Percent of postabortion care clients who left the facility with a contraceptive method
Of those women receiving either triage, stabilization, referral for emergency treatment, or emergency treatment services for complications related to miscarriage or unsafe abortion during the past year – regardless of location – the percentage of women who received a modern contraceptive method prior to leaving the facility.
This indicator is calculated as:
(Number of women who received postabortion care services and a contraceptive method/ Total number of women receiving postabortion care services) x 100
Counts of women presenting to a health facility (private office, health center, or hospital) for emergency treatment of abortion-related complications during a one-year period and who left the facility with a contraceptive method. If possible, evaluators should disaggregate clients by those 25 years and older and youth (≤ 24).
If possible, evaluators should disaggregate clients by the following age ranges: 10-14, 15-19, and 20-24.
Special studies or service statistics from health facilities providing triage, stabilization, treatment, and/or referral.
Note: In hospitals in developing countries, treatment of abortion complications may be performed in many different locations within the facility, such as the gynecological ward, emergency room, or operating room; data collection should therefore include encounters from all locations.
The provision of contraception is a critical part of postabortion care (PAC). This is a useful indicator for monitoring if this element of PAC is being provided and where gaps in quality of care may be – either from the provider’s end or in contraceptive commodity security. Numbers of encounters for abortion complications can also provide denominators for other useful indicators, such as the percentage of PAC patients under the age of 20 or the percentage of PAC patients presenting at 12 or fewer weeks of pregnancy. In some individual facilities, such as private offices, health huts, health posts, and health centers, however, the number of encounters for abortion complications may be small so the calculation of percentages may be inappropriate.
This indicator includes both complications due to spontaneous abortion and induced abortions. Service providers often times assume a woman’s future reproductive intentions and her desire for family planning based on whether the abortion was spontaneous or induced abortion. However, at the time of PAC treatment, counseling should be offered to each woman to help her clarify her reproductive intentions. Even a woman who has had a spontaneous abortion and wants to become pregnant again immediately, may benefit from delaying a subsequent pregnancy.
While it is often of interest to distinguish between the two types in order to estimate the number of induced abortions, this information may be difficult to obtain, particularly in a legally and/or socially restrictive environment, or inconsistently recorded. Moreover, many would question the ethics of asking young women if they have had an abortion in restrictive legal settings. Clinical evidence is often inconclusive, and reports may also be heavily biased in restrictive environments. Even where service providers are fairly certain that an abortion-related complication resulted from an induced abortion, they may not record this. This omission results in service data that are potentially misleading in terms of the number of spontaneous versus induced abortions.
Also an additional issue with increased used of misoprostol for PAC treatment, is that women may not be completing the procedure in the facility. In these cases, certain methods of contraception, such as IUD insertion, will not be provided before the woman leaves the facility.
access, postabortion care, family planning, quality