- Focus Areas
Postabortion Care: Two Decades of Uneven Progress and Where We Go From Here
In May, the Postabortion Care (PAC) Consortium convened in Kuala Lumpur at the world’s largest conference on the advancing the status of women and girls: Women Deliver. Although we gathered in part to celebrate the progress made on the postabortion care front, the celebration was tempered. The stark reality is that far too many women around the world continue to die from unsafe abortion.
Although postabortion care is legal in most of the world, it too often remains inaccessible, limited, and of poor quality. Unsafe abortion claims the lives of at least one in ten victims of maternal mortality, and with better data, we would likely discover the toll is much more severe than our limited figures show.
The world’s women and girls deserve better. They deserve quality, comprehensive, and stigma-free care. With this in mind, PAC Consortium participants set out to answer the question, “Where do we go from here?”
The rich conversation, led by a panel of experts from the World Health Organization, UNFPA, the International Planned Parenthood Federation, and the International Federation of Gynecology and Obstetrics, produced a number of actionable recommendations that will be crucial to keep in mind as the international reproductive health community’s efforts to improve postabortion care move forward.
Invest in better data collection and reporting
Data available on the consequences of unsafe abortion is very limited. With better information about the drivers and consequences of unsafe abortion in the context of each particular country, postabortion care efforts could be better tailored to meet the unique needs of different communities and populations. Investment in studies and data collection pays off as we more often turn to data for improved decision-making and program design. Funding for postabortion care is limited, and improved, quality data can be used to demonstrate the need for postabortion care programs and advocate for funding.
Improve access to quality service delivery
Service providers must offer comprehensive postabortion care services, including reproductive health, contraception, and counseling services. There are often huge skills gaps amongst service providers which must be addressed. Increasing access to postabortion care services also requires that they be brought closer to the community level. This is best accomplished through task-sharing and moving service provision responsibilities to the primary health care level with greater use of misoprostol for postabortion care.
Integrate family planning into postabortion care
Offering family planning services at the time of postabortion treatment is critical in helping women limit and space their pregnancies, prevent subsequent unsafe abortion, and reduce maternal morbidity and mortality. There is clear evidence that if contraception is offered to a woman before she leaves the postabortion care treatment area, uptake of a method will be higher than if she is referred elsewhere for family planning counseling.
Stigma is a major barrier to accessing postabortion care, at both the facility and community levels. We must address stigma to effectively break down barriers to care. If women, especially young women, perceive that they will be criticized and condemned by providers, or by neighbors and family, they may hide complications until it is too late. Stigma is a violation of human rights, and directly contributes to death from complications of unsafe abortion.
Increase global acceptance of misoprostol use
Strengthening advocacy efforts around global acceptance of misoprostol use for postabortion care and registering misoprostol for countries’ national essential medicines lists is an urgent priority. The importance of popularizing misoprostol and publicizing its positive impact on reducing complications of unsafe abortion cannot be understated. Misoprostol is a safe, inexpensive, heat-stable drug that can be provided at low-level health facilities, empowering women to access non-surgical treatment of unsafe abortion closer to their own communities.
Reduce the barriers youth face in accessing postabortion care
Young people need access to stigma-free, confidential, affordable, and youth-friendly postabortion care from trained providers. One way to promote youth-friendly services is through use of technology: mHealth, SMS, social media outreach, and informational hotlines. Youth-friendly postabortion care messages have also proven especially effective when coming from other youth, peers, or friends.
Embrace and scale-up evidence-based practices
We must appreciate the importance of evidence-based practices in advocacy, training, service delivery, and community engagement. This enables us to find out what practices work best, disseminate those practices, and then scale up to improve our work. Most importantly, women’s right to respectful, quality postabortion care services must be universally provided, according to international laws, treaties and agreements, and women’s rights.
Focus Area: Abortion