The INPAC project proposes to integrate the post-abortion family planning (PAFP) services into existing abortion services in hospital settings in China, and to evaluate the effectiveness of the interventions in terms of reduction of unintended pregnancies and repeated abortions.
Based on the project findings, policy recommendations on health system organization aiming at improving equitable access to reproductive healthcare more specific to FP services will be developed.
The project will contribute to standardizing the post-abortion family planning services and to decreasing the long-term costs related to abortion in China. The results of this research will also be of interest to other countries with high abortion rates.
INPAC project has been designed in four phases distributed by 9 work packages (WP).
In China, thirteen million induced abortions were estimated in 2008, of which one third were repeated abortions. Repeated induced abortion is associated with a high risk of long-term physical and psychological morbidity and with a heavy social-economic burden. The direct medical costs for abortion were 3 billion Chinese Yuan in 2002 (326 million euro) and it has been growing with the increase of the number of abortions.
The large numbers of induced abortions in China are primarily due to contraceptive failure or less/no use of contraception, abortion is a common way to end an unintended pregnancy. The vast majority of induced abortions are performed in hospital settings, though family planning clinics also provide abortion services. PAFP services are often lacking in hospital settings and women who have undergone abortion are usually not referred to family planning clinics for FP counselling and services. The fragmentation of FP services is leaving high risk to vulnerable groups such as young and unmarried women, as well as rural-to-urban migrant women.
The INPAC project aims to develop an optimal post-abortion family planning service package in hospitals settings in China, thus to increase the use of contraception and reduce the rates of unintended pregnancy and repeated abortion.
The preliminary results achieved for phase I are described below:
The critical review (WP2) was conducted on a total of 210 full-text documents among 790 identified articles from 18,538 citations. As a conclusion of the review: Free technical services mainly focus on married couples, while the relevant policy for unmarried youth and migrant population is not fully developed; Repeated abortion rate varied from 19.0% to 57.9% depending on different study population; The reason for abortion is mainly no contraceptive use or contraception failure; Unmarried and migrant youth and adolescents were mainly underserved population; Policy on PAFP is currently absent in China. In addition, factors in relation to provision, utilization and quality of FP and PAFP service in China include social-economic factors, demonstration factors of the abortion users, physical environment, as well as social support network.
There are two components of the detailed situation analysis (WP3): a qualitative study and a quantitative survey.
The qualitative study has been conducted in 3 provinces in different economic regions. A total of 18 focus group discussions and 93 in-depth interviews were carried out on the perceptions of key stakeholders (abortion service users, different groups of women and men in the general population, policy makers, health service managers and health service providers) of the social and health systems context for PAFP, including sexual behaviour, abortion, current FP policy, current post-abortion FP services and the feasibility of the integration approach.
Six themes have been identified including:
The quantitative research maps provision and utilisation of abortion services, and the characteristics of service users, assesses the capacity of hospitals for providing PAFP, and identifies the knowledge, attitudes and practises of medical staff towards PAFP. A total of 295 hospitals, nearly 80,000 women seeking abortion and 600 health providers were included in the analysis.
The preliminary results show that
However, barriers exist in lack of human resources, insufficient knowledge of PAFP, lack of access to technical guidelines and training materials, limited counselling time and inadequate counselling environment, as well as lack of policy and management supports.
Based on the final project results, optimized PAFP service packages in hospital settings in China will be developed with standard PAFP service procedures and training materials, this would optimize the PAFP services in China national wide.
A coherent approach to the health system policies will also be expected, especially to the organization, management and to the delivery of more efficient, socially equitable and sustainable reproductive health services, hence to reduce the rates of unintended pregnancy and repeated abortion in a long run.
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