Easing the pain: pain management in the treatment of incomplete abortion.

Although there have been significant improvements in post-abortion care programmes around the world, improving pain management has remained a significant challenge. The introduction of manual vacuum aspiration (MVA) has led to many positive changes in programmes, but the guidelines for pain control have generally been vague. Women are often treated with no pain control or in some cases receive too much pain medication. There are many factors contributing to this situation, including: the belief that women who have induced an abortion should be punished, the idea that pain control is unnecessary, the lack of availability of drugs and inadequate training and/or skills of providers. This paper argues for a greater focus on this important element of quality of care and for clearer guidelines on pain management during treatment of incomplete abortion with MVA. This includes the provision of analgesics immediately before the procedure, counselling and reassurance during the procedure and local anaesthesia when necessary.

Creating linkages between incomplete abortion treatment and family planning services in Kenya.

Postabortion care has received increasing emphasis as an important intervention to address part of the problem of unsafe abortion. Although a good deal of attention has been paid to improving emergency treatment of abortion complications, the other elements of postabortion care, including providing postabortion family planning services, have received less attention and are rarely found in health-care settings around the world. This report describes a study that was conducted in Kenya to test three different models of ways to provide postabortion family planning. The study shows that these new services are both feasible and acceptable to providers and patients, and also shows how effective they can be. Whereas only 7 percent of women received family planning counseling according to the baseline survey, this proportion increased to 68 percent in the postintervention period. In addition, 70 percent of women who decided to begin using contraceptives received a method, compared with only 3 percent at baseline. The provision of postabortion family planning counseling and methods on the gynecological ward by ward staff was found to be the preferred and most effective model.

A comparison of the 1995 and 1989 Kenya Situation Analysis Study findings.

PIP: This study examined quality of care in delivery of services among Ministry of Health Service Delivery Points (SDPs) in Kenya in 1989 and 1995. The situation analysis focused on method availability, IEC, supervision, training, number of clients served by method, choice of methods, information provided, and integration of services. More information was collected and a diversity of sites were included in 1995. The logistics system for contraceptive availability was viewed as low to moderate in 1989, with under 50% of the SDPs offering foam, condoms, and IUDs. Depo-Provera and Norplant were more available in 1995. Foam tablets were less available in 1995. Sterilization data was not available in 1989. In 1995, 25% of SDPs offered tubal ligation and 11% offered vasectomy. Method availability increased over time. IEC was rated as low in 1989. The display of family planning posters and the availability of pamphlets improved by 1995, but the lack of health talks on the day of the visit remained the same. Supervision was rated low in both 1989 and 1995, based on the number and quality of supervisory visits. Personnel and training were rated as moderate in 1989. In-service training for nurses delivering family planning increased from 1989 to 1995, from 32% to about 60%. During 1989-95, the proportion of clinics that served no clients for each method declined sharply, and the proportion of SDPs serving 1-19 clients/month increased sharply. There were large shifts in the proportion serving over 100 clients/month. The proportion of clinics serving oral pills to over 100 clients/month declined from 28% to 13%, and the proportion offering Depo-Provera increased from 4% to 25% during 1989-95. More clients had heard about permanent methods and fewer about spermicides. More clients had heard about side effects and their management in 1995. The Situation Analysis documented important changes and showed quality of care improvements.^ieng