INPAC

Integrating Post-Abortion Family Planning Services into China's existing abortion service in hospital settings

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 Obiettivo del progetto (Objective)

'In 2008 an estimated 13 million induced abortions were conducted in China. Induced abortions are associated with a high risk of injury or long-term physical and psychological morbidity and a heavy social and economic burden. Most abortions occur in cities and the epidemic affects young and unmarried women as well as rural-to-urban migrant women.

The large number of abortions is primarily due to contraceptive failure or no use of contraception. The Chinese Family Planning (FP) program focuses mainly on birth control among married couples and the services are provided by an independent FP system. Young and unmarried women including rural-to-urban migrant women are less likely to access professional FP services. Abortion is a commonly used way to end unwanted pregnancy, however, post-abortion family planning services are often lacking in hospital settings.

The INPAC project consortium proposes to integrate post-abortion family planning services into existing abortion services in hospital settings in China and to evaluate the effectiveness of the interventions in terms of reduction of unwanted pregnancies and repeat abortions. Based on the project findings, policy recommendations on health system organization aiming to improve equitable access to reproductive healthcare and FP service will be developed.

Context-specific interventions will be developed based on a situation analysis of the effects of the current FP policy and a feasibility assessment of the integration approach. The proposed interventions will be implemented in 30 divisions of mainland China and evaluated with regard to its effectiveness. The project will contribute to standardize the post-abortion family planning services and decrease 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.'

Introduzione (Teaser)

In China, about 13 million induced abortions occurred in 2008. To reduce this number, an EU-funded project is looking at the feasibility of post-abortion counselling.

Descrizione progetto (Article)

The large number of induced abortions is primarily due to contraceptive failure or irregular/no use of contraception. Most of these procedures are performed in a hospital setting, though family planning (FP) clinics also can provide them. Post-abortion family planning (PAFP) is often lacking in hospital settings, and women are often not referred to FP clinics for counselling.

To address these issues, the EU-funded project http://www.inpacproject.eu (INPAC) is assessing the needs and feasibility of integrating PAFP into abortion services in hospitals. This is being accomplished through a review of FP policy and current practices in China, as well as in developed and developing countries. The project also will be conducting an intervention involving policymakers, health managers, abortion service providers, and women who have undergone abortion. The end result will be detailed strategies for improving access to and quality of FP services.

To date, the project has completed its critical review of China's policy and practice of family planning. The review included qualitative and quantitative components. The qualitative study was conducted in three provinces in different economic regions. INPAC held 18 focus groups with key stakeholders on such topics as sexual behaviour, abortion, current FP policy, and current post-abortion FP services.

The quantitative component included information about the provision and utilisation of abortion services and characteristics of these services. A total of 295 hospitals, nearly 80 000 women, and 600 health providers were included in the analysis.

Based on this work, a three-arm cluster randomised controlled trial has been designed. Two interventions are aimed at optimising PAFP in hospitals to increase the use of more effective contraceptive methods and reduce unintended pregnancies and repeated abortions. The intervention is being implemented in 90 hospitals in 30 provinces.

Based on the findings of the study, INPAC will ultimately develop policy recommendations on sustainable strategies for enhancing equitable access to reproductive health care.