Moving from Research to Program: The Egyptian Postabortion Care Initiative

Abstract

In settings where abortion is legally restricted and socially sanctioned, the medical treatment of women who have had unsafe or incomplete abortions is often a willfully neglected service. Research conducted in the 1990s brought attention to the low quality of care and inhumane treatment that many patients receive as a result of this neglect. 1 The concept of postabortion care was central to this research, which highlighted three essential services for providers to offer women who seek care for an incomplete abortion: emergency medical treatment of complications, family planning counseling and services, and referral for other reproductive health care needs. By clearly positioning the problem within the health care domain-as opposed to religious, legal or social arenas-advocates of postabortion care have created a less-volatile atmosphere for research and program development.Yet, tension continues to surround activities concerned with abortion. As postabortion care programs expand out of the pilot phase and scale up their activities as elements of larger, ongoing health care programs, they test the limits of public officials' support. The literature offers little evidence of how successfully these programs have managed resistance associated with the politics of abortion and grown from pilot studies to national programs.An additional difficulty confronting postabortion programs concerns the supply of manual vacuum aspiration instruments. The overwhelming body of evidence favors the use of manual vacuum aspiration for the treatment of incomplete abortion at an early gestational age; 2 as a result, it has become the standard for postabortion care. 3 Pilot postabortion projects and small-scale expansion programs generally operate with donated instruments, because they are conducted before the commercial importation or local manufacturing of instruments receives regulatory approval. This partly reflects the sociopolitical tensions surrounding abortion-related health care, which create extraordinary pressure to demonstrate medical benefits and acceptability of new clinical practices. Attention to ensuring sustained provision of manual vacuum aspiration is generally put off until after the program has achieved a degree of success and recognition.Foundations' and donor agencies' generous donations of manual vacuum aspiration instruments have greatly eased the implementation of demonstration projects and research studies. However, the long-term viability of a program that relies on donated instruments is uncertain (at best), and a sustainable supply of instruments is crucial for a national program. In settings where access to abortion is legally restricted, it is extremely difficult to gain approval to purchase or manufacture the instruments, because of their association with abortion. Procurement decisions are frequently made by officials who are not clinicians or who are unfamiliar with the need for improved postabortion services. 4 As a result, operational policies that govern the availability of manual vacuum aspirati...

Rewriting abortion: Deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

“…The public health rationale for ensuring emergency treatment for complications of spontaneous or induced abortion to reduce maternal morality is well-established (Corbett & Turner, 2003; Curtis, 2007; Greenslade et al, 1994; Singh, 2006; WHO, 2011). Operations research on PAC has yielded many best practices with respect to implementing high quality, accessible PAC services at various levels of the health system (Billings, Crane, Benson, Solo, & Fetters, 2007; Dao et al, 2007; Huntington, 1999; Johnson, Ndhlovu, Farr, & Chipato, 2002; PAC-Consortium, 1995; PopCouncil, 1999; Wood, Ottolenghi, & Marin, 2007). This literature offers little insight into the legal implications of treating abortion complications for health providers in settings where abortion is legally restricted.…”