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WHO RHT MSM 96.25.Pdf TABLE OF CONTENTS ACKNOWLEDGEMENTS........................................................................................................1 ORGANIZATION OF THIS DOCUMENT ................................................................................2 Introduction ............................................................................................................................3 1.1 Purpose of this document.................................................................................3 1.2 Background ......................................................................................................4 1.3 Three key steps in the research process ........................................................7 Assessing the local context of unsafe abortion ................................................9 Designing and testing service-delivery and community interventions using the local context as a foundation ..............................................................10 Linking the research findings to policy and practice ......................................11 1.4 Commonly overlooked issues related to unsafe abortion...............................12 1.5 Ethical concerns.............................................................................................12 Privacy and confidentiality..............................................................................12 Informed consent............................................................................................13 Conducting Research..........................................................................................................16 2.1 Introduction.....................................................................................................16 2.2 Developing the research question..................................................................18 2.3 Study designs.................................................................................................20 Choosing a study population ..........................................................................22 Time-frame .....................................................................................................23 Sampling techniques ......................................................................................23 Interviewer training .........................................................................................25 2.4 Data collection................................................................................................25 Hospital record review....................................................................................25 Individual interviews .......................................................................................26 Group interviews ............................................................................................28 Observation ....................................................................................................29 Pretesting and modifying data collection instruments ....................................29 2.5 Data management..........................................................................................30 2.6 Data analysis..................................................................................................31 2.7 Data dissemination.........................................................................................31 Summing up C linking research results to policy and practice .......................31 Hospital/Health Facility Studies on Unsafe Abortion .......................................................33 3.1 Introduction.....................................................................................................33 3.2 Hospital-based research ................................................................................34 Clinical studies ...............................................................................................34 Managing the treatment of abortion complications.............................34 Diagnostic studies ..........................................................................................35 Documentation and assessment of services ......................................35 Monitoring service statistics................................................................35 Patient and provider interviews...........................................................36 Cost assessment and comparison of treating abortion complications37 Hospital intervention studies ..........................................................................41 3.3 Hospital studies on unsafe abortion: ..............................................................42 Community Studies on Unsafe Abortion...........................................................................48 4.1 Introduction.....................................................................................................48 4.2 Indicators of performance...............................................................................50 4.3 Community research......................................................................................51 4.4 Examples of Community Research Studies ...................................................53 GLOSSARY...........................................................................................................................59 Annex 1 .................................................................................................................................64 Abortion Care: Actions by level of the health care system....................................................64 Annex 2 .................................................................................................................................65 WHO Classification of Abortion..............................................................................................65 Annex 3 .................................................................................................................................67 Developing indicators of performance within communities and for health services...............67 Annex 4 .................................................................................................................................70 Examples of questions related to unsafe abortions ...............................................................70 BIBLIOGRAPHY ...................................................................................................................94 ACKNOWLEDGEMENTS This document was compiled and edited by IPAS in Carrboro North Carolina, USA under contract from the World Health Organization, with primary writing and editing by Brooke R. Johnson, Robert E. Gringle, and Traci L. Baird. Judith Winkler, Janie Benson, and Deborah Billings provided expert editorial review and subject matter suggestions. Additional support within IPAS was provided by Forrest Greenslade, Ann Leonard, Ann Gerhardt, Colleen Bridger, and Joan Healy. Graphic design of text figures are the work of Beth L. Rimmer, and Veronica Williams assisted with bibliographic research. The following select group of international health professionals provided invaluable review, revision, and content input: Francine Coeytaux, Henry David, Tomas Frejka, Mihai Horga, Michael Mbizvo, and Kajsa Sunström. The ground-breaking work of Irene Figà-Talamanca on conducting studies on unsafe abortion served as an inspiration and model for this work. 1 ORGANIZATION OF THIS DOCUMENT Chapter 1 of this document provides the reader with an introduction to the steps needed to conduct research on unsafe abortion. Chapter 2 provides information about data collection, management, and analysis, including a description of the basic research tools necessary to conduct research. Chapters 3 and 4 provide literature sources, examples, and various suggestions for conducting local-level, hospital, and community studies on the problem of unsafe abortion. A glossary provides detailed definitions of all words and terms highlighted in bold print in the text. In the annexes readers will find: a list of essential interventions to prevent and manage abortion at different levels of the health care system(Annex 1); the WHO criteria for categorizing induced abortion (Annex 2); issues to consider when developing indicators of performance for health services (Annex 3); and a list of questions that might be asked of patients (Annex 4). Each chapter is referenced with suggested readings that can provide researchers with more detailed information about past studies and more technical aspects of data collection, management and analysis. A complete bibliography concludes the document. 2 Chapter 1 Introduction 1.1 Purpose of this document As part of an effort to provide responsive and comprehensive reproductive health services, an important question must be asked: Is there a problem of unsafe abortion1? If there is, policy-makers, programme managers, and health-care professionals have an obligation to follow up with the question: What can be done to address this problem? Providing answers can lead to initiatives that reduce the incidence of unsafe abortion, while improving women's overall health, and promoting safe motherhood. In many countries, whether or not to provide legal, induced abortion on request or for specified indications is a contentious issue. Countries with legal restrictions or limited access to safe reproductive health services must look beyond the cultural and/or religious debate associated with induced abortion to the
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