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Richard Lord

In Southeast Asia where unsafe abortion causes nearly 16 percent of maternal mortality, family planning to prevent unwanted pregnancy is key to preventing death and injury. In Cambodia in particular, 472 out of 100,000 women die in childbirth — a ratio 10 times higher than that of neighboring Thailand. Limited access to and use of contraceptives has left women with few choices to control their fertility in Cambodia. Abortion is legal, increasingly common and yet it remains often unsafe.

So why then do women who receive postabortion care leave the clinic without contraceptives so often? According to a study just published this month in Studies in Family Planning, the factors that strongly increase women’s acceptance of contraceptives after abortion are all structural. The Cambodian women in the study were more likely to accept a contraceptive method when:

• A midwife or nurse managed abortion and postabortion services.
• Contraceptives and abortions were provided in the same room.
• Four or more forms of birth control methods were offered.

Ipas’s Tamara Fetters and Kathryn Anderson Clark, along with co-authors Janna McDougall of the International Center for Research on Women and Tung Rathavy, deputy director of Cambodia’s National Maternal and Child Health Center analyzed data collected from Cambodia’s public health facilities, giving the study a national lens from which to view the public health system.

“We looked at a group of women who told their provider they didn’t want to get pregnant again soon. They all had a lot of reasons to have an unwanted pregnancy. They may have been using contraception that failed, seeking care after an unsafe abortion, had as many children as they wanted, or they may have been young and unmarried. No matter what we looked at, none of those factors made more difference than whether or not the facilities were prepared to give them contraception,” says Fetters.

All women seeking abortion or postabortion care must receive contraception information, regardless of their personal or socioeconomic characteristics, adds Fetters. In the study, the authors found that typical assumptions held by providers about a woman’s age or previous use of birth control had little bearing on whether or not a woman took a contraceptive method home with her. The authors also point out that physicians who provide abortion care should be targeted to improve deficits in their contraceptive services. Previous studies show that midwives tend to offer higher-quality counseling and contraceptive provision in general, compared with physicians.

The study’s findings indicate that improved training for contraceptive counseling, especially for midwives and nurses, and increasing contraceptive method choices in the abortion procedure room can reduce Cambodian women’s risk of unwanted pregnancy and unsafe abortion. According to both Rathavy and John Naponick, team leader of the Reduction in Maternal Mortality Project (RMMP), the findings can easily be applied to other developing countries in their efforts to increase contraception. The RMMP, which is led by Options UK and includes several organizations like Ipas, trains health service workers to include postabortion contraceptive counseling as a way to reduce repeat abortions and prevent death and injury from unsafe abortion.

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For more information, contact media@ipas.org