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Woman-Centered, Comprehensive Abortion Care Reference Manual

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Second Edition Woman-Centered, Comprehensive Abortion Care Reference Manual Disclaimer: The regularly updated Clinical Updates in Reproductive Health (www.ipas.org/clinicalupdates) provides Ipas’s most up-to-date clinical guidance, which supersedes any guidance that may differ in Ipas curricula or other materials. ISBN: 1-882220-87-0 © 2005, 2013 Ipas. Produced in the United States of America. Ipas. (2013). Woman-centered, comprehensive abortion care: Reference manual (second ed.) K. L. Turner & A. Huber (Eds.), Chapel Hill, NC: Ipas. Ipas is a nonprofit organization that works around the world to increase women’s ability to exercise their sexual and reproductive rights, especially the right to safe abortion. We seek to eliminate unsafe abortion and the resulting deaths and injuries and to expand women’s access to comprehensive abortion care, including contraception and related reproductive health information and care. We strive to foster a legal, policy and social environment supportive of women’s rights to make their own sexual and reproductive health decisions freely and safely. Ipas is a registered 501(c)(3) nonprofit organization. All contributions to Ipas are tax deductible to the full extent allowed by law. Cover photo credits: © Richard Lord Illustrations: Stephen C. Edgerton The illustrations and photographs used in this publication are for illustrative purposes only. No similarity to any actual person, living or dead, is intended. For more information or to donate to Ipas: Ipas P.O. Box 9990 Chapel Hill, NC 27515 USA 1-919-967-7052 [email protected] www.ipas.org Printed on recycled paper. Ipas Woman-Centered, Comprehensive Abortion Care: Reference Manual Acknowledgments - Second edition This second edition of Ipas’s Woman-Centered, Comprehensive Abortion Care: Reference Manual was revised by the following Ipas staff and consultants: Katherine L. Turner, USA, editor and lead reviewer Amanda Huber, USA, editor and lead reviewer Jennifer Soliman, USA, revision coordinator Lead revision team: Alice Mark, USA Bill Powell, USA Joan Healy, USA Technical reviewers: Alyson Hyman, USA Anna de Guzman, USA Nadia Shamsuddin, USA Acknowledgments - First edition The first edition of this manual, Woman-Centered Abortion Care: Reference Manual, was written by Alyson G. Hyman and Laura Castleman, based in large part on the 2004 Ipas curriculum Woman-Centered PostabortionCare: Reference Manual by Jeannine Herrick, Katherine Turner, Teresa McInerney and Laura Castleman. Other first edition credits: Joan Healy, lead reviewer Marty Jarrell, publication Karah Fazekas, revision coordinator i Ipas Woman-Centered, Comprehensive Abortion Care: Reference Manual We give special thanks to the colleagues who reviewed the first edition: Jean Ahlborg, EngenderHealth Allison Bingham,PATH Michelle Folsom, PATH Ann Gerhardt, National Abortion Federation Sally Girvin, Ipas consultant Lorelei Goodyear, PATH Jill Molloy, Ipas Marianne Parry, Marie Stopes International We give thanks to Ipas staff and consultants who contributed to the development of the first edition: Traci Baird, USA Sangeeta Batra, India Maria de Bruyn, USA Amy Entwistle, USA Rivka Gordon, USA Leila Hessini, USA Ann Leonard, USA Teresa McInerney, USA Philip Mwalali, Kenya and USA Charlotte Hord Smith, USA Karen Trueman, South Africa Judith Winkler, USA ii Ipas Woman-Centered, Comprehensive Abortion Care: Reference Manual About Ipas Ipas is dedicated to the belief that all women, including young women, have a basic right to reproductive and sexual health care and to make their own reproductive and sexual choices. We work globally to increase access to high-quality reproductive health care and to improve women’s ability to exercise their reproductive rights, especially their right to safe, legal abortion. We concentrate on preventing unsafe abortion, improving treatment of its complications and reducing its consequences. We strive for women’s empowerment by increasing access to services that enhance their reproductive and sexual health. The International Conference on Population and Development (ICPD) and its five-year review (ICPD+5) provided a clear mandate to all signatory governments: make abortion care safe and accessible to women, including young women, in their communities. Ipas is dedicated to scaling up safe abortion services globally and to the full extent of local laws through training, service-delivery improvement, advocacy, linkages between communities and health systems, research and provision of reproductive health technologies. Scaling up is defined as achieving universal access to high-quality, sustainable abortion-care services. • Achieving universal access ensures that wherever a woman seeks help when she has unprotected sex, unwanted sex or an unwanted pregnancy, she will find the accessible care that she needs, whether it be information, referral, or clinical or related services. Universal access to abortion requires that every public and private facility in a country’s health system is trained and equipped and has other measures in place to ensure that abortion-related care is accessible to women, including young women. • Achieving sustainability in abortion-care services requires political leadership, policy development, financial resources and an adequate health-system infrastructure with trained health-care providers. About this manual This reference manual is part of the Woman-Centered, Comprehensive Abortion Care curriculum which includes a trainer’s manual and two reference manuals. There are two reference manuals for different legal, policy and service delivery settings. Woman-Centered, Comprehensive Abortion Care: Reference Manual reflects Ipas’s comprehensive abortion care service delivery model, which encompasses induced abortion as well as treatment for incomplete abortion and complications of unsafely-induced abortion and postabortion contraception. Woman-Centered Postabortion Care: Reference Manual focuses iii Ipas Woman-Centered, Comprehensive Abortion Care: Reference Manual on postabortion care (PAC) only for countries where there are restrictions on addressing induced abortion or where there is a need to strengthen a particular component of PAC, such as postabortion contraception. There are legal indications for abortion in almost all countries in the world. Even in PAC programs, training and interventions should include abortion for legal indications. Those planning to conduct courses should obtain the Woman-Centered, Comprehensive Abortion Care: Trainer’s Manual, which includes trainer instructions, activity materials and competency-based evaluation and other training tools and is written to address the needs of all adult-learning styles. This curriculum is useful for a broad audience, including sexual and reproductive health clinicians, trainers, program managers, health educators, social workers, outreach workers and other health-care workers. The curriculum brings a women’s rights perspective to abortion-care training and service delivery. This manual provides guidance to health-care personnel on improving the quality of care available to women seeking uterine evacuation services. It introduces the Ipas MVA Plus®aspirator and Ipas EasyGrip® cannulae and explains the manual vacuum aspiration (MVA) uterine evacuation procedure in detail. It also explains uterine evacuation methods that use the pills misoprostol and mifepristone (often called medical abortion). All the methods described here offer women safe, effective options for first- trimester uterine evacuation. All the clinical information in this manual was up to date at the time of submission for publication. For updated clinical guidance, please see the Clinical Updates for Reproductive Health series at Ipas’s website, www.ipas.org. The scope of this curriculum is first-trimester uterine evacuation. Although modified vacuum aspiration and medical methods can be used after the first trimester, second-trimester uterine evacuation is not covered in this curriculum. For this information, please search for “second-trimester” on Ipas’s website at: www.ipas.org. This manual is not intended to serve as a self-guided learning tool. It is designed to be used as a participant’s manual during trainer- facilitated courses that include simulated practice and clinical practice with clients under the supervision of an experienced clinical trainer; as a learner’s resource to help refresh and strengthen participants’ skills after completion of a course; and as a reference document for those seeking up-to-date information on comprehensive abortion care. This manual provides in-depth clinical information on uterine evacuation with both MVA and pills. Whenever possible, a choice in uterine-evacuation methods should be made available to women. Information in this manual can be included in clinical protocols for abortion-related services at health-care centers and systems. In addition to clinical information, the modules address broader service delivery and access issues such as women’s sexual and reproductive rights, including the rights of young women, client-provider communication, provider and community iv Ipas Woman-Centered, Comprehensive Abortion Care: Reference Manual partnerships, quality of care, and monitoring to improve services. Ipas’s woman-centered training strategy addresses the clinical and non-clinical aspects of care to ensure overall quality of abortion services. This approach requires learners to follow evidence- based clinical recommendations and also to reflect on values, attitudes and
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