Postabortion Family Planning: Addressing the Cycle of Repeat Unintended Pregnancy and Abortion
Curtis, Carolyn, Huber, Douglas, Moss-Knight, Tamarah, International Perspectives on Sexual and Reproductive Health
Some 35 million abortions occur in developing countries each year. Approximately 20 million of these are unsafe abortions, which claim the lives of 67,000 women as a result of related complications. These deaths represent 13% of all pregnancy-related mortality and in some countries as much as 25% of maternal deaths. (1) In developing countries, one of every 75 women die of pregnancy- or childbirth-related causes, compared to one of every 7,300 women in developed countries. (2)
If contraception were accessible and used consistently and correctly by women Wanting to avoid pregnancy, maternal deaths would decline by an estimated 2.5-35%. (3) Fifty-five million unintended pregnancies in developing countries occur every year to women not using a contraceptive method. Another 25 million occur as a consequence of incorrect or inconsistent use of a contraceptive method and method failure. (4), (5)
The Role of Postabortion Family Planning Services
These statistics provide firm evidence that family planning reduces abortion, thus decreasing the risk of maternal death. In addition, over the last two decades, there has been increasing evidence that family planning interventions have a role to play not only before a woman has become pregnant, but after she has had an abortion or miscarriage.
In 1994, the international health community identified postabortion care (TAG) as an important strategy to reduce maternal mortality by treating complications related to unsafe abortion and miscarriage, and by providing postabortion family planning counseling and services to prevent repeat unplanned pregnancies and abortions. Although postabortion family planning counseling and service delivery is part of all postabortion care models, PAC services have historically sought to reduce maternal mortality by treating the symptoms of hemorrhage and sepsis rather than by treating women's unmet need for family planning, thus overlooking the potential of postabortion care to interrupt the cycle of repeat unplanned pregnancy, abortion and complications leading to maternal death.
For many postabortion patients, the lack of family planning counseling and services quickly leads to another induced abortion, because fertility returns within two to three weeks after miscarriage or induced abortion. This makes it essential to ensure that postabortion family planning counseling and service delivery are offered to all women who present for emergency obstetric or postabortion care, regardless of the method of treatment (sharp curettage, electric or manual evacuation) or place of treatment (operating theatre or PAC treatment room) as well as to all postpartum women.
Postabortion Family Planning Service Models
Postabortion family planning has been implemented in countries using two main methodologies. In countries where abortion is legal, programs offer postabortion Jamily planning only. When women make an appointment for their abortion, they also receive family planning counseling. After their abortion has been completed, women are provided with family planning services before discharge from the facility.
In countries where abortion is illegal, emergency treatment and postabortion family planning counseling and services are provided as a single service. Both examples have resulted in increased family planning uptake and reduced repeat abortion. When deliberate efforts are made to strengthen the family planning component of postabortion care, improvements in family planning uptake can be realized within 12 months of implementation.
Benefits of Postabortion Family Planning
Regardless of the model used, providing postabortion family planning benefits individuals, families, communities and countries in many ways: increased modern contraceptive use and decreased abortion; reduced maternal and child mortality; prevention of mother-to-child HIV transmission and new HIV infections; and reduced social costs. …