Replacement of dilation and curettage/evacuation by manual vacuum aspiration and medical abortion, and the introduction of postabortion contraception in Pakistan

• Published in: International journal of gynecology and obstetrics 2014-07, Vol.126 (S1), p.S40-S44
• Main Authors: Zaidi, Shahida, Yasmin, Haleema, Hassan, Lubna, Khakwani, Mehnaz, Sami, Shehla, Abbas, Tazeen
• Format: Article
• Language: English
• Subjects: Abortifacient Agents, Nonsteroidal - administration & dosage; Abortion, Incomplete - therapy; Aftercare - methods; Contraception - methods; Dilatation and Curettage - methods; Dilatation and Curettage - statistics & numerical data; Dilation and curettage; Female; FIGO initiative; Gynecology - organization & administration; Hospitals, Public; Humans; Manual vacuum aspiration; Medical abortion; Misoprostol - administration & dosage; Obstetrics - organization & administration; Obstetrics and Gynecology; Pakistan; Postabortion contraception; Pregnancy; Prevention; Societies, Medical - organization & administration; Unsafe abortion; Vacuum Curettage - methods; Vacuum Curettage - statistics & numerical data
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2014.03.016

Abstract Manual vacuum aspiration (MVA) and medical abortion were introduced to replace dilation and curettage/evacuation for incomplete abortions, and postabortion contraception was provided in 5 selected public hospitals in Pakistan. In the largest hospital, an Ipas MVA training center since 2007, MVA use reached 21% in 2008. After the International Federation of Gynecology and Obstetrics (FIGO) and UNFPA provided MVA kits, MVA use increased dramatically to 70% − 90% in 2010 − 2013. In 2 of the remaining 4 hospitals in which the Society of Obstetricians and Gynecologists of Pakistan trained doctors in May 2012 and January 2013, the target of having 50% of women managed by MVA and medical abortion (MA) was met; however, in the third hospital only 43% were treated with MVA and MA. In the fourth hospital, where misoprostol and electric vacuum aspiration use was 64% and 9%, respectively, before training, an MVA workshop introduced the technique. Postabortion contraception was provided to 9% − 29% of women, far below the target of 60%.