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Postabortion Family Planning in Kyrgyzstan

Postabortion Family Planning in Kyrgyzstan. Key Findings, Interventions and Expected Results. Leah Levin, MHS Richard Mason, MPH Regional Coordinator, E. Europe and Eurasia Monitoring and Evaluation Specialist IntraHealth International, Inc. IntraHealth International, Inc.

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Postabortion Family Planning in Kyrgyzstan

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  1. Postabortion Family Planning in Kyrgyzstan Key Findings, Interventions and Expected Results Leah Levin, MHS Richard Mason, MPH Regional Coordinator, E. Europe and Eurasia Monitoring and Evaluation Specialist IntraHealth International, Inc. IntraHealth International, Inc. PRIME II Project PRIME II Project

  2. Presentation topics: • Fertility regulation and contraception in Kyrgyzstan • Assessment goal and objective • Key performance gaps • Interventions • Next steps

  3. Geography

  4. Induced Abortion in Kyrgyzstan • 30% of women of reproductive age have had an abortion • 60% of women who have had an abortion have more than one • 75.7% of women who terminated their last pregnancy had not been using a method • 27% of induced abortions were preceded by a method failure • Abortion rate is highest among women with 3-4 number of living children

  5. Contraceptive Use • 49% of married women use modern method • 38% use an IUD • followed by condoms, pills and traditional methods • Most of these users are 30-44 years of age • 94% of women age 30-49 do not use and do not intend to use an FP method • menopause (32.5%) • subfecund or infecund (30%) • infrequent sex (13%) • wants more children (9.8%) • opposed (5.4%) • health concerns (2.6%)

  6. Postabortion FP Initiative Goal: • Increase the use of FP by postabortion women Objective: • Develop and test an approach to increasing the availability and use of FP services by postabortion women

  7. Assessment Overview Methodology • Interviews with providers • Exit interviews with clients • Observations of FP counseling between provider and postabortion client • Inventories of facilities where abortion and FP are provided • Focus groups discussions with women and men

  8. Sample Facilities where abortions are provided: 5 • Abortion providers: 26 • Postabortion clients: 104 Facilities where FP is provided: 22 • FP providers: 18 • FP clients: 67 Provider/postabortion client FP counseling observations: 41 Focus groups • Married women > 2 children: 2 (n=30) • Married women > 4 or less children: 2 (n=30) • Married men 20-40 years old: 2 (n=30)

  9. Postabortion Client Profile • Average age: 31.2 years • Marital status: 92.3% married • Number of living children: 2.6 • Number of abortions: • Average number 1.6 • Maximum number 5 • 55.3% had more than 1 abortion

  10. Profile of Providers of Abortion Services • 100% ob/gyns • 92.3% female, 7.7% male • Mean age: 43.8 years • Average length of service: 10.5 years • Average # of abortions performed in last 3 months (per abortion provider): 16.9

  11. PAFP Gold Standard • Postabortion contraception reduces repeat abortion (Johnson and B’desh) • Postabortion contraception should start immediately for women who want to prevent unintended pregnancy (before woman leaves facility) Laht… • Postabortion FP counseling and methods offered in the same ward or service by same provider is the most preferred and most effective model (Solo) *Sources: Lähteenmäki 1993; Lähteenmäki et al 1980 **Source: Johnson et al 2002

  12. Key Performance Gaps • Immediate FP services not available to postabortion women who want FP services • Family planning commodities not always available at facilities 3. Clients and consumers mis-informed about potential side-effects and health effects of contraceptives

  13. Gap 1: Immediate PAFP services available Information for postabortion clients on return to fertility • Desired performance: All abortion providers tell all postabortion women they can become pregnant as early as 11 days after an abortion • Actual performance: 4.8% of providers gave correct information during observations

  14. Gap 1 Abortion provider knowledge about appropriate methods for use by postabortion women • Desired performance: 100% of providers know that most postabortion clients can use injectables, pills and IUDs immediate postabortion • Actual performance • 30.8% of providers said a postabortion woman must wait for her period to return before she can begin injectable • 15.4% said a postabortion woman must wait for her period to return before she can begin pills *no IUD knowledge baseline was collected

  15. Gap 1 Proper information given on potential side effects • Desired performance: • 100% of providers counsel postabortion women on potential side effects of their chosen FP methods • Actual performance: • 30.8% of providers counseled postabortion women on potential side effects of chosen FP method

  16. Gap 1 Postabortion woman receives FP method before leaving the facility • Desired performance: • 100% of postabortion women who chose a method in stock leave the facility with that method • Actual Performance: • 85.6% of postabortion clients chose a method • 19.2% of those received a method • 53.6% said method was not available • 28.9% were told to come back later

  17. Gap 1: Interventions • Develop protocol for PAFP services for use by providers of abortion services • MOH working group underway • Training of trainers in PAFP counseling and service delivery • 7 PAFP counseling and clinical updates for family doctors and ob/gyns who provide abortions • 7 PAFP counseling and clinical updates for midwives at Family Medical Practices

  18. Gap 2: Family Planning Commodities Availability of FP methods in facilities where abortions are provided • Desired performance: • Facilities offering abortion should have 4 most popular methods available for postabortion women • Actual performance: • 2 facilities had all 4 methods in stock at time of assessment • 2 facilities had no methods in stock at time of assessment

  19. Gap 2: Interventions: • Monitoring of contraceptive stocks in intervention facilities • Send monitoring reports to local facility chiefs, UNFPA and local and national MoH representatives

  20. Gap 3: Community/Client Education Misinformation about FP, especially postabortion, and other fertility issues • Desired performance: • Consumers and postabortion women have correct knowledge about fertility and FP • Actual performance: • 49% of postabortion women did not know when during their menstrual cycle they could get pregnant* • Women have misconceptions about side effects – pills give you cancer and hairy legs** • Insufficient access to education in rural areas** *Kyrgyzstan DHS, 1997 **Focus group discussion

  21. Gap 3: Interventions: • Radio messages in markets • Print or obtain existing informational materials (UNFPA, ZdravPlus) • Prepare women leaders in the Aliakh (like mukhala for women) to promote correct information about FP, especially postabortion and other key fertility messages

  22. Next Steps • Finalize official MOH PAFP protocol • Implement and monitor interventions

  23. Thank you www.prime2.org

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