Incorporating Postabortion Care into
Emergency Obstetric Care
The Magnitude of Unsafe Abortion
• 42 million abortions annually
• 22 million safe,
• 20 million unsafe
• Unsafe abortions estimated to cause about 70,000 maternal
deaths each year
• 192 women each day, one woman every
8 minutes
• 54% of deaths occur in Africa (for only
13% of all reproductive age women)
• Miscarriages and incomplete abortions due to that (app. 8% of
all pregnancies)
Source: Shah I and Ahman E.
Causes of Maternal Mortality
205 million
pregnancies
Indirect causes
20%
40% of them
unplanned
137 million women
have unmet need
for FP
20 million unsafe
abortions
Severe bleeding
24%
Other direct causes
8%
Unsafe abortion
13%
67,000 women die
from unsafe
abortion: 13% of all
pregnancy-related
deaths
Source: WHO, 2005, Make Every Mother and Child Count
Obstructed labor
8%
Infections
15%
Eclampsia
12%
Complications of Unsafe Abortion:
Early
• Hemorrhage or severe vaginal bleeding
• Pelvic infection
• Uterine perforation
• Retained tissue
• Shock (septic or hemorrhagic)
• Renal failure
• Trauma to genital track
Late
• Infertility
• PID
• Vesico-vaginal fistula
Women with Complications of Unsafe
Abortion
• Need support / info at the community level
• Need a service as close to them as possible
• Need effective services
• Wellcoming/Nonjudgemental
• Able to support vital functions
• Able to start antibiotics, IV fluids
• Able to evacuate uterus using MVA/EVA
• Need prevention for the future
• Contraception counselling and immediate
method provision
•
•
•
•
•
Women Suffering Complications of
Unsafe Abortion Need Services
Close to them
Affordable
Around the clock
Comprehensive
Good quality
• PHC : Capacity
• EmOC (EmONC)
1.
2.
3.
4.
5.
6.
7.
The Signal Functions of Basic
Emergency Obstetric Care
Administer IV antibiotics
Administer uterotonic drugs (IV oxytocin)
Administer parenteral anticonvulsants for
eclampsia and pre-eclampsia
Manually remove the placenta
Remove retained products (vacuum
aspiration or D&C)
Perform assisted delivery (e.g. vacuum
extraction, forceps delivery)
Perform neonatal resuscitation
Questions to Consider
• Why should we consider
incorporating PAC into EmOC?
• What would be the benefits?
• What opportunities would this
present?
• What challenges would this
present?
Why Include PAC in EmOC?
• Unsafe abortion is a significant cause of
maternal mortality
• Abortion is a complication of pregnancy (not an
STI, cervical CA, etc.)
• Having it seprate allows it to be sidelined and
neglected
• Within maternal health, stigma around PAC can
be addressed much more effectively
• Capacity, skills, drugs, etc. (including integrated
contraception) needs are similar to PAC and
other EmOC’s
What are Some of the Challenges?
• Integrating PAC effectively into EOC requires serious
resource planning to assure high-quality patient management.
• The curricula for EmOC training is already full and Ministries
of Health do not want to have their providers away too long.
• EmOC as a program is focused on life saving so that its
indicators do not necessarily include counseling and the
provision of FP
• FP is not an emergency need and will always take a back
seat during Emonc clinical training.
• Without addressing FP the same woman will be back with the
same problem the second time around and may not be lucky
enough to survive another abortion
• The instruments and commodities for FP in PAC would have
to be programmed into EmOC packages.