CONTENTS
Preface = 7
Acknowledgement = 10
Chapter 1 : Introduction = 11
Maternal mortality and morbidity = 11
The role of abortion in maternal mortality and morbidity = 13
Improving maternal health high-quality abortion care = 17
References = 17
Chapter2 : Overview of abortion care = 19
Definition = 19
Categories of abortion care = 19
Levels of health care = 20
References = 25
Chapter 3 : Legal and societal factors affecting abortion care = 27
Laws and regulations = 27
Sociocultural and religious perspectives = 29
References = 31
Chapter 4 : Planning fora bortion care = 32
Strategic planning = 32
Problem identification and definition = 33
Setting objectives = 37
Interventions = 37
Reference = 39
Chapter 5 : Initial assessment in emergency abortion care = 40
Initial assessment = 40
Complications of abortion requiring emergency care = 43
References = 47
Chapter 6 : Methods of uterine evacuation = 48
First-trimester emergency methods = 48
Early second-trimester emergency methods = 51
Late second-trimester emergency methods = 51
First-trimester elective procedures = 51
Second-trimester elective procedures = 52
Cervical dilatation = 53
References = 53
Chapter 7 : Additional clinical elements of abortion care = 55
Anaesthesia, sedation and analgesia = 55
Tissue inspection and disposal = 57
Postoperative monitoring = 58
Discharge instructions = 58
Post-abortion family planning = 60
Infection control = 66
Management of rhesus-negative abortion patients = 68
Laboratory requirements = 68
References = 69
Additional reading = 70
Chapter 8 : Information and counselling for the patient = 71
Needs for medical information = 71
Counselling = 73
References = 76
Chapter 9 : Facilities and equipment = 77
Facilities for emergency abortion care = 77
Facilities for elective abortion = 82
Outpatient care = 82
Caseload considerations = 83
Patient flow = 83
Equipment and drugs for emergency and elective abortion care = 84
Chapter 10 : Personnel : tasks, training and supervision = 89
Tasks in abortion care = 89
Training = 90
Staff supervision = 94
Staff attitudes = 95
References = 96
Chapter 11 : Overcoming obstacles to access through decentralization, referral, transport and coordination = 97
Delegation of functions between the different levels of abortion care = 97
Referral systems = 98
Transportation issues = 99
Coordination within facilities = 100
References = 101
Chapter 12 : Quality of care, monitoring and evaluation = 102
Quality of care = 102
Monitoring = 104
Evaluation = 104
Record-keeping = 105
Ensuring the medical quality of abortion care = 106
Operations research = 107
References = 108
Additional reading = 108
Chapter 13 : Cost-effective management of abortion care services = 109
Budgeting for abortion care = 110
Sources of funding for abortion care = 112
Financial management and audit = l13
References = 113
Chapter 14 : Prevention of unsafe abortion : a safe motherhood intervention = 115
Educating the public = 116
The role of family planning in preventing abortion = 116
Expanding access to safe, high-quality emergency abortion care = 118
The role of elective abortion = 120
Alliancestoimprovematernalhealth = 120
References = 121
Annex l. Infection control procedures = 122
Annex 2. Equipment and drugs needed for abortion care = 129
Annex 3. Training materials = 138
Annex 4. Model records for use in abortion care services = 145
