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Post-Abortion Care: A Review of the Literature with Implications for Nursing and Midwifery Practice
Submitted by: CFC State Contact Janet Singer, CNM
Inadequate post-abortion care (PAC) and complications of unsafe abortion are major contributors to global maternal mortality.1 Ninety-five percent of the twenty million unsafe abortions per year occurring around the globe are conducted in developing countries. The complications from these procedures lead to 80,000 maternal deaths per year, and account for 13% of the global maternal mortality. Post-abortion morbidity affects hundreds of thousands of women each year, and PAC is an essential aspect of life-saving care for women in the developing world. Recommendations from the 1994 United Nations International Conference on Population and Development included the provision of safe PAC. In response to this, the International Confederation of Midwives published a policy statement in 1996 affirming commitment to safe PAC.2
The developed world experienced a dramatic decrease in maternal mortality during the 20th century, and the increased availability of safe abortion and post-abortion services was an important factor in this achievement. For example, the Centers for Disease Control and Prevention in the United States has attributed 89% of the decline in maternal mortality in the third quarter of the twentieth century to the increased availability of safe abortion services.3 However, variations in the legal regulation and availability of abortion services affect women and girls in many countries. In some countries in which abortion is illegal, women routinely travel out of the country in order to obtain needed services. In countries where abortion is legal it may not be available in all regions and women may need to travel a great distance.4 In many cases, women lack continuity to PAC when they return home, and this contributes to decreased use of contraceptive services and repeat unintended pregnancies.
In this presentation, the international literature on PAC will be reviewed. The question of nursing and midwifery's role in PAC will be discussed with reference to the situations in the Ireland and the United States.
- Thonneau, PF. Maternal mortality and unsafe abortion: a heavy burden for developing countries. Safe motherhood strategies: a review of the evidence. Studies in Health Services Organization & Policy 2001; 17: 151-174.
- International Confederation of Midwives. Care of women post-abortion. 2002. http://www.internationalmidwives.org/Statements/Care of women post abortion.pdf
- Centers for Disease Control and Prevention. Healthier mothers and babies - 1900-1999. October 1999. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm
- Finer LB, Henshaw S. Abortion incidence and services in the United States in 2000. Perspectives on Sexual and Reproductive Health 2003; 35: 6-13. http://www.guttmacher.org/pubs/journals/3500603.html