abortion vs. post-abortion care in africa: challenges and opportunities
DESCRIPTION
Dr. Solomon Orero, Consulting Obstetrician/Gynecologist Nairobi, Kenya May 8, 2008TRANSCRIPT
CPAC IN KENYA WHERE WE ARE
By Dr Solomon Orero
(MD,MMED,IMH)
The Origin of PAC
The history of legalization of abortion care From the 1950s This is not visible in the African Continent
and Latin America
Arguments for legalization
Maternal mortality and morbidity The public Health Platform and resources The Sexual reproductive Health and Rights
Platform
The Landmark Decisions in Abortion Care
The USA 1973 Judicial ruling-How it has since affected the rest of the world
The 1984 Mexico policy and its impact-The “Gag Rule”
The 1994 Landmark ICPD The Mexico City Liberalization of abortion
Law-GIRE
PAC
The term PAC first articulated in 1991 The Historical origins of PAC The logic of inclusion of PAFP The logic for the inclusion of referrals and
linkages with other RH services
In 1993-The PAC consortium
AVSC now Engender health IPPF IPAS Pathfinder International JHPIEGO
The Original PAC model 1994
Emergency Treatment-Evacuation of the uterus
Post Abortion Family Planning counseling and services
Referrals and Linkages with other RH services
ICPD 1994 and Land mark para 8.25
“All governments and organizations to strengthen their commitment to women’s health" and “deal with the health impact of unsafe abortion”
Expansion of the programmes and access issues
Decentralization of:– The provider skill-– The health facility– Involvement of the informal providers and the
community
ConsultantsReferralhospitals
General PractitionersFirst level referral hospitals
Sub-district hospitals
Mid level providersAll hospitals
Health CentersDispensaries
Informal providers( TBAs, Health workers, community based health workers)
Found in the communities
The reviewed PAC concept
Community and service provider partnership Counseling Emergency treatment Family Planning and Contraceptive Services Referrals and Linkages to RH and other
services
Community and service provider partnership
1. Community and service provider partnerships for prevention (of unwanted pregnancies and unsafe abortion), mobilization of resources (to help women receive appropriate and timely care for complications from abortion), and ensuring that health services reflects and meet community expectations and needs
Community and service provider partnershipCont’d
2. Counseling to identify and respond to women’s emotional and physical health needs and other concerns.
3. Treatment of incomplete and unsafe abortions and complications that are life threatening.
Community and service provider partnershipCont’d
4. Contraceptive and family planning services to help women prevent unwanted pregnancy or practice birth spacing: and
5. Linkages with other reproductive health services that are preferably provided on- site or via referral to other accessible facilities in the providers network.
Community and provider partnerships
The partnership includes education:1. To increase FP use, prevention of unwanted
pregnancies
2. Risks and consequences of unsafe abortions
3. Promotion of client oriented health rights based on sexual and RH services
4. Signs and symptoms of obstetric emergencies
Community and provider partnerships cont..
5. In what sexual and RH services are provided
6. Mobilization of community resources to ensure that women with obstetric emergencies (including PAC) receive timely and appropriate care
7. Planning and sustaining PAC and other RH services (HIV/AIDS, FGM, gender violence etc)
Counseling
1. To find and affirm the women’s feelings
2. Ensure that women receive appropriate answers to their questions or provided with adequate information on their condition and treatment.
3. Help women clarify their thoughts about pregnancy, PAC, return of ovulation and RH future
4. Address other concerns that women may have
Treatment
Provision of emergency treatment by evacuation of the uterine contents through:
1. Manual Vacuum Aspiration (MVA) or
2. Sharp Curettage (SC) or
3. Electric Vacuum Aspiration (EVA) or
4. Use of chemicals e.g Misoprostol.
Contraceptive and FP services
Access to a wide range of contraceptive methods to women who desire to delay or avoid pregnancy so as to avoid unwanted pregnancies.
What is going on in the recent past and now?
Community Based Abortion Care Creation of community partnerships High profile newspaper reported cases
regarding unsafe abortion ,Street dumped fetuses
What is new in Kenya?
The challenges of providing all the PAC components:– PAFP -counseling and services– Continuous decentralization of MVA/PAC services– Obs/Gyn,MOs,MLPs,Informal Providers– Training,MVA kit new to MVA Plus– The Environment is getting more hostile
40th Anniversary of FP
On May 13th,2008 will be the 40th anniversary of FP as a recognized Human rights issue
“On that day, there will be many couples who will have an unmet need for FP”For many reasons they will not access Family planning methods
One reason in Kenya :there has been no major investment in FP the last almost 2 decades
On Investment in Health
Investment at the community level in creating awareness and seeking to improve health seeking behaviour
Investment in the institutional level in getting the infrastructure up and running with the right mix of skills
On Investment in Health
Investment in health systems development and use of RH abortion included as a fulcrum for change
Investment in policy and strategy development for Health and therefore RH and undertake advocacy for stronger legislation and better services integration
CPAC
EQUITY FOR WOMEN
PRIMARY HEALTH CARE
Basic Maternity Care
PILLARS OF SAFE
MOTHERHOODF
amil
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Ess
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Safe Delivery
ANC
MAP OF KENYA & KMET PROJECT AREAS
The Map of Kenya and some facts
Kenya: Country Background
•Population: 33 million
•GDP: Kshs. 920 b (US $ 12.5 b)
•Per capitalincome: US$ 380
A map of Kenya showing the PEV hot spots what it will mean in PAC
KMET PROGRAMS
SAFEMOTHERHOOD
INITIATIVE
KMET PROGRAMS
POST ABORTION CARE
HOME BASEDCARE FOR
PLWHA
NUTR’N AS A COMPONENT
OF HBCSAGAM COMMHOSPITAL
CLINICAL SERVICES
MICRO-FIANANCE
YOUTH FRIENDLY SERVICES
INT’L STUDENTS/
VOLUNTEERS
The allocation of health budget-Kenya
Reproductive health services cover a meager 0.6% of the health budget.
Households are the greatest source of expenditure on health they spend from their pockets.
The households expenditure on RH is minimal
Transportation of a patient with impending uterine rupture and choriamnionitis worse for abortion patients.