Ipas > New book collects advances in PAC in Latin America and the Caribbean

New book collects advances in PAC in Latin America and the Caribbean

November 5, 2007

(from left to right) Ricardo Vernon, Gustavo Gutiérrez, Nadine Gasman and Deborah Billings at the launching of Avances in La Antigua, Guatemala

Dr. Salvador Estévez

Since it was first published as a model of care in 1994, postabortion care (PAC) has become an increasingly important approach to reproductive health in the developing world. In addition to providing emergency treatment for miscarriages and abortion complications, PAC offers women contraceptive counseling and links to other reproductive health services. PAC has become especially important in reducing death and disability in Latin America and the Caribbean, where women continue to have abortions despite restrictive laws in the region.

But even as PAC has become an essential component of reproductive health care, getting hospitals and other health-care facilities to practice new and improved standards of care remains a constant challenge. Doctors and nurses must learn new techniques, and health-care administrators may be reluctant to adopt new methods unless there is obvious evidence that they will significantly improve services. A new book published by Ipas and the Population Council, Avances en la atención posaborto en América Latina y el Caribe (Advances in postabortion care in Latin America and the Caribbean), attempts to help overcome these obstacles.

Aimed at hospital administrators, health-care personnel and other decision makers, Avances will be distributed throughout Spanish-speaking countries in Latin America and the Caribbean in hard copies and electronic formats. Avances collects the advances in PAC made over the past decade, as well as scientific evidence for these advances. It marks the first time that this information, which had been previously available in conferences, presentations and flyers, has been collected in a single, comprehensive format. More than 20 authors contributed to the effort.

“When you look at the whole region, there have been a lot of great lessons learned, and there was just a feeling of, ‘this needs to get out to the public,’” says Avances’ lead editor and Ipas Senior Associate Debbie Billings. “Even when you have evidence, change in health systems and practices tends to be really slow,” Billings says. “We thought, ‘let’s put something together that is so unequivocal that [any] administrator could make evidence-based changes.’”

Avances’ recommendations offer improvements on multiple fronts. By using manual vacuum aspiration (MVA) rather than dilatation and curettage (D&C) to deal with complications of miscarriage and incomplete abortions, health-care providers can offer better-quality services for women, and can reduce hospital costs by allowing women to be treated on an out-patient basis instead of hospitalizing them overnight, Billings says.

Billings says that one of the interesting discoveries from the book was that the strength of a country’s health-care system did not predict how well that same country adopted new techniques related to postabortion care. “The greatest uptake [in PAC] took place in Central America and Bolivia, some of the areas with the greatest need,” she says. “Central America made some great advances in adopting MVA and improving overall quality of care, but change has been slower in larger countries with better-funded health-care systems, like Mexico, where you’ve got to convince more stakeholders,” Billings says.

Other PAC improvements deal with how health-care providers interact with patients. For example, Avances offers models that empower patients to negotiate with doctors to receive the services they want and need, rather than simply accepting the services that are initially offered. Avances also contains a human-rights framework that encourages health-care providers to think of the care they provide in the context of women’s human right to health. Billings says these approaches are especially important considering the stigma and strong emotions surrounding abortion, which often make communication difficult. “A provider who can offer a woman information and choices, and not stigmatize her and not make her feel judged, is really opening up new possibilities,” Billings says.

Additional information about PAC, including a recent comparative study examining expansion of postabortion care in Bolivia and Mexico, is available on the Ipas publications website. A discussion of the importance of working to spread innovative changes in medical care from last week’s issue of the Journal of the American Medical Association is available here.

For more information, contact media@ipas.org