to help resolve problems.

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