This chapter discusses two
related but conceptually distinct health concerns in low- and middle-income
countries (LMICs): (a) voluntary family planning, and (b) abortion, including
postabortion care. In the first section, on family planning, the health
condition of interest is unmet need: the percentage of women who would like to
either stop or delay childbearing but who are not using any contraceptive
method to prevent pregnancy. The unmet need for family planning (to either
limit family size or determine the intervals between children) results in
unintended and unwanted pregnancies, which in turn lead to a broad range of maternal
and child conditions that increase morbidity and mortality. Surgical procedures
for family planning can help reduce this unmet need, particularly the need to
limit childbirth.
The second section concerns surgery for induced abortion (as
opposed to spontaneous abortion, or miscarriage) and the surgical management of
the complications of induced, mostly unsafe, abortion. Unsafe
abortion is defined as abortion performed outside of health facilities (or any
other place legally recognized for the procedure) or by an unskilled person
(WHO 1992). The demand for abortion is high in many LMICs, and the illegality
of the procedure in most of these countries increases the likelihood of
postabortion complications from clandestine, unsafe procedures (Grimes and others
2006; Shah and Ahman 2009; Singh and others 2006; Singh 2010). Therefore,
postabortion care is a significant health issue in LMICs. Timely, safe surgical
interventions can reduce the morbidity and mortality associated with unsafe
abortions. The same surgical procedures used for abortion are also used to
manage incomplete abortion, which is one of the most common postabortion
complications and is often accompanied by other complications such as bleeding,
sepsis, and genital injury. The surgical procedures used to manage such
complications include laparotomy for sepsis and uterine injury and a wide range
of minor procedures to repair injuries to the proximal birth canal. Both
sections discuss the burden of reproductive health conditions, including morbidity,
mortality, and other effects. We discuss surgical procedures (their
performance, inputs, and implementation) and the health workforce implications
of scaling up those procedures in LMICs. We also explore evidence on the
procedures’ effectiveness in reducing morbidity and mortality and improving
quality of life as well as evidence on their cost-effectiveness.
Finally, we
outline future directions—including implementation challenges and
considerations for increasing access to these surgical interventions—and
conclude by summarizing the findings and recommendations.
Sections
- Introduction: http://goo.gl/iVswFu
- Surgery for Family Planning: http://goo.gl/iuVhp0
- Surgery for Abortion and Postabortion Care: http://goo.gl/IOODSg
Source
Essential Surgery: Disease Control Priorities, Third Edition (Volume 1). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2015 Apr. Chapter 7.
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