Costs of alternative treatments for incomplete abortion

Unsafely performed abortion is one of the five leading causes of maternal deaths worldwide. Many women who have undergone unsafe abortions enter the healthcare system to seek help for the resulting complications, including incomplete abortion. This human and financial cost of this health problem is tremendous, especially in the developing world. This study examined the potential for reducing costs to healthcare systems by changing the standard method of treatment for incomplete abortion. Vacuum aspiration (VA) has been shown to be safer than dilation and curettage (D&C) for uterine evacuation; the World Health Organization includes VA as an essential service at the first referral level. The technique most commonly used for treating first-trimester incomplete abortion in developing countries, however, is D&C. This study examined the hypothesis that use of manual vacuum aspiration (MVA) - a variation of VA - would be less costly than D&C and thus advantageous to healthcare systems with limited resources. The purpose of the study was to identify and, where possible, to explain the factors that contributed to cost differences between MVA and D&C for treatment of first-trimester incomplete abortion. To achieve this objective, researchers observed patient management and documented resource use at hospital sites in Ecuador, Kenya, and Mexico. In most cases, treatment with MVA required a shorter patient stay and fewer hospital resources than D&C, as the two techniques were practiced at the various study sites. The policy decision to adopt MVA, supported by procurement of instruments and incorporation of training in its use, is the chief prerequisite for achieving these improvements. But the full advantages of MVA are realized only if it is introduced in conjunction with certain changes in patient-management practices, such as offering outpatient treatment of incomplete abortion. Further, decentralizing MVA services can maximize the benefits of the technique, facilitating (hospitals'and) healthcare systems'efforts to decrease the cost of delivery service and improve the quality of care.Health Monitoring&Evaluation,Gender and Health,Health Systems Development&Reform,Information Technology,Business Environment

Reproductive health operations research, 1995–1998

This book presents in-depth reports on promising new interventions that have been developed and important programmatic changes that have been achieved by operations research in Latin America between 1995 and 1998. The INOPAL III project has made advances in five areas including access and quality of services, integration of family planning and other reproductive health services, financial sustainability, post-abortion care, and emergency contraception. Each of these topics are represented by at least three studies conducted in two or more countries. The operations research projects discussed under each topic are not replications of a single study. They use different research designs and address different questions. Nevertheless, when taken together, they provide managers and decision-makers with a body of programmatically relevant information on each broad topic covered

Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh

Unsafe abortion is a significant contributor to worldwide maternal mortality; however, abortion law and policy liberalization could lead to drops in unsafe abortion and related deaths. This review provides an analysis of changes in abortion mortality in three countries where significant policy reform and related service delivery occurred. Drawing on peer-reviewed literature, population data and grey literature on programs and policies, this paper demonstrates the policy and program changes that led to declines in abortion-related mortality in Romania, South Africa and Bangladesh. In all three countries, abortion policy liberalization was followed by implementation of safe abortion services and other reproductive health interventions. South Africa and Bangladesh trained mid-level providers to offer safe abortion and menstrual regulation services, respectively, Romania improved contraceptive policies and services, and Bangladesh made advances in emergency obstetric care and family planning. The findings point to the importance of multi-faceted and complementary reproductive health reforms in successful implementation of abortion policy reform

Sustainability of postabortion care in Peru

The goal of this study was to determine the sustainability of the postabortion care (PAC) training and service delivery intervention introduced in the Hospital Nacional Daniel Alcides Carrión in Lima, Peru, and the extent to which the outcomes of the intervention have continued. The objectives of the study were to assess changes over time in the following outcomes: the use of manual vacuum aspiration for incomplete abortion, provision of family planning information to postabortion patients, acceptance of contraception by postabortion patients prior to discharge, provision of medical care information to patients, length of hospital stay, and resources used by the hospital and patients for PAC services. The findings indicate that the PAC services and related outcomes have been well sustained over the three-year period since the original study. The lessons learned from the long-term experience of Hospital Carrión show that with minimal resource investment and strong political leadership this model of sustainable, high-quality care has the potential for broad application in countries throughout the region

Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh

Abstract Unsafe abortion is a significant contributor to worldwide maternal mortality; however, abortion law and policy liberalization could lead to drops in unsafe abortion and related deaths. This review provides an analysis of changes in abortion mortality in three countries where significant policy reform and related service delivery occurred. Drawing on peer-reviewed literature, population data and grey literature on programs and policies, this paper demonstrates the policy and program changes that led to declines in abortion-related mortality in Romania, South Africa and Bangladesh. In all three countries, abortion policy liberalization was followed by implementation of safe abortion services and other reproductive health interventions. South Africa and Bangladesh trained mid-level providers to offer safe abortion and menstrual regulation services, respectively, Romania improved contraceptive policies and services, and Bangladesh made advances in emergency obstetric care and family planning. The findings point to the importance of multi-faceted and complementary reproductive health reforms in successful implementation of abortion policy reform.</p