据估计,发展中国家每年有5000万例人工流产,估计有700万妇女因与不安全堕胎有关的并发症而接受治疗。根据2012年的估计,每1000名15-49岁的妇女在私营和公共部门寻求与堕胎有关的健康并发症的治疗。巴基斯坦对计划生育的需求没有得到满足,产后采用避孕方法的妇女比例很低,导致意外怀孕成为不安全堕胎的原因之一。堕胎后护理(PAC)是一种综合服务提供模式,包括孕产妇保健和计划生育干预措施。该研究旨在通过在人口最多的两个省-旁遮普省的各级公共卫生服务提供系统中实施PAC模式,来研究与堕胎相关的做法的改善。信德省,开伯尔·普赫图赫瓦,和巴基斯坦的伊斯兰堡首都地区(ICT)。改进模式包括医疗保健提供者的临床培训,社区参与,和社区妇女关于安全堕胎后做法的咨询。这是一项描述性研究,利用服务提供商从2018年3月至2021年12月在ICT中记录和报告的来自104个选定公共卫生设施的日志中的27,616个PAC客户的数据。旁遮普,信德省,和巴基斯坦的开伯尔-普赫图赫瓦省。接受PAC服务的妇女年龄超过25岁,22,652(82%),平均年龄29岁。这些女性大多数都在孕早期,26,110(95%),大多数被诊断为PAC(不完整,missed,或先兆流产),26838(97%)。大多数女性,25,324(92%),接受了安全的流产后护理方法,包括使用米索前列醇,15,804(58%),和手动真空抽吸,8898(32%)。总的来说,17,105(72%)的妇女选择了包括长效可逆避孕药的避孕方法,2,313(10%);短期不包括避孕套,3,436(27%);和避孕套,8,113(34%)。确定采用堕胎后计划生育方法的关键预测因素表明,25岁以上的妇女,在妊娠中期早期,接受堕胎后计划生育咨询的人比其他人更有可能采用避孕方法。增加获得堕胎后护理和计划生育的机会可能会减少不安全堕胎的发生率,意外怀孕,和相关的孕产妇死亡率。巴基斯坦的经验表明,可以在整个公共卫生系统中有效实施综合堕胎后护理服务提供模式。
An estimated 50 million induced abortions occur in developing countries annually, and an estimated 7 million women are treated for complications associated with unsafe abortions. According to a 2012 estimate, 15 per 1,000 women aged 15-49 years seek treatment for abortion-related health complications in both private and public sectors. A high unmet need for family planning in Pakistan and a low percentage of women adopting a contraceptive method in the post-partum period led to unwanted pregnancy becoming one of the reasons for unsafe abortion. Post-abortion care (PAC) is an integrated service delivery model that includes both maternal health and family planning interventions. The
study aims to examine improvement in abortion-related practices through the implementation of the PAC model at all tiers of public health service delivery systems in the two most populous provinces-Punjab, Sindh, Khyber Pakhtunkhwa, and Islamabad Capital Territory (ICT) region-of Pakistan. The improvement model comprises clinical training of healthcare providers, community engagement, and counseling of community women on safe post-abortion practices. It was a descriptive
study utilizing data of 27,616 PAC clients recorded and reported by the service providers on the logbooks from 104 selected public health facilities from March 2018 to December 2021 in ICT, Punjab, Sindh, and Khyber Pakhtunkhwa provinces of Pakistan. Women who received PAC services were older than 25 years, 22,652 (82%), with a mean age of 29 years. Most of these women were in their first trimester, 26,110 (95%), and the majority diagnosed with PAC (incomplete, missed, or threatened abortion), 26,838 (97%). The majority of women, 25,324 (92%), received safe methods for post-abortion care that included the use of misoprostol, 15,804 (58%), and manual vacuum aspiration, 8,898 (32%). In total, 17,105 (72%) of women opted for a contraceptive method that included long-acting reversible contraceptives, 2,313 (10%); short-term excluding condoms, 3,436 (27%); and condoms, 8,113 (34%). The key predictors identified for uptake of the post-abortion family planning method indicated that women more than 25 years of age, in the early second trimester, and who were counseled on post-abortion family planning were more likely to adopt the contraceptive method than others. Increased access to post-abortion care and family planning could potentially reduce the incidence of unsafe abortion, unintended pregnancies, and associated maternal mortality. The experience of Pakistan suggests that the integrated post-abortion care service delivery model can be effectively implemented across the public health systems.