Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
CARE Democratic Republic of the Congo, Goma, DRC.
Glob Health Sci Pract. 2019 Aug 27;7(Suppl 2):S285-S298. doi: 10.9745/GHSP-D-18-00368. Print 2019 Aug 22.
Postabortion care (PAC) is a lifesaving intervention that, when accessible and of good quality, can prevent the majority of abortion-related deaths. However, these services are only sporadically available and often of poor quality in humanitarian settings. CARE International, the International Rescue Committee, and Save the Children strengthened the Congolese Ministry of Health to provide PAC, including voluntary contraceptive services, in North and South Kivu, DRC.
We aimed to gain understanding of the demographic and clinical characteristics of PAC clients, the experiences of women who sought PAC at supported health facilities, and the women's perceptions of the quality of care received. We also explored how client perspectives can inform future PAC programming.
A PAC register review extracted sociodemographic and clinical data on all PAC clients during a 12-month period between 2015 and 2016 at 69 supported facilities in 6 health zones. In-depth interviews were conducted between September 2016 and April 2017 with 50 women who sought PAC in the preceding 3 months at supported health facilities. Interviews were recorded, transcribed, and translated into French for analysis. Thematic content analysis was subsequently used as the data analytic approach.
In 12 months, 1,769 clients sought PAC at supported facilities; 85.2% were at less than 13 weeks gestation. Over 80% of PAC clients were treated for incomplete abortion, and of these, 90% were treated with manual vacuum aspiration. The majority (75.2%) of PAC clients chose voluntary postabortion contraception. All but one interview participant reported seeking PAC for a spontaneous abortion, although most also reported their pregnancy was unintended. Clients were mostly made aware that PAC was available by community health workers or other community members. Experiences at the supported facilities were mostly positive, particularly in regards to client-provider interactions. Most women received contraceptive counseling during PAC and selected a modern method of contraception immediately after treatment. However, knowledge about different methods of contraception varied. Nearly all women said that they would advise another woman experiencing abortion complications to seek PAC at a supported health facility.
The findings demonstrate the successful implementation of good-quality, respectful PAC in North and South Kivu. Overall, they suggest that the organizations' support of health workers, including competency-based training and supportive supervision, was successful.
流产后护理（PAC）是一种拯救生命的干预措施，在可及且质量良好的情况下，可以预防大多数与流产相关的死亡。然而，在人道主义环境中，这些服务只是零星提供的，而且往往质量较差。国际救助委员会、拯救儿童组织和 CARE 国际组织加强了刚果民主共和国卫生部在北基伍省和南基伍省提供 PAC 的能力，包括自愿避孕服务。
我们旨在了解 PAC 客户的人口统计学和临床特征、在受支持的卫生机构寻求 PAC 的妇女的经验，以及妇女对所接受的护理质量的看法。我们还探讨了客户观点如何为未来的 PAC 规划提供信息。
PAC 登记册审查从 2015 年至 2016 年期间的 12 个月内，从 6 个卫生区的 69 个支持设施中提取了所有 PAC 客户的社会人口学和临床数据。2016 年 9 月至 2017 年 4 月，对在过去 3 个月内在支持的卫生机构寻求 PAC 的 50 名妇女进行了深入访谈。访谈进行了录音、转录，并翻译成法语进行分析。随后使用主题内容分析作为数据分析方法。
在 12 个月内，有 1769 名客户在支持的设施中寻求 PAC；85.2%的人怀孕不到 13 周。超过 80%的 PAC 客户因不完全流产接受治疗，其中 90%的人接受手动真空抽吸治疗。大多数（75.2%）PAC 客户选择自愿流产后避孕。除一名参与者外，所有参与者都报告说她们因自然流产而寻求 PAC，尽管大多数人也表示怀孕是意外的。客户主要是通过社区卫生工作者或其他社区成员了解到 PAC 是可用的。在支持的设施中的体验大多是积极的，特别是在医患互动方面。大多数妇女在 PAC 期间接受了避孕咨询，并在治疗后立即选择了现代避孕方法。然而，她们对不同避孕方法的了解各不相同。几乎所有妇女都说，如果另一名经历流产并发症的妇女向她们寻求建议，她们会建议她在支持的卫生机构寻求 PAC。
这些发现表明，在北基伍省和南基伍省成功实施了高质量、有尊严的 PAC。总体而言，这些发现表明，这些组织对卫生工作者的支持，包括基于能力的培训和支持性监督，是成功的。
