Postabortion Family Planning Operations Research Study in Perm, Russia

According to this 71-page report published by the Frontiers in Reproductive Health at the Population Council, the introduction of postabortion family planning service delivery, involving training in counseling skills and job aids for providers, led to increased use of modern contraceptive methods at 12 months postabortion. Provision of family planning counseling at a postabortion follow-up visit appears to be an important factor in reducing repeat abortions.

From the Executive Summary

The number of abortions carried out in Russia has declined dramatically over the past decade, thanks to a growing use of contraception that has been prompted, in part, by the government family planning program. However, Russia continues to have one of the highest rates of abortions in the world, with three out of five pregnancies ending in abortion. Rates of repeat abortion are of particular concern to health authorities, as two out of five abortion clients report having terminated another pregnancy within the previous two years.

In August 2000, EngenderHealth, the Population Council's FRONTIERS Program and the Research Center of Obstetrics, Gynecology, and Perinatology of the Russian Academy of Medical Sciences (RAMS), with support from the Perm Health Departments, undertook an operations research study to test models for increasing contraceptive use and reducing the repeat abortion rate among abortion clients in Perm, Russia. The study also assessed the direct and indirect costs of abortion and contraceptive use incurred by women in the year following their index abortion (the abortion which took place the day of entry into the study).

Researchers interviewed 1,516 women who had an elective abortion procedure at five facilities in Perm, Russia before and after two models of interventions were carried out through the John Snow, Incorporated, Women and Infant Project (JSI/WIN). The Model I intervention sought to institutionalise pre-discharge family planning counseling and information for all postabortion clients and to ensure that this counseling would be carried out in a respectful, non-judgmental, and non-coercive manner. This was accomplished through:

• Training health care providers in family planning counseling and interpersonal communication skills;
• Developing and supplying provider job aids and client-education materials on postabortion family planning.

The Model II intervention employed all the elements of Model I but also provided clients with a free initial supply of contraceptive commodities.

The findings of the study were significant for the training interventions and dissemination of educational materials and job aids. The study showed an increase in client and provider knowledge of postabortion family planning after the intervention, as well as a 20% increase in the use of modern contraceptive methods at twelve months postabortion among the intervention groups. Clients who participated in counseling interventions after the training had a greater knowledge of fertility return and the correct use of family planning methods during the postabortion period than did those counseled before the training interventions. In addition, the repeat abortion rate at the study sites declined dramatically at one year after the intervention, dropping by half to a level of 10%.

The availability of commodities increased the likelihood that providers would discuss family planning with abortion clients and that clients would be discharged with a method; however, it did not result in a significant increase in the use of contraception at 12 months postabortion, compared to clients who only received counseling. Health care workers appeared more motivated and more likely to provide family planning counseling to abortion clients if family planning methods are available and if management buy-in and support is present.

With the exception of costs related to the use of the IUD, the financial costs to the client of using a contraceptive method over the course of one year were significantly higher than the costs of abortion. However, given that abortion has costs to the health care system, which were not measured by this study, it would be premature for health care administrators, policy-makers, and insurance companies in Russia to conclude that abortion is "cheaper" than contraception.

Results of the study indicate that institutionalising family planning counseling for all abortion clients is a low-cost quality-enhancing intervention for the existing healthcare system that does not require increased personnel, purchase of expensive equipment, or remodeling of health care facilities. Because of this, the counseling interventions included in the study can be easily replicated in any Russian oblast or city health care facility.

Click here to download this report in PDF format [2.7 MB].