12.YF post abortion care.pptpost abortion care.ppt

Youth Friendly Post
Abortion Care

Unsafe Abortion
A Serious Threat To Women's
Health And Lives
• Complications from abortion are a serious threat to
women’s health
• Unsafe abortion accounts for around 13 percent of
pregnancy-related deaths, as well as long-term
morbidity

A Serious Threat To Women's Health
And Lives cont..
• 19 million unsafe abortions occur each year around
the world, 5 million women are hospitalized and
68,000 women die (WHO 2004)
• 99% of deaths from unsafe abortion are in developing
countries
• Improved access to contraception and postabortion
care can reduce unwanted pregnancy and death

Adolescents: A Priority Population
For PAC Programs
• 20 percent of the world’s population
• 30 percent of total population in the developing world
• Have limited access to RH/FP information and services
• Are especially vulnerable to sexual violence & coercion
• Increasingly engage in premarital sex

Adolescents: A Priority Population
For PAC Programs
Adolescent sexual behavior
(whether consensual or coerced)
+
limited access to RH/FP information
& services
=
a high rate of early and/or unwanted pregnancy and unsafe
abortion

Youth Friendly PAC
• Pathfinder spearheaded an effort to develop technical
guidelines for youth friendly PAC
• Technical guidelines were adopted by the PAC
Consortium in 2006

Pathfinder and YFPAC
• In 2007 – 2008,
Pathfinder will
implement YFPAC
programs in eight
country offices in Sub-
Saharan Africa, using
the Technical
Guidelines and other
resources
 Angola
 Ethiopia
 Ghana
 Kenya
 Nigeria
 Mozambique
 Tanzania
 Uganda

What Do we Know About
Adolescents And Abortion?
It is estimated that worldwide, every year:
 4.5 million adolescents have an abortion
 4.3 million adolescent abortions take place in
developing countries
 1.8 million abortions are unsafe (WHO

From Data The Regions:
Africa Asia LAC
Percent of all
unsafe
abortions
attributed to
women <25
60 30 42
This portion is disused on Abortion related maternal
mortality presentation

Why Are The Numbers So High?
Young women are a vulnerable group due to:
 Physical, psychological and social development
 Power and gender imbalances
 Poverty
 Sexual abuse and coercion
 Limited or no access to RH/FP information and
services, AND…

Why Are The Numbers So High?
Young women are also vulnerable due to…
 Delays in seeking abortion
 Use of cheap and often unsafe providers
 Delays in seeking care for abortion complications
when they occur
• All of which lead to higher rates
of complications, compared to
other age groups

Why Are Adolescents Less Likely To Seek RH/FP
Services For Prevention And/or Treatment?
 Limited understanding of their bodies and sex
 Little knowledge of available services
 Embarrassment and/or shame
 Societal disapproval of premarital sex
 Belief that services are not intended for them
 Fear of medical procedures and side effects of
contraception

In Addition To Their Own Perceptions,
It Is not Easy For Youth To Access RH/FP Services
 Laws & policies restrict adolescent access
 Facility hours are inconvenient
 Services may be costly
 Staff may be hostile or judgmental
 Services provide limited privacy and confidentiality

Postabortion Care (PAC) is
An Important Service For Adolescents
Given the high rate of unsafe abortion among
adolescents,
 Government health policies
 Standards & guidelines
 Services
 Providers
must consider how best to treat complications and prevent
future unwanted pregnancies among this priority
population.

The PAC Consortium
And Pathfinder Recommend:
Improving the quality of PAC services
provided to adolescents
Increasing adolescent access to PAC
services
A key strategy is
to make PAC services more
“Youth Friendly”

What is Youth Friendly PAC?
It addresses the concerns of adolescent clients through
increased attention to ensuring:
 Privacy
 Confidentiality
 Non-judgmental and respectful staff
 Making services affordable or free

The Five Elements of PAC
 Partnership between community and providers
 Counseling
 Treatment of complications
 Contraceptive services
 Referrals for needed RH and other services

Community & Service
Provider Partnerships
• Involve youth & youth-serving organizations as partners
including schools, youth groups, and other providers of
care to youth/adolescents
 Community-provider partnerships facilitate dialogue and
create an enabling environment that supports the
provision of needed information and services to
adolescents
 Community and youth input helps providers address
quality of care and structure of services

However…
 Be realistic about what you can achieve through
community partnerships, especially in communities
with conservative views of adolescent sexuality,
pregnancy and abortion
 Consider community broadly, beyond traditional
stakeholders
 Take small steps and develop solid alliances

Creating Partnerships With Youth
 The most important partners are youth
 Build the skills of youth so they can participate as
equals. For example, training youth as peer educators
consistently shows that young people develop
important skills in facilitation and communication
 Sensitize adults to the importance of respecting
adolescent perspectives and participation

Community Participation:
Illustrative Examples
 Community meetings or discussion groups
 Peer education to prevent unwanted pregnancy and
refer youth for PAC services
 Informational and skills building workshops

Community Participation:
Illustrative Examples cont..
 Communication campaigns
 Linking services to existing youth programs
 Outreach to schools
 Community action planning to address unsafe
abortion

Providing Youth
Friendly Clinical Services
• Overall, national laws, health policies, standards and
guidelines for PAC should address the importance of
providing confidential and quality care to women of
ALL ages

Providing Adequate Support
To The Adolescent PAC Client
 Involve a support person of the client’s choice during care and
treatment, such as a partner, friend, or family member
 Ensure privacy and confidentiality
 Promote positive, non-judgmental provider attitudes
 Be sensitive to possible sexual coercion and violence
 Facilitate timely delivery of services

Counseling The Adolescent PAC
Client
A PAC visit may be the only time a young client comes
to the facility. Use this opportunity to address
important issues during counseling, including:
 Anatomy and physiology
 Information on medical procedures
 Directions for any needed medication

Counseling the adolescent PAC client
cont..
A PAC visit may be the only time a young client comes
to the facility. Use this opportunity to address
important issues during counseling, including: cont..
 How to recognize complications and the need to
return to facility
 Contraception, including condoms
 Dual protection
 STIs/HIV
 Sexual decision-making and negotiation

A Youth Friendly
Approach To Counseling
 Tailored to individual adolescent
 Founded on clear communication
 Supportive
 Empathetic
 Patient
 Addresses myths and misinformation
 Allows adequate time for dialogue

Key Points To Address In Counseling
 Give clear and simple information on procedure and follow up care
 Help client anticipate and deal with pain or discomfort
 Encourage client to talk about her feelings, help her clarify her
thoughts and plan for the future.
 Discuss return to fertility and contraceptive options
 Screen for abuse, violence, STIs and HIV.
 Provide a contact name and number for follow up

Treatment of Complications
In Adolescents
Clinical treatment of PAC is similar for adolescents and
adults. Special considerations for adolescent clients
include:
 Use of a smaller speculum
 Use of misoprostol for cervical dilation/ripening and
to facilitate completion of abortion
 Enhanced attention to pain management
 A preference for MVA or EVA to facilitate timely
discharge, when clinically possible

Treatment of Complications
In Adolescents cont….
Adolescents often wait longer before seeking an
abortion, which can lead to more severe
complications and influence the type of treatment.
Treatment considerations include:
 MVA/EVA preferred over D&C because of fewer
complications
 Need for other treatment strategies, pain
management and emotional support
 Other RH problems (e.g. STIs) may be present and
should be addressed and treated

Post Abortion Contraception
PAC provides a window of opportunity to help young
women prevent a future unwanted pregnancy through
provision of contraception at the time of the visit.
Importantly, providers should:
 Promote dual protection against pregnancy and
STIs/HIV
 Encourage the use of condoms as a priority method
for adolescents

Providers should discuss and assess client’s future
reproductive intentions:
 For those who want to become pregnant, emphasize
the importance of waiting six months to facilitate
recovery

For those who do not want to become pregnant,
remember:
 Age is not a contraindication for any method
 Dual protection should be promoted
 Proper condom use should be discussed

cont..
 Contraceptive negotiation skills should be addressed
 Constraints in using certain methods should be
identified
 Information should be provided (where appropriate)
about emergency contraceptive pills (ECPs) and how to
obtain them
Where feasible, involve partners
in counseling on contraception

PAC And Other Services
PAC can be an important gateway to other health &
social services
 Where possible, provide these services on site
 As needed, ensure referral networks are in place
 The quality of PAC care can significantly
determine if an adolescent client will return for
follow-up or referred services

Referral
At times, it will be necessary to refer adolescent clients to
other services or providers
 Be knowledgeable of available services, including
community-based services, hotlines and websites
 Referral points should ideally be “youth friendly”
 The purpose of referral should be carefully explained
 Records should be kept of referral

Measuring The Success of
YFPAC: Illustrative Indicators
Partnerships
 level of community (including adolescent)
participation in identifying and addressing issues
 Number of community meetings
 Evidence of formal partnership agreements

YFPAC, Continued
Counseling
 % who receive counseling
 % who express satisfaction with services
Clinical treatment
 % adolescents treated appropriately

YFPAC, Cont…
Contraception
 % who receive information about contraceptives
 % who receive a method before leaving the facility
Other services
 % screened for other health needs
 % who receive treatment and/or referral

YF PAC Is An Investment
In Quality of Care
Providing youth friendly PAC:
 Increases adolescent access to life-saving services
 Promotes healthy behaviors, including contraceptive use
 Improves overall quality of PAC to meet needs of all
clients

12.YF post abortion care.pptpost abortion care.ppt

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