Scaling-up a public health innovation: A comparative study of post-abortion care in Bolivia and Mexico

Billings, Deborah L.; Crane, Barbara B.; Benson, Janie; Solo, J; Fetters, Tamara

doi:10.1016/j.socscimed.2007.02.026

Cited by 37 publications

(41 citation statements)

References 13 publications

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“…[18][19][20] At the study site, condoms are offered freely as the only means of contraception. Only 109 (16.9%) of the 645 participants accepted the condoms offered by the clinic and the remainder indicated that they would obtain contraception from a family planning clinic in their district.…”

Section: Discussionmentioning

confidence: 99%

An audit of surgical termination of pregnancy at a level 1 health facility in South Africa

Devjee

Khedun

Moodley

2012

South African Family Practice

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Section: Discussionmentioning

confidence: 99%

An audit of surgical termination of pregnancy at a level 1 health facility in South Africa

Devjee

Khedun

Moodley

2012

South African Family Practice

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“…Postabortion care (PAC) is a technologically simple intervention package for treating complications of unsafe abortion and spontaneous abortion with manual vacuum aspiration (MVA) or medical abortion, provision of contraceptives and counseling to prevent future unintended pregnancies, and linking women to additional reproductive health services they may need. The PAC concept was developed in the 1990s to address the disproportionate burden of maternal mortality and morbidity in countries with restrictive abortion laws [13]. The global success of the PAC intervention is well documented [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…The PAC concept was developed in the 1990s to address the disproportionate burden of maternal mortality and morbidity in countries with restrictive abortion laws [13]. The global success of the PAC intervention is well documented [12][13][14]. In Nigeria, however, many healthcare providers lack information, equipment, or authority to provide PAC services, leaving women's lives in danger [2][3][4]7,10,15].…”

Section: Introductionmentioning

confidence: 99%

“…Although still not sufficient, there are more than 2.5 times as many nurses and midwives as physicians in Nigeria [16]. The PAC model promotes a shift in technology from a more uncomfortable and unsafe technology, namely sharp curettage provided only by physicians, to a woman-centered ambulatory care approach with a strong emphasis on counseling and postabortion contraception [13,14]. Studies have shown that with effective training, midwives are capable PAC providers, including performing uterine evacuations using MVA or medical abortion [17,18].…”

Section: Introductionmentioning

confidence: 99%

“…Scaling up postabortion care would save and improve many lives, yet the resources, political will, and strategy to make this happen continue to elude Nigerian and many international policymakers [10,13,19]. Although certainly not the only action necessary, training healthcare workers in the provision of PAC is considered an essential minimum element necessary to ensure providers have the knowledge and skills to provide these services.…”

Section: Introductionmentioning

confidence: 99%

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An evaluation of a national intervention to improve the postabortion care content of midwifery education in Nigeria

Akiode¹,

Fetters²,

Daroda³

et al. 2010

Intl J Gynecology & Obste

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Objective: To examine the impact of a national intervention to improve the postabortion care (PAC) content of midwifery education in Nigeria. Methods: A 3-part quantitative assessment was carried out during and post-intervention. The first baseline component developed and examined the intervention to improve teaching capacity and improve the PAC curriculum among 6 midwifery schools that were to become regional training centers. The second survey was a pre-and post-assessment conducted among midwifery instructors from all schools of midwifery in the country. In the third component, 149 midwives graduating from the 6 regional midwifery schools were interviewed once 3-9 months after graduation to evaluate whether the intervention had improved their knowledge of PAC and clinical practice, and the likelihood that they would provide PAC after graduation. Results: Data from 6 schools of midwifery in 2003 showed that none offered PAC or had educators trained in PAC prior to the intervention. Incorporation of PAC content and teaching capacity increased in all 6 study schools during the 3 years after a national intervention. Midwifery instructors demonstrated statistically significant improvements in knowledge of and exposure to PAC and manual vacuum aspiration (MVA) after the intervention. A follow-up interview with 149 student midwives post graduation showed increased knowledge, exposure to, and use of MVA in the workplace. Conclusion: Significant changes in graduate midwives' exposure, practice, and provision of PAC services resulted from a national intervention to improve the training environment and skills of midwifery instructors and students in the 6 schools of midwifery selected for evaluation.

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The effects of interventions to integrate long‐acting reversible contraception with treatment for incomplete abortion: Results of a 6‐year interrupted time series analysis in hospitals in mainland Tanzania and Zanzibar

Baynes

O’Connell

Lusiola³

et al. 2022

Intl J Gynecology & Obste

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Objective To evaluate an intervention that aimed at strengthening voluntary access to long‐acting reversible contraception (LARC) within postabortion care (PAC) in hospitals in mainland Tanzania and Zanzibar. Methods From 2016 to 2018, we conducted PAC quality improvement interventions, emphasizing family planning (FP) counseling and voluntary access to LARC. Researchers conducted an interrupted time‐series analysis of service statistics compiled from 2014 to 2020 using segmented linear mixed effects regression models to assess the interventions' effect on postabortion contraceptive uptake. Results The intervention in mainland Tanzania was associated with an immediate 38% increase in postabortion LARC uptake, a trend that declined from late 2016 to mid‐2020 to 34%. In Zanzibar, the intervention was associated with a gradual increase in LARC uptake that peaked in late 2018 at 23% and stabilized at approximately 15% by mid‐2020. Whereas the interventions in mainland facilities did not generate significant changes in postabortion FP uptake overall, the launch of interventions in Zanzibar in mid‐2016 was associated with a precipitous rise in that outcome over time, which plateaued at approximately 54% by 2019. Conclusion Increased voluntary uptake of postabortion contraception was associated with the introduction of training in PAC, including FP, and quality improvement interventions and gains were sustained over time.

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Scaling-up a public health innovation: A comparative study of post-abortion care in Bolivia and Mexico

Cited by 37 publications

References 13 publications

An audit of surgical termination of pregnancy at a level 1 health facility in South Africa

An audit of surgical termination of pregnancy at a level 1 health facility in South Africa

An evaluation of a national intervention to improve the postabortion care content of midwifery education in Nigeria

The effects of interventions to integrate long‐acting reversible contraception with treatment for incomplete abortion: Results of a 6‐year interrupted time series analysis in hospitals in mainland Tanzania and Zanzibar

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