Hospital staff trained to provide family planning.

PIP: This article insert describes a program in Cali, Colombia, for training hospital staff in family planning counseling of postabortion patients. Hospital staff at Hospital Universitario del Valle treats about 250 women per month for complications of incomplete abortion. Many are repeat clients. Unwanted pregnancies are attributed to lack of contraception, incorrect use of contraception, and mistaken beliefs about the protective properties of drinking seven glasses of water after intercourse. Postabortion patients range in age from 12 years to over 49 years. 14% are aged under 20 years. The number of women with abortion complications or women with miscarriages puts pressure on inadequate staff and facilities. Therefore, the hospital introduced a new program for postabortion patients. The program includes family planning counseling and provision of contraceptives before release from the hospital. Women are also informed of where to obtain contraceptive supplies in their local communities. The hospital must refer women seeking sterilization to secondary health facilities due to the intensive use of operating rooms. Family planning counseling includes information about the use of traditional and modern methods. Staff members who are trained in family planning include all levels from volunteers to physicians. The hospital is trying to improve client-provider relations by eliminating the fear factor. Emergency room department staff are also trained in family planning. The hospital is reaching out to the special needs of indigenous people who are unfamiliar with hospital settings and family planning information. Hospital staff provide each patient or client with a card that indicates the date of the woman's next menstrual cycle on a calendar. Staff inform the client that family planning must be used before the cycle begins. A variety of methods are explained.^ieng

Latin American hospitals improve postabortion care. Maternal health.

PIP: Approximately 4 million women undergo illegal abortions each year in Latin America and the Caribbean, and hundreds of thousands of women with postabortion medical emergencies or incomplete abortions seek hospital care. Once in an emergency ward, a woman may await treatment for 24 hours, bleeding, frightened, and in pain. A woman in such a situation may also experience nurses who chastise her for becoming pregnant or committing a sin, be examined with several staff members observing, undergo unexplained treatment without anesthesia, and/or leave the service facility without knowing whether she is still fertile or how to avoid pregnancy. INOPAL, Population Council's operations research program on family planning and reproductive health in the region, is working to find the best ways, medically and financially, for hospitals to deliver high-quality, comprehensive services to postabortion patients. Most maternal deaths and injuries could be prevented by access to family planning services and information about contraceptive use. The Population Council and colleagues from hospitals, governments, and nongovernmental organizations are conducting studies in Guatemala, Peru, and Mexico on the emergency treatment of incomplete abortions with the goal of improving and standardizing postabortion services.^ieng

Postabortion contraception: few family planning services available.

PIP: The Association for Voluntary Surgical Contraception (AVSC) investigated the linkages between induced abortion and family planning services in a qualitative research project conducted in Colombia, India, and Turkey. Study methodologies included interviews with abortion and family planning service providers, record review, observation, and discussions with policy-makers. In general, abortion and family planning services were entirely separate. Although postabortion clients clearly wanted to avoid another unwanted pregnancy, they generally failed to receive family planning information and services. Abortion providers tended not to view contraceptive provision as their responsibility and, in many cases, had negative attitudes toward abortion patients. Services for abortion and family planning often were not available on the same day or in the same location. In some areas in India, where abortion patients were provided with contraception (IUD and sterilization), its provision was coerced as a condition for abortion. AVSC is working to raise awareness of the need to integrate service links between abortion and family planning programs.^ieng

[Assessment of the promotion component in the postpartum/postabortion program]. / Evaluación del componente de promoción en el programa postparto/postaborto.

PIP: To study the low acceptance rate of contraception, the authors investigated the postpartum postabortum program of family planning in 8 hospitals run by the Mexican Ministry of Health. During 1 week all patients, 502 women who were leaving the hospital were interviewed; the personnel in charge of family planning were also interviewed. The number of acceptors leaving the hospital went from 1% of patients in Hermosillo to 47% in the General Hospital, a rate of acceptance much lower than that observed with other programs. Sociocultural characteristics of patients were very similar in all hospitals, and acceptance of IUDs was much greater than acceptance of the pill. In all hospitals, promotion of contraception consisted of a talk given to groups of patients and never to individuals; in most hospitals there were no other possibilities to receive contraceptive information. Most patients, either before or after the talk, still equated family planning with better education for children and better social conditions for the family; very few mentioned the health of mothers and children. 4% of patients did not know what contraceptives were available at the hospital even after the talk; many patients stated that the type of presentation and the vocabulary used were too difficult. Only 4% left the hospital with an adequate knowledge of both oral contraception and the IUD. Duration of the talk went from 7-39 minutes, depending on the hospital. The personnel delivering the talk were not specifically prepared for that purpose, and many times failed to answer questions or to expound on important aspects of contraception, such as side effects or contraindications. No teaching materials were available and even the meeting rooms were inadequate. It is obvious that postabortum postpartum programs of family planning should be restructured and reorganized, personnel should be trained, patients should receive individual attention, husbands should be encouraged to participate, and simple, inexpensive teaching materials, such as slides and prints, should be made available.^ieng