We know that women seeking comprehensive abortion care—whether treatment for complications of an unsafe abortion, or a safe, induced abortion—welcome information about and access to contraceptive methods as part of their care. Ensuring access to contraception is crucial to avoiding future unintended or unwanted pregnancies. Logically, all women receiving abortion care should also receive contraceptive information, and a method if they wish one; likewise, family planning providers should be equipped to support women who have unintended pregnancies.
However, integrating family planning and abortion care is often a challenge. Barriers include administrative and physical separation of abortion and family planning units in health facilities, unavailability of a range of contraceptive methods, lack of training among abortion providers in contraceptive delivery, and women’s lack of knowledge about contraceptive options. But when a concerted effort is made to ensure supplies and train health center staff, a majority of women who receive abortion care will leave with a contraceptive method—even in countries with low contraceptive use rates and restrictive abortion laws.
Ethiopia, where abortion is legal under a broad range of circumstances
and where the 2013 International Conference on Family Planning was held, demonstrates the effectiveness of this equation—integrating both family planning and abortion services at the primary care level. In a 2008 study of 335 health facilities, 75 percent of women receiving abortion care in those facilities left with a family planning method in hand; and in primary care facilities, nearly 90 percent of women adopted a contraceptive method. The numbers would likely show greater contraceptive uptake now in 2013.
The results of a multi-country analysis that I presented last week with my Ipas colleagues
Dalia Brahmi, Kathryn Andersen, and Achieng Ajode further bolster the crucial integration of abortion care and family planning. We reported on contraceptive method receipt among more than 500,000 women at the time of their abortion care. These services were offered in more than 3,000 health facilities across 14 countries in Asia, Africa, and Latin America.
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Uptake of contraception by abortion clients was strong, ranging from 55 to 79 percent across countries. Most women, regardless of location, choose oral contraceptives, injectables, and condoms. Acceptance of long-acting, reversible methods is relatively low in intervention sites in some countries. The type of facility also makes a difference; women seeking comprehensive abortion care in hospitals are less likely to receive a contraceptive method than those receiving care in primary-level centers.
Most of the interventions to improve abortion care were implemented in public sector hospitals, health centers, and clinics and included provider training in abortion services and contraceptive care, use of clinical guidelines consistent with the World Health Organization guidance for safe abortion, upgrades in abortion service record keeping, and increased availability of abortion and contraceptive commodities.
For example, the benefits of integrating family planning and abortion care are evident in Nigeria—a country in which abortion is legally restricted—where we examined several facilities. Nationally, just 8 percent of married women of reproductive age use modern contraception. Yet, in the intervention facilities included in the analysis, 68 percent of comprehensive abortion care clients left with a contraceptive method. And in Bangladesh, other Ipas research has yielded similar findings. In a study from earlier this year that examined the integration of family planning, menstrual regulation, and post-abortion care, post-abortion contraceptive uptake went from 3.2 percent at the beginning of an 18-month period to more than 45 percent at the end.
The lesson to those in the global health community is clear: Comprehensive interventions to improve abortion and post-abortion care can lead to women leaving health facilities with contraception to reduce repeat unintended pregnancy. The key to the success of interventions is training providers in contraceptive care, ensuring contraceptive commodities are available in the procedure room, and providing
women with the needed information and a range of methods to choose from.
Women need compassionate care through all stages of their reproductive lives and must understand their options for such care. They must have supported access to family planning services, abortion care, and follow-up care without judgment.