Postabortion care (PAC), which includes treatment for complications from miscarriage or induced abortion, is an opportune time to counsel and offer clients voluntary contraception. Even if a woman wants to become pregnant again soon, she should probably wait six months to reduce the chances of low birth weight, premature birth, and maternal anemia.*, All PAC models include two essential services: (1) treatment of emergency complications, and (2) voluntary family planning counseling, including provision of contraception.3 Research studies and data from program implementation consistently show that when clients are counseled and offered contraception as part of postabortion care most women will opt to leave the facility with an effective family planning method (see Figure 1).4
Despite this evidence and decades of investments to improve PAC programs, health care systems continue to fall short. In Bangladesh, only 18% of all facilities providing PAC routinely offer contraceptive methods to clients.5 Similarly, only 6% of clients in Georgia, 17% in Tanzania, and 26% in Pakistan receive their contraceptive method of choice as part of PAC.6-8 Furthermore, studies in Kenya and Nepal show that even when services are in place, method choice may be limited.9,10 In Kenya, 9 of 10 postabortion clients left the facility with a method, but the vast majority left with male condoms due to limited contraceptive choice.9 The study also found significant gaps in information provided to clients, such as how to use the method correctly and follow-up information. In Brazil, only one-third of postabortion clients reported being counseled on contraception and less than 1 in 10 left the facility with a contraceptive method.11
Postabortion family planning is one of several high impact practices in family planning (HIPs) identified by a technical advisory group of international experts. When scaled up and institutionalized, HIPs will maximize investments in a comprehensive family planning strategy.12 For more information about other HIPs, see http://www.fphighimpactpractices.org/overview.
* A systematic review and meta-analysis suggests that an interval of less than six months following miscarriage is not associated with adverse outcomes.2 The meta-analysis was mainly of studies from developed countries