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The impact of post-abortion care family planning counselling and services on women in low-income countries: a systematic review of the evidence

What do we want to know and why?

In 2010, the UK government strengthened its commitment to family planning as a strategy to reduce maternal mortality, marking a significant shift in the UK’s approach to addressing the most off-track Millennium Development Goal: to improve material health.  Addressing the unmet need for post-abortion contraception to prevent repeat unplanned pregnancies remains a key part of the new developments in policy.  We systematically reviewed the evidence to identify the impact of providing post-abortion care family planning and services to women in low-income countries.

What did we find?

The current evidence on the use of post-abortion family planning counselling and services in low-income countries as a strategy to address the problem of unsafe abortion and its harmful consequences is inconclusive.  This is due to a lack of good quality evaluations measuring outcomes which are important for future programming and policy-making.  Currently, there is no evidence on the impact of post-abortion family planning counselling and services in low-income countries on maternal mortality or morbidity and there is insufficient evidence on their impact on repeat abortions and unplanned pregnancies. Although insufficient, there is promising evidence on the impact of post-abortion family planning counselling and services on acceptance or use of contraception. 

What are the implications?

There is a need for rigorous evaluations with research designs that can provide conclusive evidence about the impact of post-abortion counselling and services in low-income countries.  Abortion-related maternal mortality and morbidity are widely recognised as being difficult and expensive to measure, suggesting a need to focus on other outcomes of importance, particularly repeat abortions and unplanned pregnancies but also use of long-acting, semi-permanent methods of contraception.

Whilst the emerging body of research on this topic conducted in low-income countries is generally of low quality, it is encouraging that is supported by key partnerships between different stakeholders (including non-government organisations and government agencies), at both national and international level.  This suggests considerable potential for further research collaboration.

How did we get these results?

Systematic review procedures and techniques were used to generate the results.  The search was conducted in two phases and involved ten electronic bibliographic databases/specialist registers and the websites of nine organisations specialising in post-abortion care and/or reproductive health.  We also contacted the authors of included studies and other individuals, conducted citation searches and searched the reference lists of key papers. 

The systematic review uncovered 119 potential relevant reports, of which 15 were selected for the final in-depth review.

The EPPI-Centre reference number for this report is 1906.

Tripney J, Schucan Bird K, Kwan I, Kavanagh J (2011) The impact of post-abortion care family planning counselling and services in low-income countries: a systematic review of the evidence. Technical report. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.
ISBN: 978-1-907345-11-1

  
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