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Use of long acting reversible contraceptive (LARC) methods in postabortal period

Presenter: Yolande Hyjazi

Objectives
Describe the background of PAC in Guinea; Describe the intervention to strengthen PAC services delivery introducing LARC methods;

Describe key results (PAC & LARC);


Discuss lessons learnt from the integration of PAC & LARC services

Background
Maternal mortality due to abortion complications: 17% (hospital based data in 1998); Contraceptive prevalence rate: 6% modern methods (0.1% for DIU, EDS 2005); PostAbortion Care (PAC): One of strategies adopted by the Ministry of Public Health to address maternal mortality reduction due to abortion and increase the use of FP services; Actions:
Since 1998: Jhpiego supports the MOH in collaboration with others

partners to implement PAC services gradually in 38 facilities


LARC: Identified by the MOH as strategy to revitalize family

planning in Guinea in 2008.


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PAC COMPONENTS (USAID MODEL)


FP Counseling, provision; selected RH (STI, HIV)

Emergency Treatment

Immediately do

Community empowerment trough community awarness and mobilisation

PAC sites in Guinea


Koundara Mali Gaoual Koubia Siguiri Dinguiraye Tougu

Lelouma
LABE BOKE Tliml Pita Dalaba

Kouroussa Dabola Boffa Fria KINDIA Dubrka MAMOU

Mandiana

FARANAH KANKAN

Coyah
CONAKRY Forcariah SIERRA LEONE Kissidougou Krouan

Guckdou

Beyla
Macenta

LIBERIA

NZEREKORE Lola Yomou

PAC Services: : Jhpiego : Hospital : EH : Health C

LARC & PAC INTEGRATION PROCESS


PAC services: an opportunity to reinforce the provision of LARC. 2011, integration of LARC into 24 sites offering PAC: Training Provision of equipment and supplies for service startup Orientation of all staff Transfer of learning and supportive supervision visits Availability of contraceptives where PAC services are provided; Development of trainers
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RESULTS 1
From January 2011 to June 2013:
4973 women benefited from PAC services

% of PAC cases by age group


LESS THAN 15 years 1%

15-19 yearsS 23% 25 Years and more 44% 20-24 years 32% 7

RESULTS 2
95% of the 4973 patients (4724) were counseled on family planning and healthy timing and spacing of pregnancy 3931 (79%) women left the service with one modern contraceptive method; (2007: 46% - 2012: 72%)

LARC as a method of choice were selected by 23% (IUD 21%, Implants 2%)
2007: 8% (IUD) 2012: 17% (IUD)

Pills are mostly used by 41% of women (2007: 45%; 2012: 42%) and
Injectables represent 22% (2007: 39%; 2012: 39%)
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LESSONS LEARNT
Train PAC providers to offer LARC, increases the method

mix and choice available to women, as well as their use;


Support for services startup, all staff orientation and large diffusion contributed to program success; The availability of all contraceptive methods including LARC were PAC are provided is key also;

Regular follow-up and supportive supervision help to


improve the quality of PAC services.
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CONCLUSION
PAC services are an opportunity to reinforce the provision

of LARC methods;
The use of LARC methods in postabortal period contribute on the reduction of FP unmet need.

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