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Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality

https://doi.org/10.1016/j.bpobgyn.2016.07.008Get rights and content

Access to contraception reduces maternal deaths by preventing or delaying pregnancy in women who do not intend to be pregnant or those at higher risk of complications. However, not all unintended pregnancies can be prevented through increase in contraceptive use, and access to safe abortion is needed to prevent unsafe abortions. Despite not preventing the problem, provision of emergency care for complications can help prevent deaths from such unsafe abortions. Safe abortion in early pregnancy can be provided at primary care level and by non-physician providers, and the risks of mortality associated with such safe, legal abortions are minimal. Although entirely preventable, unsafe abortions continue to occur because of numerous barriers such as legal and policy restrictions, service delivery issues and provider attitudes to abortion stigma. Overall, the provision of contraception and safe abortion is important not just to prevent maternal deaths but as a measure of our ability to respect women’s decisions and ensure that they have access to timely, evidence-based care that protects their health and human rights.

Introduction

In general, approaches to reducing maternal mortality include improving care in pregnancy, labour and the postpartum period; preventing pregnancy particularly among women at high risk of morbidity and mortality; and preventing unsafe abortion. In this study, we first review the contribution of birth spacing and timely prevention of pregnancy and then determine the role of safe abortion services and post-abortion care (PAC) in reducing maternal mortality.

Section snippets

Family planning and maternal mortality

Paradoxically, the introduction of family planning services in a population may increase the maternal mortality ratio (MMR). The first to adopt contraception are usually the more educated, who have a lower risk of maternal death [1]. Thus, while the denominator of the ratio (number of births) will decrease, the numerator (maternal deaths) will not decrease in the same proportion with an initial apparent increase in the MMRs. It is only when these services reach a larger population that MMRs

High levels of unmet need for contraception and high levels of abortion

Prevalence of contraceptive methods has been rising; nevertheless, an estimated 146 million (95% uncertainty interval (UI) 130–166 million) women worldwide aged 15–49 years who were married or were in a union had unmet need for family planning in 2010 [28]. Additionally, it is important to note that unintended pregnancies can and do occur among contraceptive users as all contraceptive methods even with perfect use can fail. Pregnancies also result from sexual assault or rape. Sometimes, health,

Conclusion

Access to contraception and the provision of family planning is an essential reproductive health intervention that helps reduce maternal deaths by preventing or delaying pregnancy in women who do not intend to be pregnant or those at higher risk of morbidity and mortality. The provision of safe abortion is essential to prevent the complications arising from unsafe abortion, and the provision of emergency care for complications is essential to prevent deaths from those complications. Equally

Conflict of interests

The authors have no conflicts of interest. The views expressed in this article are those of the authors and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

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