Woman Centered Postabortion Care

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     1  Contraceptive Services 1 Woman-Centered Postabortion Care
     2  Contraceptive Services 2 Contraceptive Services
     3  Contraceptive Services 3 Purpose This module discusses why contraceptive counseling and method provision are critical components of PAC. It covers the knowledge, attitudes and skills needed to provide high-quality postabortion contraceptive counseling and services.
     4  Contraceptive Services 4 Objectives At the end of this module, learners should be able to: Identify goals of PAC contraceptive counseling and method provision Identify contraceptive service-delivery models Identify ways of overcoming barriers to offering PAC contraceptive services Explain importance of EC
     5  Contraceptive Services 5 Objectives (cont.) Understand partner involvement in PAC contraceptive counseling Describe elements of effective contraceptive counseling Identify women’s medical eligibility for contraceptive methods after PAC Identify need for specialized counseling and referrals
     6  Contraceptive Services 6 Contraception: Basic Human Right IPPF Charter on Sexual and Reproductive Rights: The right to decide whether or not to marry and to found and plan a family The right to decide whether or when to have children
     7  Contraceptive Services 7 Unsafe Abortion and Contraception Globally, approximately 500,000 maternal deaths each year Nearly 70,000 are from unsafe abortion A way to end unsafe abortion is through contraception
     8  Contraceptive Services 8 Varied Reasons for PAC services Circumstances for women seeking PAC are varied Counselors should not make assumptions about women Women with spontaneous abortions may want pregnancy right away Some with a spontaneous abortion may want to delay pregnancy Others may have terminated their pregnancies and want to prevent pregnancies
     9  Contraceptive Services 9 The Goal of Postabortion Contraceptive Counseling To help the woman understand the factors that led to the abortion so that she can avoid repeating the situation.
     10  Contraceptive Services 10 Contraceptive Use Reduces maternal mortality and morbidity by helping women avoid unwanted pregnancy and unsafe abortion Promotes women’s and infants’ health by allowing spacing between pregnancies Gives women freedom to improve their quality of life
     11  Contraceptive Services 11 Service-Delivery Models Offer counseling and dispensing methods at PAC facility Family-planning clinic staff attend PAC facility to counsel and dispense methods Offer counseling at PAC facility and referral for method provision
     12  Contraceptive Services 12 Timing of Contraceptive Counseling When the woman feels well enough Before or after PAC treatment
     13  Contraceptive Services 13 Who Can Be Contraceptive Counselors? Trained staff members Staff can share responsibility Trained volunteers Trained staff from family-planning clinic
     14  Contraceptive Services 14 Key Messages She could become pregnant again within 10 days Safe methods to prevent pregnancy are available How to obtain contraceptive services Most contraceptive methods can be used after PAC treatment
     15  Contraceptive Services 15 Failure of Family-Planning System Counselors do not adequately explain to the woman about methods National policies limit use of contraception Contraceptive methods are too expensive for the woman
     16  Contraceptive Services 16 Failure of Family-Planning System (cont.) Clinics cannot provide a reliable supply of the woman’s method Services are not located in the community or not open conveniently Protocols limit access
     17  Contraceptive Services 17 Privacy
     18  Contraceptive Services 18 Informed Choice Means… Choosing a method voluntarily, without pressure A variety of methods to choose from Understanding benefits and risks of each method
     19  Contraceptive Services 19 Sterilization Requires informed consent and counseling Some women chose a permanent method at an earlier time If she chooses sterilization and has been counseled, then it can be performed concurrently
     20  Contraceptive Services 20 Would You Like Your Partner Involved?
     21  Contraceptive Services 21 Women Have Less Power to Negotiate… When to have sex How many children to have Contraceptive practices Use of methods he favors or opposes Use of condoms or vasectomy Protection from STIs and HIV due to his behavior
     22  Contraceptive Services 22 Involve Partner If the Woman Desires
     23  Contraceptive Services 23 Elements of PAC Contraception Counseling Establish rapport Assess needs Explain reproduction if needed Ask if she desires to delay or prevent pregnancy Assess individual situation
     24  Contraceptive Services 24 Elements of PAC Contraception Counseling (cont.) Explain characteristics of methods Help her choose a method Ensure she understands how the method works Refer her to resources as needed
     25  Contraceptive Services 25 Establish Rapport Greet her in a friendly way; speak directly to her Determine if this is an appropriate time Assure her of confidentiality Ask if she would like her partner present
     26  Contraceptive Services 26 Effective Communication
     27  Contraceptive Services 27 Assess the Woman’s Needs Discuss factors leading to PAC Assess if pregnancy was planned or unplanned; using contraception? What were the reasons the method failed?
     28  Contraceptive Services 28 Explain Human Reproduction If Needed Explain how contraception prevents pregnancy Discuss contraception in terms of her monthly cycle Explain in terms she understands Dispel myths about how the methods work
     29  Contraceptive Services 29 Ask If She Desires to Delay Pregnancy Some women want to become pregnant Some may want contraceptive counseling on birth spacing
     30  Contraceptive Services 30 Assess the Woman’s Individual Situation Consider her clinical condition Consider her personal situation Discuss obstacles to her contraceptive use Help find ways to resolve obstacles
     31  Contraceptive Services 31 Explain Characteristics of Methods Determine which methods are available and accessible to her Discuss contraceptive methods Include information about benefits, side effects
     32  Contraceptive Services 32 Different Methods
     33  Contraceptive Services 33 Help Her Choose a Method Do not choose a method for the woman; help her make her own choice.
     34  Contraceptive Services 34 Ensure She Understands How the Method Works Explain how the method works and is used Ask her to repeat the information to show understanding
     35  Contraceptive Services 35 Refer to Community Resources Counseling may reveal factors affecting a woman, such as violence, HIV Have a resource list available
     36  Contraceptive Services 36 Medical Eligibility of Methods Most methods can be used immediately following PAC Screen for any medical precautions for particular methods
     37  Contraceptive Services 37 Uncomplicated PAC: Uterine Size to 12 Weeks or Less All methods can be used immediately.
     38  Contraceptive Services 38 Uncomplicated PAC: Uterine Size Greater Than 12 Weeks Most methods can be used immediately IUDs generally can be inserted
     39  Contraceptive Services 39 PAC with Complications: Infection IUD, IUS, sterilization appropriate when infection resolved Give condoms to prevent spread of infection to partner
     40  Contraceptive Services 40 PAC with Complications: Genital Trauma Sterilization, IUD, IUS, female barrier methods may be restricted Provider must decide whether her condition contraindicates any methods
     41  Contraceptive Services 41 PAC With Complications: Excessive Blood Loss Sterilization, IUD may be restricted Delay sterilization if the woman is too anemic
     42  Contraceptive Services 42 Emergency Contraception
     43  Contraceptive Services 43 Case Study 1: Violence A 20-year-old married woman, mother of two, discloses that she is frequently beaten by her husband. The last beating occurred while she was pregnant, and she came to the facility with a lot of vaginal bleeding and cramping. She is afraid to discuss contraception for child spacing with her husband.
     44  Contraceptive Services 44 Case Study 2: HIV A 28-year-old woman, mother of three, came into the clinic when she was extremely sick and learned that she is HIV positive. Her only sexual partner has been her husband. She wants to prevent another pregnancy until she receives treatment for HIV and is feeling better.
     45  Contraceptive Services 45 Dual Methods
     46  Contraceptive Services 46 Case Study 3: Adolescents A 15-year-old woman has a boyfriend with whom she is sexually active. They use withdrawal because she doesn’t feel comfortable asking him to use condoms.
     47  Contraceptive Services 47 Illustrations by Stephen C. Edgerton