Systematic review of experiences and effects of integrating post-abortion family planning services into existing health system worldwide

Objective: To systematic review and analyze the practices and effects of integrating post-abortion family planning (PAFP) services into existing health system worldwide in order to inform the future interventions to deliver PAFP in China. Methods: A systematic search for relevant published and unpublished literature was conducted. Based on a set of criteria, citation and full text were screened, related data were extracted. Findings of included studies were reviewed and analyzed using a textual narrative approach to synthesis. Results: A total of 28 studies were included in the synthesis. The studies were published between 1995 and 2008 and covered 20 countries. Some countries were in the stage of piloting post-abortion care (PAC)/PAFP intervention, while others were either from piloting to scaling up or examined how well a pilot PAC/PAFP intervention and resulting improvements were able to be maintained over the long term in the same intervention site. Most studies examined initiatives that were implemented at public sectors from tertiary, secondary to primary health facilities, while a few were implemented at private sectors. Efforts of integrating PAFP into existing health system from health system perspectives such as funding the programs, training of trainer (TOT) training or on the job training of physicians and mid-level service provider, expansion the range of contraceptive methods available including a few free distribution of contraceptives, improving data collection including cost analysis in a few countries, service guidelines provided to health professionals, supportive supervision at program sites to ensure quality of care, and leadership from government to strengthen PAC/PAFP service by revising or developing a new national policy. Effects of those intervention programs included that 2 studies decreased abortion rates, 7 studies improved modern contraceptive use, 1 study improved women's knowledge on sexual & reproductive health, and 5 studies reported women's high satisfaction rate with receiving PAC/PAFP services. Conclusion: Each study was conducted within a cultural, legal, social, and religious framework. There might be no single set of best practices that can be put forward as a model to integrate PAFP into existing health system in China. These areas should be taken into account in our future intervention including government's optimization and complement to the regulations related to abortion, contraception and PAFP, capacity building for service provider, continuous efforts to improve the quality of PAFP service, and accessibility of multiple contraceptive methods for married as well as unmarried youth.SCOPUS: ar.j