Glob Health Sci Pract. 2016 Sep 29;4(3):495-505.

Improving the quality of postabortion care services in Togo increased uptake of contraception

Mugore S, Kassouta NT, Sebikali B, Lundstrom L and Saad A

Introduction: High-quality postabortion care (PAC) services that include family planning counseling and a full range of contraceptives at point of treatment for abortion complications have great potential to break the cycle of repeat unintended pregnancies and demand for abortions.

Methods: We describe the first application of a systematic approach to quality improvement of PAC services in a West African country. This approach-IntraHealth International's Optimizing Performance and Quality (OPQ) approach-was applied at 5 health care facilities in Togo starting in November 2014.

Results: A baseline assessment identified the following needs:

  • - reorganizing services to ensure that contraceptives are provided at point of treatment for abortion complications, before PAC clients are discharged;
  • - improving provider competencies in family planning services, including in providing long-acting reversible contraceptive implants and intrauterine devices;
  • - ensuring that contraceptive methods are available to all PAC clients free of charge;
  • - standardizing PAC registers and enhancing data collection and reporting systems;
  • - enhancing internal supervision systems at facilities and teamwork among PAC providers; and
  • - engaging PAC providers in community talks.
  • Solutions devised and applied at the facilities during OPQ resulted in significant increases in contraceptive counseling and uptake among PAC clients: During the 5-month baseline period, 31% of PAC clients were counseled, while during the 13-month intervention period, 91% were counseled. Of all PAC clients counseled during the baseline period, 37% accepted a contraceptive, compared with 60% of those counseled during the intervention period. Oral contraceptive pills remained the most popular method during both periods, yet uptake of implants increased significantly during the intervention period-from 4% to 27% of those accepting contraceptives.

    Conclusions: This result demonstrates that the solutions applied maintained method choice while expanding access to underused long-acting reversible contraceptives. OPQ shows great potential for sustainability and scale in Togo and for application in similar contexts where the health system struggles to offer safe, high-quality, accessible PAC services.

    Comment: This paper from Togo is very relevant for all health care providers working with safe abortion: it is imperative that in places where safe abortion is offered, there is easy access to contraceptives, preferably long-acting reversible ones. (HMV)