Abortion vs. Post-abortion Care in Africa: Challenges and Opportunities

738 views
575 views

Published on

Dr. Solomon Orero, Consulting Obstetrician/Gynecologist
Nairobi, Kenya
May 8, 2008

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
738
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
24
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • The clamour for change of the unfriendly abortion laws. In Africa:mauritius,SA,Botswana,Zambia,Ethiopia
  • In SSA MMR Range from 400 to 2037 in SS.Contribution of Unsafe abortion ranges from 13% to 56%.SRH are Human Rights
  • The Mexico City liberalization of abortion Law last year.In that time up to 7000 women have benefited from the legalization
  • The studies,1989 at the KNH as an example
  • The consortium has been instrumental in ensuring that the PAC activities are continued.Ipas-Equipment,training,materials,
  • The three models of delivering the PAFP has its challenges-commodities,dogma of FP service delivery site and documentation
  • This agreement has not been implemented to the letter especially because of the USA position on Abortion
  • From the Obs/Gyn to MO,to MLPs to Informal Provider
  • With the expansion and more evidence coming from studies and programmes like COBAC informed the second review of the PAC concept
  • Abortion vs. Post-abortion Care in Africa: Challenges and Opportunities

    1. 1. CPAC IN KENYA WHERE WE ARE By Dr Solomon Orero (MD,MMED,IMH)
    2. 2. The Origin of PAC  The history of legalization of abortion care  From the 1950s  This is not visible in the African Continent and Latin America
    3. 3. Arguments for legalization  Maternal mortality and morbidity  The public Health Platform and resources  The Sexual reproductive Health and Rights Platform
    4. 4. The Landmark Decisions in Abortion Care  The USA 1973 Judicial ruling-How it has since affected the rest of the world  The 1984 Mexico policy and its impact-The “Gag Rule”  The 1994 Landmark ICPD  The Mexico City Liberalization of abortion Law-GIRE
    5. 5. PAC  The term PAC first articulated in 1991  The Historical origins of PAC  The logic of inclusion of PAFP  The logic for the inclusion of referrals and linkages with other RH services
    6. 6. In 1993-The PAC consortium  AVSC now Engender health  IPPF  IPAS  Pathfinder International  JHPIEGO
    7. 7. The Original PAC model 1994  Emergency Treatment-Evacuation of the uterus  Post Abortion Family Planning counseling and services  Referrals and Linkages with other RH services
    8. 8. ICPD 1994 and Land mark para 8.25  “All governments and organizations to strengthen their commitment to women’s health" and “deal with the health impact of unsafe abortion”
    9. 9. Expansion of the programmes and access issues  Decentralization of: – The provider skill- – The health facility – Involvement of the informal providers and the community
    10. 10. Consultants Referral hospitals General Practitioners First level referral hospitals Sub-district hospitals Mid level providers All hospitals Health Centers Dispensaries Informal providers ( TBAs, Health workers, community based health workers) Found in the communities
    11. 11. The reviewed PAC concept  Community and service provider partnership  Counseling  Emergency treatment  Family Planning and Contraceptive Services  Referrals and Linkages to RH and other services
    12. 12. Community and service provider partnership 1. Community and service provider partnerships for prevention (of unwanted pregnancies and unsafe abortion), mobilization of resources (to help women receive appropriate and timely care for complications from abortion), and ensuring that health services reflects and meet community expectations and needs
    13. 13. Community and service provider partnership Cont’d 2. Counseling to identify and respond to women’s emotional and physical health needs and other concerns. 3. Treatment of incomplete and unsafe abortions and complications that are life threatening.
    14. 14. Community and service provider partnership Cont’d 4. Contraceptive and family planning services to help women prevent unwanted pregnancy or practice birth spacing: and 5. Linkages with other reproductive health services that are preferably provided on- site or via referral to other accessible facilities in the providers network.
    15. 15. Community and provider partnerships  The partnership includes education: 1. To increase FP use, prevention of unwanted pregnancies 2. Risks and consequences of unsafe abortions 3. Promotion of client oriented health rights based on sexual and RH services 4. Signs and symptoms of obstetric emergencies
    16. 16. Community and provider partnerships cont.. 5. In what sexual and RH services are provided 6. Mobilization of community resources to ensure that women with obstetric emergencies (including PAC) receive timely and appropriate care 7. Planning and sustaining PAC and other RH services (HIV/AIDS, FGM, gender violence etc)
    17. 17. Counseling 1. To find and affirm the women’s feelings 2. Ensure that women receive appropriate answers to their questions or provided with adequate information on their condition and treatment. 3. Help women clarify their thoughts about pregnancy, PAC, return of ovulation and RH future 4. Address other concerns that women may have
    18. 18. Treatment  Provision of emergency treatment by evacuation of the uterine contents through: 1. Manual Vacuum Aspiration (MVA) or 2. Sharp Curettage (SC) or 3. Electric Vacuum Aspiration (EVA) or 4. Use of chemicals e.g Misoprostol.
    19. 19. Contraceptive and FP services  Access to a wide range of contraceptive methods to women who desire to delay or avoid pregnancy so as to avoid unwanted pregnancies.
    20. 20. What is going on in the recent past and now?  Community Based Abortion Care  Creation of community partnerships  High profile newspaper reported cases regarding unsafe abortion ,Street dumped fetuses
    21. 21. What is new in Kenya?  The challenges of providing all the PAC components: – PAFP -counseling and services – Continuous decentralization of MVA/PAC services – Obs/Gyn,MOs,MLPs,Informal Providers – Training,MVA kit new to MVA Plus – The Environment is getting more hostile
    22. 22. 40th Anniversary of FP  On May 13th,2008 will be the 40th anniversary of FP as a recognized Human rights issue  “On that day, there will be many couples who will have an unmet need for FP”For many reasons they will not access Family planning methods  One reason in Kenya :there has been no major investment in FP the last almost 2 decades
    23. 23. On Investment in Health  Investment at the community level in creating awareness and seeking to improve health seeking behaviour  Investment in the institutional level in getting the infrastructure up and running with the right mix of skills
    24. 24. On Investment in Health  Investment in health systems development and use of RH abortion included as a fulcrum for change  Investment in policy and strategy development for Health and therefore RH and undertake advocacy for stronger legislation and better services integration
    25. 25. CPAC EQUITY FOR WOMEN PRIMARY HEALTH CARE Basic Maternity Care PILLARS OF SAFE MOTHERHOODFamily Planning Essential ObstetricCare Safe Delivery ANC
    26. 26. MAP OF KENYA & KMET PROJECT AREAS
    27. 27. The Map of Kenya and some facts Kenya: Country Background •Population: 33 million •GDP: Kshs. 920 b (US $ 12.5 b) •Per capital income: US$ 380
    28. 28. A map of Kenya showing the PEV hot spots what it will mean in PAC
    29. 29. KMET PROGRAMS SAFE MOTHERHOOD INITIATIVE KMET PROGRAMS POST ABORTION CARE HOME BASED CARE FOR PLWHA NUTR’N AS A COMPONENT OF HBCSAGAM COMM HOSPITAL CLINICAL SERVICES MICRO- FIANANCE YOUTH FRIENDLY SERVICES INT’L STUDENTS/ VOLUNTEERS
    30. 30. The allocation of health budget-Kenya  Reproductive health services cover a meager 0.6% of the health budget.  Households are the greatest source of expenditure on health they spend from their pockets.  The households expenditure on RH is minimal
    31. 31. Transportation of a patient with impending uterine rupture and choriamnionitis worse for abortion patients.

    ×