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Governments in developing countries recognize the need for appropriate technology for the treatment of emergencies from incomplete abortion or miscarriage. Numerous studies have investigated the appropriateness of an integrated model of postabortion care (PAC) that includes three essential elements: emergency treatment for spontaneous or induced abortion; counseling and family planning services; and links to other reproductive health services. Many integrated PAC services include replacement of the conventional clinical treatment, sharp curettage (SC), with manual vacuum aspiration (MVA). In 1997 and 1999 the Population Council supported intervention studies in Mexico and Bolivia, respectively, to assess PAC programs in terms of safety, effectiveness, quality of care, cost, and subsequent contraceptive use by clients. Both interventions introduced integrated PAC services and compared the outcomes of MVA and SC use in large public hospitals. To assess changes in service quality and costs, researchers analyzed clinical records and interviewed clients and providers before and after the interventions. As noted in this summary, SC and MVA are equally safe and effective and can be provided on an outpatient basis. Integrating clinical treatment with family planning counseling and services increased clients’ knowledge and contraceptive use.






Frontiers in Reproductive Health