Post-abortion Care for Unsafe Induced and Incomplete Spontaneous Abortions
WHO estimates that of the 211 million pregnancies that occur worldwide each year, about 46 million end in induced abortion,[i]with approximately 40% carried out under unsafe conditions. Roughly 68,000 women die from unsafe abortions each year, which accounts for a considerable portion (10% to 50%, depending on the country) of all maternal deaths. Many of these deaths could be prevented if women could avoid unwanted pregnancies and had access to safe abortion services, including post-abortion care (PAC).
PAC includes services for early recognition and management of abortion-related complications, such as hemorrhage and sepsis, and post-abortion counseling, including contraceptive services or referral. To lower a woman’s risks of anemia and of adverse health outcomes (for example, pre-term birth, low-birth weight, premature rupture of membranes) in her next pregnancy, a woman should use an effective family planning method of her choice for at least 6 months before becoming pregnant again.[ii]
Manual vacuum aspiration to remove retained products of conception results in fewer complications than traditional dilatation and curettage, and it can be carried out effectively by non-physician providers such as midwives.
Community attitudes influence demand for unsafe abortions and how women who suffer from complications are treated. Provision of safe, effective contraceptive methods at the community level can reduce the number of unintended pregnancies and, thus, reduce the number of abortions (spontaneous or induced). Systems in place for emergency transport of complicated deliveries also can be used for complications from unsafe induced or incomplete spontaneous abortions.
In many countries, inducing an abortion is illegal, but this often does not stop women from seeking abortions. The health system needs to be able to handle abortion-related complications and provide information and counseling to women. Furthermore, national and internal organizational policies will influence how programs can address PAC.
Key Resources for PAC:
- EngenderHeatlh, 2003. Counseling the Post-Abortion Client: A Training Curriculum
- WHO, 1997. Post-Abortion Family Planning: A Practical Guide for Programme Managers
- Population Council, 2000. Meeting Women’s Health Care Needs After Abortion
[ii] Conde-Agudelo, A., et al. Effect of the interpregnancy interval after an abortion on the maternal and perinatal health in Latin America. International Journal of Gynecology and Obstetrics, 2004; 89:S34-S40.