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Woman-Centered Postabortion Care Reference Manual

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Woman-Centered Postabortion Care Reference Manual Second Edition Woman-Centered Postabortion 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: 1-882220-41-2 © 2004, 2013 Ipas. Produced in the United States of America. Ipas. (2013). Woman-centered, comprehensive postabortion 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 Postabortion Care: Reference Manual Acknowledgments - Second edition This second edition of Ipas’s Woman-Centered Postabortion 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 Postabortion Care: Reference Manual, was written by Jeannine Herrick, Katherine Turner, Teresa McInerney and Laura Castleman. Other first edition credits: Joan Healy, lead reviewer Marian Abernathy, reviewer Nina Frankel, reviewer Christina Wegs, reviewer Irina Yacobson, Contraceptive Services module reviewer Susheela Engelbrecht, technical reviewer on female genital cutting Gabrielle Ross, technical reviewer on medical abortion i Ipas Woman-Centered Postabortion Care: Reference Manual We give special thanks to the colleagues who reviewed the first edition: Lorelei Goodyear, PATH Kristina Graff, EngenderHealth Gwyn Hainsworth, Pathfinder Edgar Kessler, CIESAR Ron Magarick, JHPIEGO Yvonne Sidhom, formerly of IntraHealth International Marcel Vekemans, formerly of IntraHealth International We give thanks to Ipas staff and consultants who contributed to the development of the first edition: Nadine Burton, USA Singatsho Ndhlovu, Zimbabwe Sangeeta Batra, India Monica Oguttu, Kenya Maria de Bruyn, USA Sarah Onyango, Kenya Barbara Crane, USA Jose David Ortiz Mariscal, Mexico Ramatu Daroda, USA Orero Solomon Otieno, Kenya Eliana Del Pozo, Bolivia Evelise Pochmann da Silva, Alyson Hyman, USA Brazil Kirti Iyengar, India Lucia Rayas, Mexico Sharad Iyengar, India Andrea Saldaña Rivera, Mexico Sangeeta Kaul, India Oladapo Shittu, Nigeria Aimee Lehman, USA Doree Trottier, USA Ann Leonard, USA Judith Winkler, USA Cari Merlos-Boran, USA Mary Mukaddas, Nigeria Philip Mwalali, Kenya and USA ii Ipas Woman-Centered Postabortion 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: unsafe abortion is a public-health concern, timely life-saving treatment should be provided to women, contraception should be made available to prevent unwanted pregnancy, and safe abortion should be available in instances in which abortion is permitted by law. Ipas is dedicated to scaling up safe abortion and postabortion care 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-related 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-related services 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-related services requires political leadership, policy development, financial resources and an adequate health-system infrastructure with trained health-care providers. About this manual The primary purpose of this manual is to prepare health-care workers to provide women with high-quality postabortion care (PAC) services. Woman-Centered Postabortion Care: Reference Manual may be used for countries where there are no legal indications for induced abortion, where there are significant restrictions on induced abortion, or where there is a need to strengthen a particular component of PAC, such as postabortion iii Ipas Woman-Centered Postabortion Care: Reference Manual contraception. Those planning to conduct PAC training 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 for abortion-related care 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- related training and service delivery. In almost all countries of the world, there is a legal indication for abortion to save the life of the woman. Even in PAC programs, training and interventions should include abortion for all legal indications in the setting. This manual provides guidance to health-care personnel on improving the quality of care available to women needing 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 the uterine evacuation method that uses the pill misoprostol for treatment of incomplete 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 for postabortion care 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-fa- cilitated courses that include simulated practice and clinical prac- tice with clients under the supervision of an experienced clinical trainer; as a learner’s resource to help refresh and strengthen partic- ipants’ skills after completion of a course; and as a reference docu- ment for those seeking up-to-date information on postabortion 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 wom- en. Information in this manual can be included in clinical pro- tocols for postabortion care 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 sexu- al and reproductive rights, including the rights of young women, client-provider communication, provider and community partner- ships, quality of care, and monitoring to improve services. iv Ipas Woman-Centered Postabortion Care:
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