Findings and Lessons Learned From Strengthening the Provision of Voluntary Long-Acting Reversible Contraceptives With Postabortion Care in Guinea

The effects of interventions to integrate long-acting reversible contraception with treatment for incomplete abortion: Results of a 6-year interrupted time series analysis in hospitals in mainland Tanzania and Zanzibar

OBJECTIVE

To evaluate an intervention that aimed at strengthening voluntary access to long-acting reversible contraception (LARC) within postabortion care (PAC) in hospitals in mainland Tanzania and Zanzibar.

METHODS

From 2016 to 2018, we conducted PAC quality improvement interventions, emphasizing family planning (FP) counseling and voluntary access to LARC. Researchers conducted an interrupted time-series analysis of service statistics compiled from 2014 to 2020 using segmented linear mixed effects regression models to assess the interventions' effect on postabortion contraceptive uptake.

RESULTS

The intervention in mainland Tanzania was associated with an immediate 38% increase in postabortion LARC uptake, a trend that declined from late 2016 to mid-2020 to 34%. In Zanzibar, the intervention was associated with a gradual increase in LARC uptake that peaked in late 2018 at 23% and stabilized at approximately 15% by mid-2020. Whereas the interventions in mainland facilities did not generate significant changes in postabortion FP uptake overall, the launch of interventions in Zanzibar in mid-2016 was associated with a precipitous rise in that outcome over time, which plateaued at approximately 54% by 2019.

CONCLUSION

Increased voluntary uptake of postabortion contraception was associated with the introduction of training in PAC, including FP, and quality improvement interventions and gains were sustained over time.

Strengthening Social and Behavior Change in Postabortion Care: A Call to Action for Health Professionals

Social and behavior change approaches have shown promise for addressing the demand- and supply-side challenges in postabortion care. As implementers seek to improve the quality of postabortion care, systematically integrating long-standing models and emerging approaches, including behavioral economics, human-centered design, and attribute-based models of behavior change, can promote positive health outcomes.

Postabortion Care and the Voluntary Family Planning Component: Expanding Contraceptive Choices and Service Options

Universal access to voluntary postabortion family planning is a critical and compelling component of postabortion care. Such access should be joined with postpartum family planning services in national programs, health information systems, and training programs. The same providers and facilities deliver both services, and integration could yield cost efficiencies and increased coverage for women receiving postabortion care.