Review articlePostabortion family planning counseling and services for women in low-income countries: a systematic review☆
Introduction
Unsafe abortion imposes serious health and economic costs on both individuals and society [1], [2]. As one of the easiest preventable causes of maternal mortality, it is estimated that 90% of abortion-related morbidity could be prevented by use of effective contraception; where effective contraceptive methods are available and widely used, the total abortion rate declines sharply [3], [4]. Globally, millions of women lack access to appropriate contraceptive methods; use in low- and middle-income countries is generally much lower than that in developed countries [5]. Over 80% of unintended pregnancies in developing countries occur among women who have an unmet need for modern contraception [6]. Whilst greater use of contraception will not produce direct, immediate effects on maternal mortality or morbidity, over time, it should reduce women's recourse to unsafe abortion, thereby putting women at less risk of lifelong injury or death [7], [8].
The 1994 Cairo Programme of Action placed a particular emphasis on the importance of postabortion counseling and family planning as part of a comprehensive package of postabortion care (PAC) [9]. Improving access to contraception information, services and supplies is now increasingly advocated by policymakers as the best way to reduce the demand for abortion and thus lower maternal mortality and morbidity overall [10], [11], [12]. The production and dissemination of systematic reviews are important steps in strengthening the international communities’ capacity for evidence-informed decision making [13]. Recent reviews in this area, however, either have been nonsystematic [14] or have included literature conducted in high-income countries only [15]. The objective of this systematic review was to gather and synthesize the available research evidence on the impacts of postabortion family planning counseling and services on women in low-income countries. An extended version of this article is available as a technical report [16].
Section snippets
Study identification
We searched PubMed, Popline, CINAHL, Cochrane database, Sociological abstracts, Social Services Abstracts, International Bibliography of the Social Sciences, Virtual Health Library and health research databases/specialist registers held at the EPPI-Centre [17]. The following Web sites were hand-searched: Ipas, Jhpiego, Family Health International, Marie Stopes International, Population Council, Postabortion Care Consortium, Gynuity Health Projects EngenderHealth, PRIME II and Eldis. In
Main results
A total of 2965 potentially relevant records were identified, of which 15 studies satisfied the inclusion criteria [19], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35]. A summary of the characteristics and the findings of the included studies is shown in Table 1. Study designs varied: one matched controlled study [25], one unmatched controlled study [35], five separate pre–post samples design studies (i.e., those that compare a group of participants receiving
Discussion
Overall, there is a lack of good quality research in this area, and evidence regarding the impact of providing family planning services and contraception to postabortion women in low-income countries is sparse. This systematic review identified no evidence on the impact of such programs on maternal mortality and morbidity: a not altogether unexpected result since these outcomes are widely recognized as difficult and expensive to measure [36]. We found insufficient evidence regarding the impact
Conclusion
This review, initiated and funded by the UK Department for International Development, provides an important and timely contribution to efforts to address the gap in the provision of a systematic and unbiased assessment of evidence specific to developing countries. Given the high number of unsafe abortions in low-income countries and their wide-ranging impact on maternal health, the lack of conclusive evidence on the efficacy of family planning interventions provided to women following an
Acknowledgments
We wish to thank Josephine Kavanagh for her input to the grant application and protocol, Claire Stansfield for her contribution to the literature search and Professor Sandy Oliver for her comments on the final technical report.
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Cited by (50)
Contraceptive uptake among post-abortion care-seeking women with unplanned or planned pregnancy in western Kenya
2020, Sexual and Reproductive HealthcareCitation Excerpt :Another study in Kenya indicated that women with previous abortions were most likely to use contraception but needed counselling to minimise the risk of contraceptive failure [15]. Post-abortion contraceptive counselling, contraceptive uptake and compliance are complex and poorly documented issues [17]. Up to date and to our knowledge, there is no research on whether the stated pregnancy intention is a reliable information to select women for contraceptive counselling.
Predictors of postabortion contraception use in Cambodia
2019, ContraceptionCitation Excerpt :While abortion is legal in Cambodia, women continue to face barriers to obtaining safe procedures, and many health facilities lack comprehensive PAC services [3]. Among the postabortion contraception literature, most studies focus on the effectiveness of interventions to improve contraceptive uptake, whereas few aim to identify independent predictors or patterns of postabortion contraception use [4–7]. Further, the majority of outcomes measure contraceptive acceptance or uptake immediately after the abortion; only 4 of 15 studies included in a systematic review of postabortion contraception include follow-up beyond 1 month [4].
M-health in public health practice: A constellation of current evidence
2019, Telemedicine Technologies: Big Data, Deep Learning, Robotics, Mobile and Remote Applications for Global HealthcareProviders perspective and geographic and institutional factors associated with family planning counseling
2018, Sexual and Reproductive HealthcareCitation Excerpt :Although some providers recognize the influence of their ideas, values and beliefs on the provision of their services and the need to set limits on this influence, they admit that it is not easy to dismiss the medical judgment of the personnel [8]. This situation demonstrates the need for mechanisms to remove client and provider barriers and to achieve a reciprocal approach between FP programs and the population [21–23]. Although in this study the institutional and training factors of the providers showed no significant association with adequate FP counseling, we believe that the lack of association between the these factors can be explained by low participation in training courses for more than 20 h on FP themes during the year prior to the study.
Postpartum and post-abortion contraceptive use among unmarried young women in ghana
2020, Journal of Biosocial Science
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Funding: UK Department for International Development (DFID).