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PAC in action

VIEWS: 19 PAGES: 12

									                                  PAC         …in action                                                Issue 8, November 2005



                                              Youth-Friendly PAC: Meeting the Needs of Young
                                              PAC Clients
                                              Gwyn Hainsworth, Pathfinder International, in collaboration with the Youth-
                                              Friendly PAC Working Group
Guest Editor:                                 Adolescents1 currently account for           abortion and its complications, and
  Tonya Nyagiro,
  Director, YouthNet/FHI                      20% of the world's population.               that organizations needed more
Editor:                                       Approximately 87% of young people            information, the Youth-Friendly
  Diane Bushley                               live in developing countries, where          Postabortion Care (YF PAC) Working
Copyeditor:
  Jacqueline Dowdell                          abortion is usually legally restricted.      Group was established in 2003 with
Graphic Design:                               Young people often are more vulnerable       representation from Pathfinder
  Leslie Byrd                                 to unwanted pregnancy and unsafe             International, YouthNet/FHI, the
Current PAC Consortium Chair:
  IntraHealth International, Inc.,            abortion due to their psychosocial           CATALYST Consortium, IntraHealth
  www.intrahealth.org                         development, power imbalances vis-à-         International, Ipas, JHPIEGO, the
Communications Task Force                     vis adults, poverty, sexual abuse and        Population Council, COBAC (the
Co-Chairs:
  David Nelson, IntraHealth International     coercion, as well as traditional/cultural    Community-based Abortion Care pro-
  Laura Raney, Population Council             values that prevent access to sexual         gram in Kenya5) and the International
                                              and reproductive health (SRH) informa-       Planned Parenthood Federation (IPPF).
                                              tion and services. This is illustrated by    To respond to this need, the Working
                                              the fact that less than 5% of the poorest    Group has developed a resource list
                                              young people use modern contraceptive        and Frequently Asked Questions (FAQ)
                                              methods and that one-third of women          on adolescents and PAC, both available
                                              in developing countries give birth           on the PAC Consortium website
                                              before the age of 20.2                       (www.pac-consortium.org).
                                              Due to the sensitivities surrounding         Additionally, participants at Working
                                              abortion, it is difficult to calculate the   Group meetings identified the need for
                                              exact incidence among young women.           technical guidance on YF PAC. Through
                                              However, it is estimated that between        a collaborative effort, Working Group
                                              2 - 4.4 million abortions occur among        members have developed and are in
postabortion care
                                              adolescent women in developing coun-         the process of finalizing this technical
PAC
consortium
                                              tries each year.3 Young women are
                                              more apt to delay seeking an abortion
                                                                                           guidance, which is based on the
                                                                                           Essential Elements of PAC and high-
PAC in Action is a publication of the         (which increases their risk of complica-     lights how to apply YF principles to
Postabortion Care Consortium, and is          tions), often resort to inexpensive          each element. The guidance also
produced by IntraHealth International, Inc.
For comments, questions or suggestions
                                              providers and unsafe procedures and          includes a section on monitoring and
about the newsletter, please contact:         frequently delay seeking care for abor-      evaluation of YF PAC services.
IntraHealth International                     tion-related complications once they
6340 Quadrangle Drive, Suite 200                                                           On May 31, 2005, during the PAC
Chapel Hill, NC 27517
                                              occur. As a result, adolescents have
                                                                                           Consortium Meeting at the Global
T: 919-313-9100                               the highest risk of suffering serious
E: info@pac-consortium.org                                                                 Health Council Conference, the
                                              complications from unsafe abortion.
                                                                                           Working Group presented a draft
Editorial Review Board:
                                              For example, in Nigeria, the Society of
                                                                                           outline of the technical guidance
  Jessica A. Cohen, PATH                      Gynaecologists and Obstetricians esti-
  Maureen Corbett, IntraHealth
                                                                                           and sought input from Consortium
                                              mates that about 50% (10,000) of the
     International                                                                         members. The following sections
                                              Nigerian women who die from unsafe
  Gwyn Hainsworth, Pathfinder                                                              summarize the technical guidance
     International                            abortion each year are adolescents.
  Ron Magarick, JHPIEGO
                                                                                           and related discussion:
                                              These abortion complications are
  Joseph Ruminjo, EngenderHealth
  Kirsten Sherk, Ipas
                                              responsible for 72% of all deaths            Community and Service Provider
  Elizabeth Westley, Family Care              among women under 19 years of age.4          Partnerships
     International
                                              Recognizing that young women are             • There is a need to approach
Please visit our website:                     disproportionately affected by unsafe          community-service provider partner-
www.pac-consortium.org
A Note from the                                                     ships within the context of broader        which information should be provided
                                                                    health issues (e.g., safe mother-          and how to effectively communicate
Guest Editor:                                                       hood, youth SRH).                          the information.
Youth-friendly postabortion care (YF
PAC) is often overlooked, despite                                 • Through traditional, community and       • Privacy and confidentiality are
the fact that 1.5 billion young people                              religious leaders, programs should         absolutely essential to YF PAC,
comprise one third of the total popu-                               mobilize communities around youth          particularly during counseling.
lation of developing countries. Young                               SRH and prevention of unwanted
                                                                    pregnancy and unsafe abortion.           • Providers should exhibit a non-
women between the ages of 10 and                                                                               judgmental and supportive attitude
24 are at the highest risk of death                               • Involving all community stakeholders       so that youth clients feel free to
from unsafe abortion and abortion                                   (youth, parents, men and women)            discuss SRH issues.
complications,1 and adolescents                                     can increase community dialogue
undergo a major proportion of illegal                               on sensitive issues and create an        • Providers need adequate training on
abortions. Stigma, shame and the                                    enabling environment.                      YF PAC. This includes explaining the
disapproval of providers and adults                                                                            procedure, discussing pregnancy
can be intense and may discourage                                 • Youth involvement and strong youth-        intentions and informing clients
adolescents from seeking timely                                     adult partnerships are essential to        about their return to fertility and FP
PAC services. At the service delivery                               both prevention and community-             methods.
point, negative or judgmental provider                              service provider partnerships. As
                                                                    youth-adult partnership is a new         • Youth clients often need more time
attitudes, insufficient training and
                                                                    concept in many places, there is a         than adult clients to feel comfortable
lack of comprehensive counseling
                                                                    need to build both youth and adult         and ask questions. They frequently
are significant barriers to addressing
                                                                    capacity and skills in working             will not discuss their real problem
the reproductive health (RH) needs
                                                                    together.                                  or issue at the beginning of the
of young people who seek PAC
                                                                                                               counseling session. Therefore,
services.
                                                                  • Advocacy is essential to community         providers must allocate more time,
This issue of PAC in Action focuses                                 PAC interventions for youth. Advocacy      be patient and ask open-ended
on the efforts of PAC Consortium-                                   should include discussion around           questions to encourage conversation.
participating agencies to address                                   issues of informed consent for
                                                                    youth to access PAC services.            • Young people often are less
the PAC needs of youth. The intro-
                                                                                                               informed than adult clients and
ductory article presents the impor-
                                                                  • The involvement of existing youth          rely on information from their peers;
tance of YF PAC services and the
                                                                    groups and organizations that serve        incorrect information and rumors
work of the Consortium's Youth-
                                                                    youth is vital to the success of           need to be addressed during the
Friendly PAC Working Group to
                                                                    community-service provider partner-        counseling session.
define those services. Through a
                                                                    ships.
collaborative effort, Working Group                                                                          • Providers should maximize the
members have developed and are in                                 • It is necessary to establish linkages      opportunity of the PAC visit and
the process of finalizing technical                                 with community-based providers/            address multiple SRH needs.
guidance—based on the Essential                                     programs (e.g., peer educators,            Counseling should include informa-
Elements of PAC model—that high-                                    community-based distribution               tion on: (1) any medication or drugs
lights how to apply YF principles to                                agents, non-traditional condom             provided during PAC services; (2)
each element.                                                       distributors) to prevent unwanted          potential complications after PAC
                                                                    pregnancy and create referral linkages     and when to return to the facility;
Following this, five youth-focused
                                                                    for facility-based PAC services.           (3) contraception; (4) sexually trans-
PAC research and intervention
                                                                                                               mitted infection (STI)/HIV prevention;
activities are presented. These                                   • Reaching out-of-school and especially
                                                                                                               (5) RH decision-making; and (6)
activities represent the YF PAC                                     vulnerable youth and involving them
                                                                                                               condom negotiation.
efforts of Consortium-participating                                 in these types of partnerships is
agencies, including EngenderHealth,                                 difficult. Strategies need to be         • Some adolescents may not even
Family Health International (FHI),                                  developed for reaching various             know what causes pregnancy or that
Pathfinder International and Ipas.                                  types of youth in sometimes                there are ways to prevent pregnancy.
Together, they serve to expand the                                  challenging settings.                      There may be a need to provide
evidence base and provide useful                                                                               more extensive SRH information
insights for further work in this area.                           Counseling                                   during a counseling session for a
                                                                  • Youth are not a homogenous group.          youth client.
Tonya Nyagiro, Director,
                                                                    Differences such as age, develop-
YouthNet/FHI                                                                                                 • PAC services should include screening
                                                                    mental stage, educational/literacy
                                                                    level and marital status all influence     for sexual abuse and gender-based
1
    United Nations Population Fund (UNFPA). 2004. “Investing in
                                                                    the counseling session, and should         violence (GBV) as well as STIs/HIV.
    Youth.” New York: UNFPA.
                                                                    be considered when determining             Providers need to be trained to

2       PAC in Action
                          screen for these issues, and should        and emotional support from the               communication (IEC) materials
                          do so in a sensitive manner.               family can lead to increased anxiety         can reinforce FP messages.
                                                                     and pain. “Verbal anesthesia,” or
                        • Additional counseling or support           extra support to the youth client          • Where emergency contraceptive
                          can be provided through peer               during the procedure, and attention          pills (ECP) are available, include
                          education and peer counseling              to pain management are essential             information about ECP in case of
                          programs. Strong and consistent            for YF PAC.                                  contraceptive method failure. ECP
                          referral linkages need to be                                                            may also be provided to clients in
                          established between facility and         • Technical issues for youth clients           advance, “just in case,” to increase
                          community-based programs.                  include using a smaller speculum             accessibility.
                                                                     during both the pelvic exam and the
                        Treatment of Complications                   procedure, and using misoprostol to        • If possible, involve male partners
                        • Providers need specialized training        facilitate cervical dilation.                in FP counseling.
                          to provide YF PAC services.                                                           Reproductive and Other Health
                                                                   Contraceptive and Family Planning (FP)
                        • If youth are aware that they will                                                     Services
                                                                   Services
                          receive discreet, timely PAC services,                                                • Ideally reproductive and other health
                                                                   • Youth clients' reproductive intentions
                          they may be more likely to seek                                                         services should be provided at the
                                                                     should be discussed and clarified at
                          those services. Where feasible, a                                                       same facility where PAC services
                                                                     the outset.
                          separate waiting room for youth                                                         are offered to facilitate access for
                          clients can provide a sense of privacy   • If family planning is desired, it is         youth. This could be a range of SRH
                          and alleviate fears of being seen by       important that providers know that           services provided by the PAC
                          adult community members.                   age is not a contraindication for any        provider, or via another provider
                                                                     FP method. Youth clients should be           in the same facility.
                        • The procedure and what to expect           offered a broad range of methods.
                          should be explained to the youth                                                      • When possible, providers should
                          client (as for all PAC clients).         • Dual protection—prevention from              refer clients to YF services (either
                                                                     both pregnancy and STIs/HIV                  at a facility or in the community).
                        • Youth clients should be encouraged         through the use of condoms—                  Providers of PAC services need to
                          to have a friend or relative accom-        should always be stressed when               be aware of YF services or youth
                          pany them for support. In many             discussing FP options, especially in         programs/organizations for
                          cases, this is their first experience      high HIV/AIDS prevalence settings.           appropriate referral.
                          at a RH facility.
                                                                   • Condom use should be demonstrated;         • If a youth hotline exists, provide the
                        • Adolescents often wait longer              after viewing the demonstration,             phone number to youth clients.
                          before seeking an abortion. This           youth clients should be asked to
                          has implications for the severity of                                                  • Reproductive or other health services
                                                                     demonstrate.                                 to be offered at the same facility or
                          complications and can influence the
                          type of provider that can provide        • Young people may need extra help             via referral to a YF facility include:
                          treatment as well as the type of           learning to use their method (e.g.,          STI treatment; sexuality education;
                          technology that can be used—i.e.,          linking daily activity to taking a pill)     HIV/AIDS counseling; voluntary
                                                                                                                  counseling and testing (VCT) for
                          manual vacuum aspiration (MVA) or          and may have different concerns
                                                                                                                  HIV; counseling/support for GBV
                          dilation and curettage (D&C).6             than adult clients (e.g., weight gain,
                                                                                                                  and sexual coercion; treatment,
                                                                     acne).
                        • Clinical procedures for MVA or D&C                                                      care and support for HIV positive
                          are often the same as for an adult       • Visual aids and youth-focused                youth; and legal, emotional and
                          client. However, lack of knowledge         information, education and                   financial support for orphans and
                                                                                                                  vulnerable children and youth.
                                                                                                                It is anticipated that this technical
                                                                                                                guidance on YF PAC will be used by
                                                                                                                program managers and service
                                                                                                                providers. The final draft will be
                                                                                                                circulated to the PAC Consortium for
                                                                                                                review and comments, and a summary
                                                                                                                will be presented at the upcoming
                                                                                                                APHA Meeting in December 2005.
Photo by Richard Lord




                                                                                                                For more information on the YF PAC
                                                                                                                Working Group, please contact
                                                                                                                Gwyn Hainsworth at
                                                                                                                ghainsworth@pathfind.org.
                        Provider counsels an adolescent client on postabortion complications,
                        with an emphasis on using condoms for dual protection
                                                                                                                                          PAC in Action   3
Youth-Focused PAC Research and Intervention Activities
Presented at the May 5, 2005, PAC Consortium Meeting, Washington, DC

Activity 1                                Based on this study, recommendations       two study sites. EngenderHealth used
Adolescent PAC Clients in the             for programming in these two hospitals     the experiences and lessons learned
Dominican Republic: Their Needs           included the following:                    to design a similar study in Malawi
and Experiences                                                                      (see Activity 2). It also shared the
                                          • Enhance provider training to help        results of its study extensively with
Inés Escandón, EngenderHealth               staff better understand the psycho-
(ACQUIRE Project Partner)                                                            other agencies, including FHI, which
                                            logical complexities of adolescent       has used the findings in its own pro-
In 2002, EngenderHealth undertook           clients and help shift negative          gram (see Activity 3).
a qualitative research project in the       provider attitudes. This will promote
Dominican Republic to learn about the       more humane treatment.                   For more information, please contact
needs of adolescent PAC clients. The                                                 Inés Escandón at
USAID-funded study was carried out        • Create provider guidelines that          iescandon@engenderhealth.org.
in collaboration with the Centro de         outline how to provide PAC services      A summary of findings of this study
Estudios Sociales y Demográficos (the       to adolescents.                          and the Malawi study (see Activity 2) is
Center for Social and Demographic         • Expand interventions beyond              available at http://www.engenderhealth
Studies or CESDEM), a local research        schools to reach higher-risk             .org/res/offc/pac/adolescent/index.
agency. Forty adolescent PAC clients        adolescent clients before they           html.
(aged 13-19) and 21 doctors, nurses,        become pregnant.
residents and social workers at two                                                  Activity 2
EngenderHealth-supported maternity        The study also yielded valuable            Adolescent PAC Clients in Malawi:
hospitals in Santo Domingo were           lessons about conducting research          Their Needs and Experiences
asked about why adolescents seek          with adolescent PAC clients:               Erika Sinclair, EngenderHealth
PAC; barriers encountered in seeking,                                                (ACQUIRE Project Partner)
                                          • Build on prior work and consult
reaching and obtaining care; and                                                     Based on the study conducted by
                                            colleagues who may have greater
adolescents’ informational and                                                       EngenderHealth in 2002 in the
                                            experience working with adolescents.
service needs.                                                                       Dominican Republic (see Activity 1),
                                          • Consider the definition of “adoles-      EngenderHealth conducted a similar
Most of the client respondents (35
                                            cent” carefully, especially within the   study in Malawi in 2003 with support
or 87.5%) had not gone beyond the
                                            cultural context. Use of the minimum     from two anonymous donors. Malawi
eighth grade of school. About 60%
                                            age limits from the studies identified   was chosen because hospital data
were out of school and were also the
                                            in the background literature review      suggested that young women repre-
daughters of adolescent mothers. Half
                                            would have led to the exclusion of a     sented a substantial proportion of
were in union and 15 (37.5%) had at
                                            substantial part of the adolescent       PAC cases, and the study sought to
least one child. Although most reported
                                            PAC population seen at facilities.       determine how hospitals could better
that they were not currently planning
                                            For example, these studies used          meet adolescents' PAC needs.
to have a child, they were also not
                                            age ranges such as 16-20 and 19-
taking any measures to prevent                                                       Qualitative research was conducted at
                                            23. The research team elected a
pregnancy.                                                                           two urban and two rural hospitals in
                                            younger age group (13-19) based on
                                                                                     Malawi (in Lilongwe and Blantyre,
Shortfalls in equipment at the sites or     site data, including logbooks and
                                                                                     Kasungu and Machinga). Semi-struc-
lack of money for PAC services often        resident studies, and felt that this
                                                                                     tured in-depth interviews were con-
forced clients to delay obtaining care.     range was culturally appropriate.
                                                                                     ducted with 42 adolescent clients
As for the care itself, clients cited
                                          • Ensure that researchers are              (aged 13-19) who presented seeking
shortcomings such as inadequate
                                            sufficiently trained and sensitized      treatment for abortion complications.
pain control and counseling and
                                            in PAC and adolescent work.              The median age was 18-19 years.
punitive provider attitudes. Providers
                                                                                     Interviews were also conducted with
noted poor infection prevention and       • Allow plenty of time. Consultations      40 providers and administrators
counseling and the lack of MVA              with other agencies, establishing        (including OB/GYNs, nurses, clinical
equipment, adequate space, medication       ethical processes for studies,           officers and residents).
and analgesics. Most clients spoke          training and sensitization are all
favorably of family planning, although      time consuming but essential.            Seventy-six percent of the clients were
they did not perceive all methods                                                    married, and 33% had at least one
positively. Many also expressed           To foster the application of study         child. Eighty percent had received an
concerns about contraceptive side         results in programming and other           upper primary grade education or
effects.                                  research, EngenderHealth planned var-      less, and the vast majority was not
                                          ious activities, including a large dis-    in school at the time of the study.
                                          semination meeting in Santo Domingo        Approximately 40% reported that their
                                          and action planning sessions at the        pregnancy was planned. The fact that
4   PAC in Action
most pregnancies were planned                The provision of rapid, respectful and    program. CONECTA, the Centro de
suggests that programming should             comprehensive PAC services and infor-     Estudios Sociales y Demográficos
include a focus on improving antenatal       mation is vital to saving and improving   (The Center for Social and
care (in which women are made aware          the lives of adolescents who present      Demographic Studies or CESDEM)
of possible complications), and on           with postabortion complications.          and YouthNet, a global USAID project
providing FP information to ensure           Recommendations based on this qual-       that focuses on youth RH and HIV,
that those who want to get pregnant          itative research include the following:   collaborated on the action research
immediately after the abortion proce-                                                  described below.
dure are aware of the risk of closely-       • Improve linkages and referrals
spaced pregnancies.                            between PAC and other health            In order to achieve its goal of improving
                                               services, particularly in the areas     obstetric care services, CONECTA has
Most clients stated that they had              of family planning and STI/HIV/AIDS     sought to reduce congestion in the
been referred, and several reported            education.                              two largest maternity hospitals in
experiencing a lengthy referral process                                                Santo Domingo, which have provided
from one provider to another before          • Expand PAC services across the          the bulk of obstetric services for many
reaching the hospital where PAC                country, especially to rural health     years. To do this, the project has
services were provided. These clients          centers, which are easier and less      strengthened essential obstetric services
experienced between two and three              expensive for clients to reach than     in smaller local hospitals. Normal
referrals, which sometimes took as             the larger, urban hospitals.            deliveries and minor procedures can
long as four days. Clients whose                                                       now be performed at the smaller
                                             • Enhance provider training to help
pregnancies were planned reported                                                      hospitals, enabling the two large
                                               staff better understand the psycho-
feeling disappointed at the loss of                                                    hospitals to focus on more complicated
                                               logical complexities of adolescent
their pregnancies. Clients who either                                                  cases.
                                               clients and help shift negative
disclosed or were assumed to have
induced an abortion often expressed            provider attitudes.                     Between 1997 and 2003,
guilt and fear of rejection. All expressed   • Design and implement strategies to      EngenderHealth helped establish
sadness and fear of sterility.                 manage clients in a timely fashion      a PAC program at the two large
                                               and avoid delays that may result in     maternities in Santo Domingo. During
Very few clients stated that they were
                                               complications and further impair        the same time period, smaller local
given adequate pain medication and
                                               clients’ health.                        hospitals performed a limited set of
information on pain management;
                                                                                       PAC services, including occasional
some clients received paracetamol            • Develop and disseminate clear           treatment of incomplete abortions.
before the procedure but not during            protocols that address issues           Providers at these hospitals had
the procedure. Few clients reported            ranging from pain management to         received little support for work in PAC:
that they had received information             client-provider communication.          minimal or no training in counseling,
about family planning as part of their
                                             For more information, please contact      unclear job descriptions, irregular
PAC services. Data on the percentage
of clients who received FP methods           Erika Sinclair at                         supply of contraceptives, no job aids
are not available from the hospitals;        esinclair@engenderhealth.org              and no IEC materials for clients. Not
however, administrators reported that        or Lauren Pesso at                        surprisingly, clients' needs were not
clients received pre-procedure FP            lpesso@engenderhealth.org.                being met. CONECTA trained staff in
counseling, “intra-counseling” (coun-                                                  the smaller hospitals to use MVA for
                                             Activity 3                                treatment of postabortion complica-
seling during the procedure) and post-
                                             Improving Counseling for                  tions and in the promotion of human
procedure counseling, in which they
receive assistance in choosing a             Adolescent PAC Patients in the            rights.
method. None of the clients indicated        Dominican Republic
                                                                                       Within the CONECTA program,
that they had received counseling on         Sonia Brito, CONECTA/FHI; Donna
                                                                                       YouthNet has focused on improving
HIV/AIDS or other STIs during their          McCarraher, YouthNet/FHI; and Tita
                                                                                       the counseling component of PAC,
visit, although hospital administrators      Oronoz and Patsy Bailey, FHI
                                                                                       including developing IEC materials
at some sites indicated that all PAC         In late 2002, Family Health               specifically for young women. The
clients were offered family planning         International (FHI) was awarded a         approach aims to improve provider
and STI/HIV/AIDS services.                   bilateral agreement from USAID to         attitudes and practices regarding
                                             improve health services in the            counseling, provision of contraception
Providers noted that no formal guide-
                                             Dominican Republic. CONECTA, as           and referral to STI/HIV services for
lines or written protocols for PAC
                                             the project is known, is a consortium     young women, and to increase
existed at their facilities. Clients often
noted that providers had negative            among FHI, Abt Associates and the         postabortion contraceptive uptake
attitudes when dealing with adolescents      Agencia Latinoamericana de Expertos       among young women who do not wish
who presented with abortion-related          en Planificación H (Latin American        to become pregnant in the near future.
complications; negative provider attitudes   Agency of Experts in H Planning or
                                             ALEPH). The reproductive needs of         This pilot project has been implemented
were also observed by researchers
                                             adolescents are a high priority of the    in four smaller hospitals—three in
during interviews with facility staff.
                                                                                                                 PAC in Action   5
                                                                                       Matine, Independent Consultant in
                                                                                       Mozambique; Julio Pacca, Pathfinder
                                                                                       International-Mozambique; and Gwyn
                                                                                       Hainsworth and Jayne Lyons,
                                                                                       Pathfinder International
                                                                                       In June and July of 2005, Pathfinder
                                                                                       International-Mozambique conducted
                                                                                       qualitative research in Xai Xai City of
                                                                                       Gaza Province in Mozambique with
                                                                                       support from the Hewlett Foundation.
                                                                                       The research explored knowledge,
                                                                                       perceptions and beliefs of both youth
                                                                                       and community members related to
                                                                                       clandestine abortion and PAC. The
                                                                                       study was carried out by Geracao
                                                                                       Biz, an adolescent SRH program
                                                                                       implemented by UNFPA, Pathfinder
                                                                                       and the Ministries of Health,
Tita Oronoz of FHI leading training session in the Dominican Republic
                                                                                       Education and Youth and Sports.
Santo Domingo and a fourth less than         contraceptive methods will encourage
                                                                                       The study methodology included
two hours away. YouthNet conducted           them to have sex, and 57% reported
                                                                                       three stages. First, an assessment of
a baseline survey with providers in          that one or more methods was not
                                                                                       clandestine abortion and PAC was
September and October of 2004; a             appropriate for adolescents.
                                                                                       conducted through interviews with
follow-up survey will be implemented
                                             In addition to serving as baseline val-   health professionals and PAC clients
in early 2006 after the completion of
                                             ues for the evaluation, the information   as well as visits to health facilities
the intervention. Since the provision
                                             gathered was used to design a three-      that offer PAC services. Results of
of contraceptive methods was essen-
                                             day training for providers—primarily      this assessment were used to develop
tially zero at baseline, no baseline
                                             auxiliary nurses—focusing on topics       focus group discussion guides. Second,
survey of clients was conducted.
                                             such as: (1) how provider attitudes       four focus group discussions were
However, a cross-sectional survey
                                             toward older women differ from those      conducted with male and female ado-
of PAC clients will be conducted
                                             toward younger women (sympathy vs.        lescents (aged 15-20) and community
simultaneously with the follow-up
                                             blaming); (2) clinically-accurate symp-   leaders to explore young women’s
provider survey.
                                             toms of STIs (providers mentioned         behavior when faced with unwanted
Nearly all providers with any contact        fever and diarrhea, among other           pregnancy; social values and community
with PAC patients at the four hospitals      incorrect symptoms of STIs); and          reactions toward young women who
were interviewed (n=88). On average,         (3) contraceptive methods appropriate     undergo clandestine abortion; and
they had worked with PAC patients for        for young women (providers were           beliefs about and attitudes toward
seven years. Nonetheless, 79% had            unaware of evidence that method           health services, especially PAC services,
never had any training in PAC. More          choice should not be restrictive).        as well as possible strategies for
than half (56%) of the providers were                                                  improving those services. Third, focus
nurses.                                      The intervention efforts are ongoing.     group data were analyzed within the
                                             In addition to the trainings, materials   context of the culture, social relations
Providers were asked how they                have been developed (a provider           and life events of the participants.
emotionally support adolescent PAC           guide, patient brochure and poster).
patients. Fewer than half said that          A monitoring checklist has also been      Results of the study showed a need
they were supportive—the majority            developed and will be incorporated        to clarify community knowledge and
expressed judgmental attitudes, said         into routine supportive supervision       address harmful beliefs related to
that it was not their job to be supportive   efforts.                                  prevention of unwanted pregnancy and
of PAC clients or that they only provided                                              unsafe abortion, as well as to improve
clinical care.                               For more information, please contact      access to quality PAC services. The
                                             Sonia Brito at sbrito@fhidr.org or        health risks of unsafe abortion need
Twenty-five percent of providers said        Donna McCarraher at                       to be effectively communicated to both
they never asked about pregnancy             dmccarraher@fhi.org.                      young people and adults. Additionally,
intentions nor did they inform clients                                                 the whole community, including influen-
                                             Activity 4
about their return to fertility (and only                                              tial leaders, needs to be involved in
                                             Expanding and Strengthening
15% could accurately inform the inter-                                                 prevention efforts. Negative community
                                             Access to Postabortion Care
viewer about when fertility returns                                                    attitudes toward discussing sex and
                                             Services in Mozambique
postabortion). Sixty percent believed                                                  reproductive health with youth were
that talking to adolescents about            Luc Van der Veken, Pathfinder
                                                                                       found to hinder the promotion of
                                             International-Mozambique; Jorge
6   PAC in Action
healthy and preventive behaviors as                          menting the agreements made at the                           youth and health care providers during
well as access to safe and quality PAC                       International Conference on Population                       the past five years. One publication,
services.                                                    and Development (ICPD), held in 1994,                        co-sponsored by the federal MOH, the
                                                             and the Fourth World Conference on                           Mexican Institute of Social Security
Young people reported that they more                         Women in Beijing in 1995. Among                              (IMSS) and IPPF's Mexican affiliate
often sought services from traditional                       other areas, countries are focusing on                       (MEXFAM), among others, outlines
healers when faced with an unwanted                          the agreements as they pertain to the                        the importance of respecting youth’s
pregnancy because they felt traditional                      needs of adolescents.                                        confidentiality while, at the same
healers were more apt to offer privacy,                                                                                   time, providing them with needed SRH
confidentiality and a welcoming, non-                        Ipas programs, research, policy work                         services. The document, “En México
judgmental attitude—service charac-                          and publications highlight the need to                       sí se puede…ofrecer servicios de
teristics that they valued highly. The                       increase access to comprehensive                             anticoncepción a adolescentes:
judgmental attitudes (real or perceived)                     PAC for adolescents, given the high                          Normatividad nacional e internacional
of health providers often lead youth to                      rates of mortality and morbidity related                     [In Mexico, Yes You Can Provide
seek unsafe methods of abortion with                         to unsafe abortion they suffer                               Contraceptive Services to Adolescents:
its related risks. Most youth reported                       throughout the world. Policies should                        National and International Norms and
that they sought an abortion due to                          serve to eliminate barriers to PAC                           Laws]”8 has served to guide practice,
(1) fear of their family’s reaction to                       services, including the provision of                         provide backing to health care
their pregnancy—e.g., being expelled                         postabortion contraception, and                              providers offering services to adoles-
from the home; (2) the man not                               define the limits of parental consent                        cents and to spark discussion on this
assuming responsibility for the                              and/or notification by using the con-                        divisive issue.
pregnancy; or (3) poverty and being                          cept of evolving capacities of the child,
unable to care for the child.                                which is outlined in the Convention on                       Pre- and post-abortion counseling that
                                                             the Rights of the Child (1990).7 It                          is aimed at adolescents, both in
As a result of this qualitative study,                       establishes that youth under the age                         terms of content and methods of
Pathfinder conducted service provider                        of 18 can make critical life decisions for                   delivery, is extremely important so
training in PAC and provided technical                       themselves when they demonstrate                             that these young women have the
assistance to improve the quality of                         the skills and abilities to both antici-                     information they need to make per-
PAC services at Xai Xai Provincial                           pate and prevent the consequences of                         sonal, sound decisions regarding their
Hospital. An emphasis was placed on                          their decisions.                                             care. Clinical care also needs to meet
strengthening privacy, confidentiality                                                                                    the specific needs of adolescents,
and service provider attitudes as well                       For example, a young woman may                               which include smaller specula,
as postabortion FP counseling.                               request condoms at a local clinic and                        information that is understandable
Pathfinder also intends to provide                           does so because she is sexually                              and specialized care if the pregnancy
technical assistance in developing                           active and wants to prevent both                             is the product of rape.
guidelines for PAC and postabortion                          pregnancy and STIs, including HIV.
counseling for Ministry of Health staff                      Using the evolving capacities concept,                       Overall, we must respect and implement
and to train additional health providers                     she is demonstrating her ability to                          the agreements in the Convention on
from the provincial hospital and other                       both anticipate and prevent the                              the Rights of the Child, which state
referral facilities.                                         consequences of her sexual activity,                         that: “States parties recognize the
                                                             and should have no problem in                                right of the child to the enjoyment of
For more information on this study,                          accessing condoms without her                                the highest attainable standard of
please contact Julio Pacca,                                  parents’ consent. A young woman                              health and to facilities for the treat-
Mozambique Country Representative,                           requesting postabortion contraception                        ment of illness and rehabilitation of
at jpacca@pathfind.org.                                      is in a similar situation. She acknowl-                      health. States Parties shall strive to
Activity 5                                                   edges her past and possible future                           ensure that no child is deprived of his
Postabortion Care for                                        sexual activity and is requesting the                        or her right of access to such health
Adolescents: Policies, Counseling                            means by which she can avoid another                         care services” (Art. 24).
and Clinical Care                                            unwanted pregnancy and potential
                                                             unsafe abortion.                                             For more information, please contact
Debbie Billings, Ipas                                                                                                     Debbie Billings at billingsd@ipas.org.
Many countries throughout the world                          Ipas-Mexico has incorporated this
continue to move forward on imple-                           approach into all of its work with
1
    The PAC Consortium YF PAC Working Group uses the WHO definitions for adoles-         5
                                                                                             This program was featured in the June 2004 issue of PAC in Action, available at
    cents (ages 10 to 19) and youth (ages 10 to 24). The term “young people” can             http://www.pac-consortium.org/Newsletters/PACnewsletter0604.html.
    refer to either adolescents or youth.                                                6
                                                                                             In recent years, misoprostol has also been used as a technology for uterine evacua-
2
    UNFPA. 2003. “State of World Population 2003. Making 1 Billion Count: Investing in       tion. See the Gynuity Health Projects Programmatic Update (in the “Research and
    Adolescents' Health and Rights.” New York: UNFPA.                                        Evaluation” section) for more information.
3                                                                                        7
    Treffers, P. December 2002. “Issues in Adolescent Health and Development:                United Nations Office of the High Commissioner on Human Rights (UNHCHR), 1990.
    Adolescent Pregnancy.” Geneva: WHO.                                                      “Convention on the Rights of the Child.” Full text available at
4
    Raufu, A. 2002. “Unsafe Abortions Cause 20,000 Deaths a Year in Nigeria.” British        http://www.unhchr.ch/html/menu3/b/k2crc.htm. Geneva: UNHCHR.
                                                                                         8
    Medical Journal 325:988. November.                                                       Available at www.ipas.org in pdf format.

                                                                                                                                                             PAC in Action     7
Calendar                               Programmatic Updates
December 10-14, 2005                   General Programmatic Information           communication materials, including
133rd Annual Meeting and               In 2004, CATALYST awarded 12-              leaflets and posters, were developed
                                       month PAC grants to two nongovern-         in collaboration with the MOH. The
Exposition of the American Public                                                 project also facilitated care-seeking
                                       mental organizations: the Society for
Health Association (APHA).             Education in Contraception and             behavior by reimbursing women who
Philadelphia, Pennsylvania,            Sexuality (SECS) in Romania and the        sought PAC for their transportation
                                       Reproductive and Child Health              costs.
Philadelphia Convention Center.
                                       Alliance (RACHA) in Cambodia.              For more information, please contact
December 11, 2005                      In the city of Orastie, Romania, SECS      Kamlesh Giri at kgiri@rhcatalyst.org.
(2-7 p.m.), PAC Consortium             aimed to dispel myths and misconcep-
                                                                                  Research and Evaluation
                                       tions regarding contraceptives by
Meeting at the APHA Meeting,                                                      Gynuity Health Projects is involved in
                                       updating clinic- and community-based
“Misoprostol and the Postabortion      providers’ knowledge about family          a number of clinical studies to
                                       planning and their counseling skills.      assess the use of misoprostol for the
Care Setting.” Philadelphia,
                                       SECS trained 44 providers in Orastie.      treatment of incomplete abortion in
Pennsylvania, Philadelphia                                                        low-resource settings. Since 2001,
                                       Based on the training, these providers
Convention Center Room 103B.           have counseled PAC clients on the          studies have been conducted in
                                       dangers of repeat abortions and the        Burkina Faso, India, Tanzania and
December 11, 2005                      need for family planning and where to      Uganda; studies are ongoing in
                                       obtain FP methods. Seventeen nurses        Ghana, Moldova and Mozambique.
(12-2 p.m.). PAC Consortium
                                       who participated in the training held      Oral misoprostol has been compared
Youth-Friendly PAC Working Group                                                  to surgical treatment—either dilation
                                       more than 100 informational sessions
Meeting at the APHA Meeting.           with 1,117 women to inform them            and curettage (D&C) or manual vacu-
                                       about the risks associated with abortion   um aspiration (MVA)—depending on
Location to be announced.
                                       and danger signs of complications of       the surgical standard of care at the
Contact Gwyn Hainsworth at                                                        site. Different routes of misoprostol
                                       spontaneous and induced abortion.
ghainsworth@pathfind.org for more                                                 (oral versus sublingual) are also being
                                       Participants were also informed about
                                                                                  compared for efficacy and acceptability.
information.                           contraceptives, their role in preventing
                                       unintended pregnancies and their           Data from all completed studies indicate
May 30, 2006                           safety. Behavior change communication      a comparable efficacy profile for
(time and location TBA). PAC           materials were developed and distributed   misoprostol and the surgical standard
                                       in the informational sessions and in       of care. Success rates of over 90%
Consortium Meeting at the Global       one-on-one counseling sessions. The        have been found in all treatment
Health Council annual conference.      project helped double the distribution     arms with no significant differences
Washington, D.C.                       of FP methods in Orastie between July      between the treatment groups under
                                       2004 and June 2005. Additionally, the      study. Over 90% of all women report
May 30-June 2, 2006                    Medical Association of Romania has         being satisfied or very satisfied with
                                       adopted the PAC service model that         the methods and indicate that side
33rd Annual International Conference   SECS developed with the grant into         effects are tolerable. Based on avail-
on Global Health. Global Health        their service guidelines.                  able data, misoprostol alone for the
Council (GHC). Washington, D.C.                                                   treatment of incomplete abortion
                                       In Cambodia, RACHA worked in part-
                                                                                  appears to be as safe and effective
Omni Shoreham Hotel.                   nership with the Ministry of Health
                                                                                  as surgical intervention.
                                       (MOH) to implement a series of train-
                                       ings at the district level in order to     Recent Articles Published by Gynuity
                                       update the knowledge of community          Health Projects:
                                       health volunteers, service providers
                                                                                  Weeks A., G. Alia, J. Blum, B.
                                       and traditional healers about the
                                                                                  Winikoff, P. Ekwaru, J. Durocher and
                                       danger signs of complications of
                                                                                  F. Mirembe. 2005. “A randomized trial
                                       spontaneous and induced abortion
                                                                                  of misoprostol compared with manual
                                       and the need for immediate referral
                                                                                  vacuum aspiration for incomplete
                                       of these cases to health facilities.
                                                                                  abortion.” Obstetrics and Gynecology
                                       Providers also participated in an
                                                                                  106:540-7.
                                       orientation on postabortion FP coun-
                                       seling. More than 33,000 people in         Winikoff B. 2005. “Pregnancy failure
                                       383 villages received PAC and FP           and misoprostol—Time for a change.”
                                       messages through the community             New England Journal of Medicine
                                       awareness sessions. Behavior change        353:834-6.
8   PAC in Action
For more information, please contact           “Russia: Postabortion family planning       vide direction on policies, counseling
Sheila Raghavan at                             counseling and services lead to             and clinical care that can help prevent
sraghavan@gynuity.org.                         increased contraceptive use,”               unwanted pregnancies and offer abor-
                                               FRONTIERS OR Summary no. 44.                tion-related care tailored to adolescents’
Lessons from FRONTIERS research                Washington, DC: Population Council,         needs.
on PAC in Bolivia, Brazil, Honduras,           2004. http://www.popcouncil.org/
Mexico, Peru, Russia and Senegal               frontiers/orsummaries/ors44.html            Postabortion Counseling and
were featured at two recent USAID                                                          Community Education Materials.
PAC meetings. The first took place on          The introduction of postabortion family     Family Care International, September
February 14, 2005, at USAID, and               planning service delivery involving         2005.
was sponsored by the USAID PAC                 training in counseling skills and job       Designed to enhance postabortion
Working Group and the Office of                aids for providers led to increased         client counseling and community
Population and Reproductive Health,            use of modern contraceptive methods         education related to unsafe abortion,
Research, Technology and Utilization           at 12 months postabortion. The              this set of materials includes a
Division (GH/PRH/RTU). The second              provision of family planning counseling     flipchart, a prototype client brochure
and larger meeting, the USAID                  at a postabortion follow-up visit           and a user’s guide. Developed for use
Postabortion Care Partners Meeting,            appears to be an important factor in        in Anglophone Africa and comprised of
was held March 15, 2005.                       reducing repeat abortions.                  four separate sections, the flipchart
FRONTIERS studies from Bolivia,                3. “Taking PAC Services Where               focuses on the following topics: (1)
Brazil, Honduras, Mexico and Peru              They Are Needed: Decentralization           pre-procedure counseling; (2) post-
addressed the integration of services          of PAC to Rural Clinics in Senegal,”        procedure counseling; (3) postabortion
for PAC, pain management and the               John W. Townsend, Ph.D., Director,          family planning (PAFP); and (4) unsafe
use of D&C as an outpatient proce-             FRONTIERS Presentation.                     abortion in the community. A client
dure for emergency treatment where             http://www.popcouncil.org/frontiers/        education brochure provides simple
MVA is unavailable. Studies from               meetings/pacmar05/townsend_files/           information on self-care after treatment
Russia and Senegal addressed                   frame.htm                                   for abortion complications and on
postabortion family planning and the                                                       PAFP. The accompanying User’s Guide
decentralization of PAC services.              “Senegal: Expand access to safe             provides tips on using the materials
                                               postabortion care services in rural         to strengthen PAC services, and
Presentations and Related                      areas,” FRONTIERS OR Summary no.            offers an overview of key service
Publications:                                  43. Washington, DC: Population              delivery and quality of care issues
1. “Integration of Family Planning into        Council, 2004. http://www.popcouncil.       related to PAC as well as up-to-date
Postabortion Care,” James R. Foreit,           org/frontiers/orsummaries/ors43.html        information on the status of abortion
Ph.D., Associate Director, FRONTIERS           A study conducted in rural Senegal          in sub-Saharan Africa, clinical guid-
Presentation. http://www.popcouncil.org        demonstrated that mid-level providers       ance for PAFP and annotated lists of
/frontiers/meetings/pacmar05/foreit_           at primary health care clinics can safely   available programmatic and resource
files/frame.htm                                and efficiently offer integrated PAC        materials. For more information or to
                                               services. Though the intervention           order, contact Ellen Brazier at
Foreit, James R. 2005. “Postabortion                                                       ebrazier@fcimail.org.
Family Planning Benefits Clients and           increased local availability of skilled
Providers,” FRONTIERS Program Brief            providers, costs and transportation         Gonzáles, Fernando and Máriel
no. 4. Washington, DC: Population              remain a problem for clients.               Loayza. 2005. “Operations research
Council. http://www.popcouncil.org/            Resources                                   to improve postabortion care (PAC)
frontiers/briefs/fpbriefs4.html                                                            services in three public hospitals,
                                               Note: Unless otherwise indicated,
                                                                                           Bolivia,” FRONTIERS Final Report.
Provision of family planning methods           all resources are available only in
                                                                                           Washington, DC: Population Council.
is a central feature of postabortion           English.
                                                                                           http://www.popcouncil.org/frontiers/
care. Ensuring reliable on-site availability   De Bruyn, M. and S. Packer. May             projects_pubs/topics/pac/pac_lac.html
of family planning methods for all clients     2004. Adolescents, Unwanted
following abortion or miscarriage can                                                      In collaboration with CATALYST/
                                               Pregnancy and Abortion. Policies,
result in benefits for clients, providers                                                  Pathfinder-Bolivia and the Ministry of
                                               Counseling and Clinical Care. Chapel
and programs.                                                                              Health (MOH), FRONTIERS provided
                                               Hill, NC, Ipas.
                                                                                           technical assistance for the development
2. “Integrating Family Planning into           http://www.ipas.org/publications/en/
                                                                                           and implementation of operations
Postabortion Services in Russia,”              ADOLPOL_E04_en.pdf
                                                                                           research (OR) projects at three MOH
Emma Ottolenghi, M.D., Associate               A notable gap exists in policymaking        hospitals to address challenges in
Consultant, FRONTIERS Presentation.            and programming to address the con-         existing PAC service delivery. Two
http://www.popcouncil.org/frontiers/mee        sequences of unwanted adolescent            hospitals developed and implemented
tings/pacmar05/emma_files/frame.htm            pregnancies, including abortion-relat-      a model for integrated PAC to address
                                               ed care. This document seeks to pro-        the lack of linkages between emergency
                                                                                                                      PAC in Action   9
Programatic Updates Continued
                                                                                       Working Group Updates
care and other outpatient RH services,      for a follow-up visit seven days after
                                                                                       Communications Task Force
including family planning. A third          the procedure; such repeat visits
hospital developed and implemented          increase opportunities for contracep-      Co-chairs: David Nelson, IntraHealth
an OR study to improve contraceptive        tive counseling and decision-making.       International,
counseling after they identified unmet      The study also found that hospital         dnelson@intrahealth.org; Laura
need for contraception at the time          directors have limited capacity to         Raney, Population Council,
clients were discharged from the            introduce new techniques or provide        LRaney@pcdc.org
hospital. A cyclical training strategy      effective oversight to ensure the          Renuka Bery and Holley Stewart, both
was implemented for medical interns         compliance of providers.                   of the SARA project, stepped down as
at the hospital and has continued after                                                co-chairs of the Communications Task
the project ended. In the other two         Foreit, James R. 2005. “Postabortion
                                            Family Planning Benefits Clients and       Force. Laura Raney of the Population
hospitals, the strategies tested were                                                  Council and David Nelson of
moderately successful in decreasing         Providers,” FRONTIERS Program Brief
                                            no. 4. Washington, DC: Population          IntraHealth International are the new
unmet need for contraception—i.e.,                                                     co-chairs. The CATALYST project has
the percentage of women who did not         Council. http://www.popcouncil.org/
                                            frontiers/briefs/fpbriefs4.html            ended; therefore, IntraHealth will now
wish to get pregnant and wanted to                                                     produce the newsletter and Pathfinder
use a method but did not receive a          Provision of family planning methods       International will maintain the website.
method. In one hospital, the pre-inter-     is a central feature of PAC. Ensuring      CATALYST shared the results of an
vention unmet need was 98%; this            reliable, on-site availability of family   evaluation of the newsletter and web-
declined to 54% post-intervention. In       planning methods for all clients           site, which was conducted between
the other hospital, the intervention        following abortion or miscarriage          November 2004 and January 2005.
resulted in an increase in the percentage   can result in benefits for clients,        The majority of the 79 respondents—
of clients who returned to the hospital     providers and programs.                    50% of whom live in the United
                                                                                       States—indicated that the newsletter
                                                                                       provides them with information that
                                                                                       is not easily available from other
MVA Drawdown Account                                                                   sources. Respondents also suggested
The Manual Vacuum Aspiration (MVA) Drawdown Account (DDA), which is                    some improvements, including dis-
managed by Ipas, was established with funding from the Packard Foundation              semination of the newsletter via other
to support the donation of MVA instruments. MVA instruments provided                   listservs (in addition to the PAC
through the DDA are to meet a short-term need and initiate the establish-              Consortium listserv). Given the results
ment of a sustainable, local supply of MVA instruments.                                of the evaluation, participants felt that
                                                                                       this may be an opportune time to
Specifically, instruments provided through the DDA are intended to serve as            reassess the audience and format of
an interim supply to seed and generate interest in MVA; to facilitate access           the newsletter and website. It was
to MVA instruments for providers who could not otherwise obtain them; to               also noted that the objectives of the
encourage agencies to undertake programming that supports the use of MVA               newsletter and website should be
instruments in quality improvement efforts; and, where appropriate, to serve           understood within the context of an
as a bridging mechanism while long-term sustainable means for instrument               overall PAC Consortium
supply are developed locally.                                                          Communications Strategy. Task Force
The DDA supplies MVA instruments to organizations that are directly engaged            members plan to meet to discuss and
in clinical training and/or service delivery in developing countries, and              draft a new communications strategy in
should be used only when other funds cannot be secured. Multi-year                     late 2005 and early 2006. This strategy
requests for MVA instruments are discouraged. MVA instruments provided                 will be shared with Advisory Group
through the DDA should not be stocked nor sold. Whenever possible, the                 members and the Consortium at large
delivery of donated instruments is managed through the local Ipas product dis-         for comments.
tributor so that future orders for instruments can be placed directly through          Essential Elements Task Force
that local distributor.                                                                Co-chairs: Inés Escandón,
If you have questions or would like to receive a form to submit a request for          EngenderHealth,
donated MVA instruments, send an email of inquiry to Beverly Tucker at                 iescandon@engenderhealth.org or
tuckerb@ipas.org                                                                       inesnatalia2003@yahoo.com; Kiyomi
                                                                                       Tsuyuki, Socios para el Desarrollo-
                                                                                       Bolivia, ktsuyuki@prosalud-
                                                                                       socios.org.bo
                                                                                       The Essential Elements Task Force
                                                                                       meeting focused on three items: (1)
                                                                                       reviewing and finalizing the working
10   PAC in Action
                        draft of the monitoring and evaluation    PAC and Safe Motherhood                   pregnancy-related ill health, and how
                        (M&E) indicators for the essential ele-   Task Force                                does that vary from region to region?;
                        ments of PAC (EE/PAC) framework; (2)      Co-Chairs: Koki Agarwal, ACCESS           and (5) How much effort is going into
                        deciding on new directions for the        Project (JHPIEGO),                        PAC in comparison with other areas
                        team; and (3) identifying a new co-       kagarwal@jhpiego.net; Elizabeth           of pregnancy-related care (using John
                        chair. Inés Escandón presented a draft    Westley, Family Care International,       Ross’ Maternal and Neonatal Program
                        document of proposed indicators for       ewestley@familycareintl.org               Index [MNPI])? This index measures
                        PAC M&E within the context of the EE                                                program effort in maternal and neona-
                        framework, which included changes         Note: This task force was revived at      tal health in developing countries.
                        recommended by participants at the        the May 2005 meeting after it was
                        November 2004 Task Force meeting.         dissolved one year prior.                 2. Based on information garnered
                        Participants offered suggestions for                                                through fact-finding, participants
                                                                  Participants briefly discussed the his-   agreed to develop advocacy materi-
                        improving the framework based on          tory of the task force, which has been
                        experiences with the model in the                                                   als—possibly in the form of talking
                                                                  problematic due to lack of continuity     points—to engage partners in inte-
                        field, including strengthening indica-    among attendees. Additionally, while
                        tors for the community element,                                                     grating PAC into SM programs.
                                                                  many PAC Consortium participants
                        adding gender-based violence and          acknowledge the importance of con-        3. Together with the PAC Consortium
                        looking at experiences with HIV/AIDS      necting PAC to safe motherhood (SM)       as a whole, participants agreed to
                        for guidance on how to measure stig-      and urge that this task force continue    work on engaging professional organi-
                        ma. After being revised, the frame-       to exist, its mission is vague. After     zations such as the International
                        work will be posted on the PAC            this discussion, the group set priori-    Federation of Gynecology and
                        Consortium website as a working           ties for the next six months:             Obstetrics (FIGO), the International
                        draft. The discussion on indicators                                                 Confederation of Midwives (ICM)
                        highlighted the need to improve           1. It was determined that fact-finding    and the American College of Nurse-
                        information exchange on the extensive     about PAC and SM is critical for this     Midwives (ACNM) to place PAC
                        and rich M&E work carried out and in      task force, focusing on questions         squarely within SM programs.
                        progress, and participants suggested      such as: (1) What are the bilateral
                        that submissions to the Consortium        programs, donors and different initia-    Since the last meeting, the co-chairs
                        newsletter should include M&E infor-      tives doing on PAC and SM?; (2)           have been working to gather informa-
                        mation, such as indicators and tools      Where does PAC fit into maternal          tion to respond to the fact-finding pri-
                        that program planners have used to        health partnerships such as Making        orities. Information gathered will be
                        measure change in the field projects      Pregnancy Safer?; (3) Is language on      presented at the next Consortium
                        featured. Kiyomi Tsuyuki agreed to        “pregnancy loss” more appropriate for     meeting.
                        join Inés Escandón as co-chair of the     SM contexts?; (4) How important is        PAC Technologies Working Group
                        Task Force.                               unsafe abortion as a contributor to       Co-Chairs: Nancy Harris, JSI,
                                                                                                            nharris@jsi.com; Sheila Raghavan,
                                                                                                            Gynuity, sraghavan@gynuity.org
                                                                                                            An update on the activities of this
                                                                                                            task force will appear in the next
                                                                                                            PAC in Action
                                                                                                            Youth-Friendly PAC Working Group
                                                                                                            Chair: Gwyn Hainsworth, Pathfinder
                                                                                                            International,
                                                                                                            ghainsworth@pathfind.org
                                                                                                            The current work of this group is
                                                                                                            featured in the introductory article
                                                                                                            to this issue of PAC in Action.
Photo by Richard Lord




                        Service provider training in the special needs of adolescent clients
                        is essential to youth-friendly PAC
                                                                                                                                      PAC in Action   11
postabortion care


PAC
consortium

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