Postabortion Care

Visit the USAID-funded INFO Project Web site for the PAC Global Resources Guide (watch video from the Guide launch on June 26, 2007), which includes the latest recommended postabortion care (PAC) resources. The site serves as a repository of evidence-based basic instruments intended for policymakers and program planners who are designing or revising their current PAC program.

Each year in the developing world, an estimated 210 million women become pregnant. Approximately 15 to 20 percent of these pregnancies will end in miscarriage and 67,000 women will die from complications related to unsafe abortion.  This represents13 percent of all pregnancy  related deaths.  Millions more women suffer serious illness and infertility. To address these severe health problems and to reduce maternal death, USAID funds postabortion care (PAC) programs that comprehensively address women's needs through three core components:

• Emergency treatment for complications of spontaneous or induced abortion
  
  
• Family planning counseling and services, and depending on disease prevalence and available resources, STI evaluation and treatment, and HIV counseling and or referral for testing
  
  
• Community empowerment through community awareness and mobilization

Postabortion care is a programmatic priority for USAID's Bureau for Global Health and is a key intervention in the pathway to maternal survival and the reduction of unplanned pregnancies that may result in repeat abortion. Postabortion care programs have received support from the Bush Administration which is noted in a statement made by the White House Press Secretary on the restoration of the Mexico City Policy in 2001. While USAID supports treatment for abortion-related complications, USAID does not support abortion as a means of family planning nor does USAID provide abortions in any circumstances. USAID does not finance the purchase or distribution of manual vacuum aspiration equipment for any purpose.

• USAID Postabortion Care Resources
• Postabortion Care Community Mobilization
• Technical Briefs
• Research and Modeling Papers on Postabortion Care

USAID Postabortion Care Resources

• Meeting Health Care Needs of Women Experiencing Complications of Miscarriage and Unsafe Abortion: USAID's Postabortion Care Program - July/August 2007 [PDF, 119KB]
  This article provides information on the history of USAID’s postabortion care program, the current PAC strategy, the Global PAC Resource package, and results from focus countries involved in the current PAC strategy.
  
  

• Download the April 2007 Report of the Postabortion Care Technical Advisory Panel [PDF, 333KB]

  Report of the Postabortion Care Technical Advisory Panel - April 2007 [PDF, 333KB]
  This report's purpose is to assist USAID in the ongoing and future scale-up of safe and effective PAC programs worldwide for women experiencing complications related to miscarriage and incomplete abortion.
  
  
• USAID Postabortion Care Strategy Paper - October 2004 [PDF, 762KB]
  The overall goal of USAID's PAC strategy is to reduce maternal mortality, morbidity, and repeat abortions.
  
  
• USAID's Postabortion Care Model [PDF, 762KB]
  • III. Core Components of the PAC Model
  • Appendix C: USAID Global and Country Results Framework, Indicators, and Commentary for Use
    (see page 35) [PDF, 762KB]
    
    
• Global Evaluation of USAID's Postabortion Care Programs
  This report is the result of a global evaluation of postabortion care conducted by USAID in 2001 and includes case studies of Bolivia, Ghana, Kenya, and Nepal.
  

Postabortion Care Community Mobilization

• Postabortion Care (PAC) Technical Meeting - Moving Forward with Postabortion Care: Lessons Learned from Five Postabortion Care Focus Countries
  View presentations and related publications from this two-day meeting, co-sponsored by USAID's Postabortion Care Working Group, the Population Council’s FRONTIERS Program, and the ACQUIRE Project, led by EngenderHealth.
  
  
• Mobilizing Communities for PAC Services [PDF, 2MB]
  This article from The Michigan Fellows Newsletter, published by the USAID-funded Populations Fellows Programs, describes the implementation of Bolivia's first PAC community mobilization model.

Technical Briefs

• Decentralization of Postabortion Care in Senegal and Tanzania [PDF, 144KB]
  In developing countries, PAC programs are frequently available only in urban or regional health facilities, placing rural women at greater risk for mortality and morbidity from complications because they lack access to services. To improve access, USAID has worked with two focus countries, Senegal and Tanzania, to decentralize PAC activities.
  
  
• Family Planning Prevents Abortion [PDF, 149KB]
  According to the World Health Organization (WHO), complications of unsafe abortion are responsible for 13 percent of all maternal deaths
  
  
• Preventing Postpartum Hemorrhage (PPH)
  PPH is the single most important direct cause of maternal deaths, with an estimated 14 million women experiencing pregnancy-related hemorrhage each year. Whether women give birth with a skilled provider at home or in a facility, up to two-thirds of PPH can be prevented using safe, low-cost, evidence-based practices.
  
  
• Postabortion Family Planning Benefits Clients and Providers [PDF, 559KB]
  Provision of family planning methods is a central feature of postabortion care. Ensuring reliable onsite availability of family planning methods for all clients following abortion or miscarriage can result in benefits for clients, providers, and programs.
  
  
• Population Reports - Care for Postabortion Complications: Saving Women's Lives [PDF, 3MB]
  In developing countries each year, more than half a million women die from maternal causes, nearly all of these deaths could be prevented. Efforts to prevent maternal deaths from complications of unsafe abortion are crucial but inadequate in most of the world. Providing appropriate medical care immediately could save many thousands of women's lives. Offering family planning could prevent many future unintended pregnancies and unsafe abortions.

Research and Modeling Papers on Postabortion Care

Decentralization of PAC Services to Health Center and Health Post Levels

• Taking Postabortion Care Services Where They Are Needed [PDF, 696KB]
  This paper reports the findings of the USAID-funded operations research in Senegal that examined the feasibility of expanding PAC services to rural areas.
  
  
• Assessment of the Extension of Postabortion Care Services in Senegal [PDF, 551KB]
  This paper documents the existing model of decentralized PAC services to 23 health centers and 300 health posts in Senegal. Lessons learned and challenges encountered are documented to inform national and global replication and scale-up efforts.
  
  
• Assessing the Feasibility, Acceptability and Cost of Introducing Postabortion Care in Health Centers and Dispensaries in Rural Tanzania [PDF, 700KB]
  This report documents the process of decentralizing PAC to health centers and dispensaries in Tanzania and prospectively assesses the feasibility, effectiveness, and cost. Information on changes in provider knowledge, attitudes and practices; experiences of postabortion clients and their perceptions of the new services; changes in community attitudes and knowledge about abortion complications; effectiveness of varied types of referral networks; and additional resources that would be required of the Ministry of Health to support the introduction of these services is discussed.

Postabortion Family Planning

• Postabortion Family Planning Operations Research Study in Perm, Russia [PDF, 2.8MB]
  This paper reports the findings of USAID-funded research in Perm, Russia, that studied the effectiveness of two different models of postabortion family planning. The study showed an increase in client and provider knowledge of postabortion family planning after the intervention, a 20 percent increase in the use of modern contraceptive methods at 12 months postabortion, and a dramatic decline in the repeat abortion rate at one year after the intervention.
  
  
• Is There Value in Adding a Follow-Up Visit to Postabortion Care? [PDF, 203KB]
  This modeling paper reports the findings of a USAID-funded review that responds to the question of whether there is benefit in adding a follow-up visit to the current one visit model for PAC services. The paper offers evidence of the benefits to women receiving services, progress toward development goals, and potential cost savings.

Cost Projection Models

• Cost-Effective Interventions to Reduce Maternal Mortality in Senegal: The Role of Postabortion Care and Family Planning - An Application of the Allocate Model [PDF, 298KB]
  The Allocate Model, funded by USAID, is an interactive, user-friendly computer tool designed to assist countries in developing integrated national reproductive health plans with realistic budgets. It's objectives are to help planners understand the relationship between funding levels and safe motherhood, postabortion care, and family planning programs and to demonstrate the effects of resource allocation on a variety of national indicators. This paper reports the findings of the use of the Allocate Model in the development of Senegal's national reproductive health strategic plan.