Abstract

PIP: This article discusses the importance of providing immediate postabortion counseling on family planning in order to prevent a subsequent unplanned pregnancy. Quality of postabortion care is compromised if family planning discussions are not included. Women need to be informed about how to prevent unwanted pregnancy and how soon fertility will resume. Methods should be provided at postabortion health service facilities, or clients should be given a location for obtaining contraceptive supplies. About 13% of maternal deaths are due to unsafe abortion; country-specific percentages can be as high as 60%. Emergency treatment centers need to be integrated with family planning provision. Access to postabortion family planning services can be adversely affected by a number of factors. Staff may not have the time or training and not know what contraceptive methods are safe for use by postabortion women. Providers may communicate punitive and negative attitudes towards abortion patients. Health services planners may lack an understanding of women's perspectives and needs and fail to acknowledge the prevalence of unsafe abortion and need for family planning. Sometimes hospital policies may restrict services for adolescent abortion patients. Women may need to be refocused away from recovery and fear of reprisal toward prevention. Women should not be asked to make a decision about a long-acting or permanent method while in a period of postabortion stress or pain. Temporary methods are recommended until women are able to make a decision about longer-term methods. Doctors should ask women if family planning was used prior to the unintended pregnancy. "Decision trees" are available to help providers direct questions based on client responses. Women must be informed about postabortion complication signs: fever, chills, cramping, backache, heavy bleeding, foul discharge, or delay in menses.