Sustainability of Postabortion Care in Peru

The opinions expressed herein are those of the authors and do not necessarily reflect the view of USAID. SUMMARY Complications of unsafely-performed abortions remain an important contributor to maternal mortality in Peru. Emergency treatment of abortion complications has long been provided by facilities of the national Ministry of Health (MINSA). However, quality of care is poor and services are usually confined to hospitals, limiting access by women residing in remote areas of the country. From 1996-98, MINSA, Ipas and the Population Council conducted a study at Hospital Nacional Daniel Alcides Carrión, a tertiary-level hospital located in metropolitan Lima. The study assessed the effectiveness of a postabortion care (PAC) training and service delivery intervention comprised of the following components: Initial and refresher training of hospital staff involved in PAC service delivery; Improvements in clinical care, including a switch from sharp curettage (SC) to manual vacuum aspiration (MVA) for treatment of incomplete abortion; Provision of postabortion contraceptive information and delivery of methods; Provision of medical care information to patients; and Reorganization of PAC services from an inpatient procedure, requiring hospitalization, to an outpatient service provided in the obstetrics-gynecology emergency room. The study described in this report is a follow-up to the original research conducted at Hospital Carrión in 1996-98. The goal of the present study, carried out from 2000-02, was to determine the sustainability of the PAC intervention introduced in the hospital and the extent to which the outcomes of the intervention have continued. Hospital Carrión has provided PAC services without external technical or financial assistance for postabortion care since the conclusion of the original study. The present study is the first known research to examine how well a PAC intervention and resulting improvements have been maintained over the long term. The objectives of the study were to assess changes over time in the following outcomes: the use of MVA 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. An additional research objective was to describe the organizational and environmental contexts that influenced changes in the PAC outcomes. The original study utilized a pre-post intervention design with no control group. Pre-intervention data (stage 1) were collected in 1996 for the outcomes listed above. Following implementation of the PAC intervention, …