scholarly journals “Right tool,” wrong “job”: Manual vacuum aspiration, post-abortion care and transnational population politics in Senegal

2015 ◽  
Vol 135 ◽  
pp. 56-66 ◽  
Author(s):  
Siri Suh
Keyword(s):  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Population Politics ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

scholarly journals Midwives’ Integration of Post-Abortion Manual Vacuum Aspiration in the Democratic Republic of Congo: A Mixed Methods Case Study & Positive Deviance Assessment

2020 ◽  
Author(s):  
Kirsty Marie Bourret ◽  
Sylvie Larocque ◽  
Amélie Hien ◽  
Carol Hogue ◽  
Kalum Muray ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Positive Deviance ◽  
Republic Of Congo ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Abstract Background: Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF.Methods: Creswell’s mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison group and further interpretations. Sources of data included a sequential survey and semi-structured interviews. Results: All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups’ demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care.

scholarly journals Midwives’ Integration of Post-Abortion Manual Vacuum Aspiration in the Democratic Republic of Congo: A Mixed Methods Case Study & Positive Deviance Assessment

2020 ◽  
Author(s):  
Kirsty Marie Bourret ◽  
Sylvie Larocque ◽  
Amélie Hien ◽  
Carol Hogue ◽  
Kalum Muray ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Statistical Significance ◽  
Republic Of Congo ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Abstract Background: This collaborative research with the Professional Association of Congolese midwives (SCOSAF) in the province of Kinshasa, Democratic Republic of Congo sought to understand how midwives have integrated manual vacuum aspiration (MVA) for post abortion care. Methods: A positive deviant approach to Creswell’s mixed method comparative case study design was used to identify midwives who have integrated MVA post training and to explore enabling factors. Case group comparisons of positive and non-positive deviant midwives provided further interpretations. Results: All 102 midwives invited to be surveyed were recruited. They included 34% who reported practicing MVA post training. No statistical significance was found between the two groups’ demographics and facility type. Overall, groups had positive attitudes regarding midwifery, MVA, and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for its overall impact on the diffusion of midwifery led MVA to improve access to safe respectful reproductive care.

scholarly journals Midwives’ Integration of Post Abortion Manual Vacuum Aspiration in the Democratic Republic of Congo: A Mixed Methods Case Study & Positive Deviance Assessment

2020 ◽  
Author(s):  
Kirsty Marie Bourret ◽  
Sylvie Larocque ◽  
Amélie Hien ◽  
Carol Hogue ◽  
Kalum Muray ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Positive Deviance ◽  
Republic Of Congo ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Abstract Background: Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF.Methods: Creswell’s mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison group and further interpretations. Sources of data included a sequential survey and semi-structured interviews. Results: All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups’ demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care.

scholarly journals Midwives’ integration of post abortion manual vacuum aspiration in the Democratic Republic of Congo: a mixed methods case study & positive deviance assessment

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kirsty M. Bourret ◽  
Sylvie Larocque ◽  
Amélie Hien ◽  
Carol Hogue ◽  
Kalum Muray ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Positive Deviance ◽  
Republic Of Congo ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Abstract Background Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF. Methods Creswell’s mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison gro cup and further interpretations. Sources of data included a sequential survey and semi-structured interviews. Results All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups’ demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies. Conclusion Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care.

scholarly journals Efficacy of Misoprostol as a Post Abortion Care

2014 ◽  
Vol 8 (2) ◽  
pp. 71-74
Author(s):  
M Jha ◽  
NS Chitrakar ◽  
B Shakya ◽  
R Jha
Keyword(s):  
Single Dose ◽  
Early Pregnancy ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Obstetrics And Gynaecology ◽  
Incomplete Abortion ◽  
Post Abortion Care ◽  
Oral Misoprostol ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Aims: This study was done to find the efficacy of Misoprostol as a post-abortion care in our setting. Methods: Women with incomplete abortion of gestational age ≤ 12 weeks or uterine size ≤ 12 weeks with open cervical os, haemoglobin ≥ 9 gm% and stable physical condition; were given 600 microgram Misoprostol orally and were observed for 24 hours for complete expulsion. If the patient failed to expel within 24 hours of Misoprostol administration manual vacuum aspiration or suction evacuation was done. Results: One hundred and twenty-two women were enrolled in the study. Among them, 41% had complete expulsion within 24 hours of administration of misoprostol and 49% had incomplete expulsions. The success rate was high in the group of < 8 weeks of pregnancy. Among 50 (41%) successful cases, 38 (76%) belonged to 8 weeks of gestation by bimanual examination (p = 0.02). Conclusions: Single dose of oral Misoprostol was effective, safe and alternative method to the management of incomplete abortion compared to the manual vacuum aspiration or suction evacuation in case of early pregnancy abortion.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 71-74 DOI: http://dx.doi.org/10.3126/njog.v8i2.9778

scholarly journals Midwives’ Integration of Post-Abortion Manual Vacuum Aspiration in the Democratic Republic of Congo: A Mixed Methods Case Study & Positive Deviance Assessment

2020 ◽  
Author(s):  
Kirsty Marie Bourret ◽  
Sylvie Larocque ◽  
Amélie Hien ◽  
Carol Hogue ◽  
Kalum Muray ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Statistical Significance ◽  
Republic Of Congo ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Post Abortion

Abstract Scientific AbstractBackground: This collaborative research with the Professional Association of Congolese midwives (SCOSAF) in the province of Kinshasa, Democratic Republic of Congo sought to understand how midwives have integrated manual vacuum aspiration (MVA) for post abortion care.Methods: A positive deviant approach to Creswell’s mixed method comparative case study design was used to identify midwives who have integrated MVA post training and to explore enabling factors. Case group comparisons of positive and non-positive deviant midwives provided further interpretations.Results: All 102 midwives invited to be surveyed were recruited. They included 34% who reported practicing MVA post training. No statistical significance was found between the two groups’ demographics and facility type. Overall, groups had positive attitudes regarding midwifery, MVA, and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.Conclusion: Results provided important insight to midwives’ integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for its overall impact on the diffusion of midwifery led MVA to improve access to safe respectful reproductive care.

scholarly journals Safe abortion service and post abortion care: Understanding complications

1970 ◽  
Vol 2 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Sudha Thapa ◽  
Indira Satyal ◽  
Kasturi Malla
Keyword(s):  
Induced Abortion ◽  
Abortion Rate ◽  
Uterine Perforation ◽  
Safe Abortion ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Manual Vacuum Aspiration ◽  
Comprehensive Abortion Care ◽  
Post Abortion

Aim: To see if unsafe abortions are getting lesser after the establishment of comprehensive abortion care (CAC) Unit since March 2004. Methods: Retrospective study of women admitted with complication of abortions [induced (medically/criminal) or spontaneous] during the entire ten years period after the inception of post abortion care (PAC) Unit 2095 May -2007 April; the last 3 years overlapping the service years of CAC Unit establishment. Result: CAC and PAC units both are using manual vacuum aspiration (MVA) to procure uterine evacuation. CAC clients in the last 3 years have reached to a little less than 10,000. This is close to MVA services provided in the PAC Unit in the last 10 years amounting to 11,519. But the number (n=3958) of service provided by the PAC Unit for a complete period of three years 2058-2060 (April 2001 - April 2004) showed a slight increase to (n=4323) as the CAC Unit became functional during the 2061-2063 (15th April 2004- 2007). The complications observed in PAC unit while providing MVA are much more than CAC unit (5.75%: 2%). But the nature of complication is much more serious in CAC Unit, 10 of them needing laparotomy for 20(0.02%) cases of uterine perforation. The induced abortion rate within the hospital, three years before and during CAC services is almost similar (4.07%: 4.34%). Seriousness of the problem has definitely reduced during recent 3 year's period (Baisakh 2061-2063 Chaitra) i.e. 52: 34 except for an unfortunate rise in uterine perforation from 8 to 29 cases, 10 being from the CAC Unit. Conclusion: Though the number of complicated cases of induced abortion seeking hospitalization has not changed much after inception of CAC services in the recent three years, there is definitely a decline in the admission of more serious complicated cases of induced abortion in the recent years with unfortunate rise in number of cases of uterine perforation.   doi:10.3126/njog.v2i1.1476 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 44 - 49 May -June 2007

scholarly journals Quality Of Post-Abortion Care In Java, Indonesia: An Essential Services Analysis 

2020 ◽  
Author(s):  
Jesse Philbin ◽  
Nugroho Soeharno ◽  
Margaret Giorgio ◽  
Rico Kurniawan ◽  
Meghan Ingerick ◽  
...  
Keyword(s):  
Health System ◽  
First Trimester ◽  
Health Centers ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Dilation And Curettage ◽  
Essential Services ◽  
Post Abortion

Abstract Background High maternal mortality in Indonesia persists despite economic growth and a reform that extended health insurance to all Indonesians. Quality of obstetric health services, in general, has been identified as a factor for this; in addition, the country’s restrictive abortion laws merit special attention to the quality of post-abortion care (PAC) services. Methods Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia’s most populous island, we used the essential services framework to measure the health system’s capacity to offer PAC. We then used this framework to explore how Java’s capacity to offer PAC could change given two hypothetical reforms. Finally, we calculated the proportion of PAC patients treated using each of four different procedures. Results No emergency obstetric health centers (PONEDs) are adequately staffed or authorized to offer basic PAC services, while 46% of all hospitals in Java have the full set of services needed. These proportions increase in hypothetical scenarios in which PAC authorization is expanded to midwives, general physicians, and PONED facilities. Eighty-eight percent of PAC patients were treated using dilation and curettage (D&C). Conclusions Allowing clinicians other than Ob/Gyns to perform uterine evacuation and offering first-trimester PAC service in PONEDs would greatly improve the capacity of Java’s health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol would lower the burden of treatment for patients, reduce costs to the health system, and facilitate the task-shifting efforts needed to expand access to this life-saving service.

scholarly journals Abortion Service Provision in South Asia: A Comparative Study of Four Countries

2019 ◽  
Author(s):  
Susheela Singh ◽  
Aparna Sundaram ◽  
Altaf Hossain ◽  
Mahesh Puri ◽  
Zeba Sathar ◽  
...  
Keyword(s):  
Public Sector ◽  
Rural Women ◽  
Rural Areas ◽  
Urban Areas ◽  
Safe Abortion ◽  
Number Of Children ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Post Abortion

Abstract Background Safe abortion services are essential if women are to fulfill their right to have the number of children they want, when they want them. This paper examines the provision of abortion and menstrual regulation (MR) services in four South Asian countries that have many commonalities in sexual and reproductive outcomes and in barriers to accessing needed services, despite variation in their abortion laws —Nepal, India (six states), Bangladesh, and Pakistan. Methods Using representative health facility surveys, we assess availability of legal abortion/MR services —relevant in three of the countries—and post-abortion care, relevant for all four countries. We examine the role of the public sector in providing these services and the proportion of facilities located in rural areas, as indicators of service accessibility for poor and rural women. We assess quality of abortion care through selected indicators: provision of WHO-recommended methods, vacuum aspiration (VA) and medication abortion (MA); use of outdated, invasive methods such as dilatation and curettage (D&C); and the proportion of facilities turning away women seeking services. Results Results show that in India and Nepal the majority of public sector facilities do not provide induced abortion services, and in India and Pakistan, the majority of facilities providing any abortion services are private sector. Further, although all four countries are mostly rural, the majority of facilities providing abortion services are located in urban areas. While facilities that provide abortion services already commonly provide MA in Nepal and India and increasingly offer MRM (MR with medication) in Bangladesh, D&C is over-used in all four countries for PAC and in India for induced abortions as well. Conclusion There is an urgent need to expand and improve provision of abortion and post-abortion care to reduce abortion-related morbidity and mortality and to fulfill the rights of all women to quality sexual and reproductive health care.

scholarly journals Constrains for seeking post-abortion care among adolescents and young women in Guangzhou, China: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yiding Wang ◽  
Jinzhi Liu ◽  
Ribo Xiong ◽  
Yan Liu
Keyword(s):  
Young Women ◽  
Cross Sectional Study ◽  
Public Hospitals ◽  
Sectional Study ◽  
Cross Sectional ◽  
Services Utilization ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Post Abortion ◽  
Youth Friendly

Abstract Background In China, post-abortion care (PAC) services mainly focus on married couples, such that adolescents and unmarried young womenhave limited access to those services for contraception counseling. The provision of youth-friendly PAC services in public hospitals is a new concept in China. This study examined the magnitude of PAC services utilization as well as factors influencing it’s uptake among adolescents and young women in Guangzhou, China. Methods A cross-sectional study was performed from 1st March 2020 to 30th September 2020 using anonymous self-administered questionnaire among 688 women aged 15–24 years in Tianhe district, Guangzhou. The Multivariate logistic regression was used to determine factors that were significantly associated with the uptake of PAC services. Results The magnitude of PAC services utilization was 35.9% among adolescents and young women in Guangzhou, China. Students were 69.0% significantly less likely to use PAC services compared to women who had no job. Immigrants were 59.0% significantly less likely to use PAC services than their native counterparts. Women who had a feeling of stigma were 70.0% significantly less likely to use PAC services compared to those who did not feel stigmatized. Conclusions The study highlights the need to strengthen youth-friendly PAC services provision, and emphasizes the importance of education about both family planning and abortion services among disadvantaged sub-groups of women in the study setting.

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