Title: Improving the counseling and medical care of post abortion patients in Egypt: preliminary results from an operations research study.

POPLINE Document Number: 102033

Author(s):

Huntington D
Hassan EO
Toubia N
Kafafi S
Elwan A
Attallah N
Naguib M
El Henie M
El Shoubary AA
Nawar L

Source citation:

[Unpublished] 1994. Presented at the 122nd Annual Meeting of the American Public Health Association [APHA], Washington, D.C.,October 30 - November 3, 1994. 20 p.

Abstract:

Unsafe abortion is a leading cause of maternal morbidity and mortality worldwide. The most cost effective and medically sound treatment for early incomplete abortion is manual vacuum aspiration (MVA), but treatment must be extended to prevention through counseling and the provision of contraceptive methods. This will require a breakdown in the current barriers between curative and preventive care services, debunking provider misconceptions, and improving clinical counseling skills. In Egypt, where a rather restrictive abortion law is in effect and is strongly moderated by Islamic considerations, the availability of safe abortion services is limited, especially for poor women. Thus, many women attempt self-abortion, and there is a dearth of data on induced abortion. In order to examine the effectiveness of MVA and improved counseling of postabortion patients in 2 Egyptian hospitals, a pre/post-test situational analysis was performed. The clinical case management protocol featured vacuum aspiration, alternative pain control measures (rather than general anesthesia), and family planning (FP) counseling as well as information about miscarriage for women who desire to become pregnant. An intensive training program was used to introduce MVA, reproductive health care counseling, and available contraceptive methods to senior obstetric/gynecology specialists. Nurses were also trained in counseling techniques and patient interactions. Data were collected through structured observations of all clinical procedures for 296 postabortion patients during a 5-week period, interviews with all clinic staff and all postabortion patients, and a review of medical records. Information was tabulated on classification of the abortion (spontaneous, certainly induced, etc.), history of unwanted pregnancy, infection control procedures, medications administered postabortion, physician knowledge about postabortion warning signs, follow-up information provided to patients, patient knowledge about postabortion warning signs, FP counseling and information and FP intentions postabortion. These baseline results show a strong reliance on general anesthesia, which should be overcome, and incomplete physician and patient knowledge about follow-up warning signs. FP information was not routinely provided despite a clear desire for such information on the part of patients. Further information will be available at the conclusion of this study in early 1995.

Keywords:

Egypt
Abortion Law
Abortion
Maternal Mortality
Postabortion
Counseling
Pregnancy, Unwanted
Delivery of Health Care
Quality of Health Care
Operations Research
Pre-Post Tests
Training Programs
Baseline Surveys
Religious Aspects
Developing Countries
Africa, North
Africa
Fertility Control, Postconception
Family Planning
Pregnancy Complications
Diseases
Mortality
Population Dynamics
Demographic Factors
Population
Reproduction
Clinic Activities
Program Activities
Programs
Organization and Administration
Reproductive Behavior
Fertility
Health
Health Services Evaluation
Program Evaluation
Research Methodology
Education
Surveys
Sampling Studies
Studies
Religion