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Counselling on contraception and contraceptive method provision are key components of post-abortion care (PAC). Some studies have suggested that adolescent PAC patients receive worse care than older women seeking these services. This study aimed to evaluate an intervention whose goal was to improve the counselling and contraceptive uptake of PAC patients, with special attention given to the needs of adolescent patients, in the four public hospitals in the Dominican Republic where PAC services were not being routinely offered. The counselling intervention effort included provider training and the development of adolescent-friendly information, education and communication (IEC) materials. Eighty-eight providers were interviewed at baseline and 6 months after the intervention was implemented. Six months after providers were trained, 140 adolescent PAC patients (≤19 years of age) and 134 older PAC patients (20–35 years) were interviewed about the contraceptive counselling messages and contraceptive methods they received before they were discharged from hospital. The adolescent and older PAC patients were matched on study hospital and time of arrival. Significant improvements were noted in provider knowledge and attitudes. No changes were noted in provider-reported PAC counselling behaviours, with close to 70% of providers reporting they routinely assess patients' fertility intentions, discuss contraception, assess STI/HIV risk and discuss post-abortion complications. Adolescent and older PAC patients reported receiving PAC counselling messages at similar rates. Forty per cent of adolescent PAC patients and 45% of older PAC patients who wanted to delay pregnancy were discharged with a contraceptive method. Adolescents were more likely to receive an injectable contraceptive method whereas older women were discharged with a variety of methods. The PAC counselling intervention increased provider knowledge and improved their attitudes and benefited both adolescent and older patients.



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Achécar, M. M., Ramírez, N., Polanco, J. J., Ochoa, L. H., Lerebours, G. & García, B. (2003) Republica Dominicana: Encuesta Demográfica y de Salud (ENDESA 2002). Marco International Inc., Calverton, MD.
Archibong, E. I. (1991) Illegal induced abortion – a continuing problem in Nigeria. International Journal of Gynaecology and Obstetrics 34, 261265.
Barnett, B. (1993) Youth often risk unsafe abortions. Network 4, 1215.
Billings, D. L. & Benson, J. (2005) Postabortion care in Latin America: policy and service recommendations from a decade of operations research. Health Policy Planning 20, 158166.
Castro Martin, T. & Njogu, W. (1994) A decade of change in contraceptive behaviour in Latin America: a multivariate decomposition analysis. Population Bulletin of the United Nations 36, 81109.
Corbett, M. R. & Turner, K. L. (2003) Essential elements of postabortion care: origins, evolution and future directions. International Family Planning Perspectives 29, 106111.
Díaz, J., Loayza, M., Torres de Yépez, Y., Lora, O., Alvarez, F., Camacho, V. et al. (1999) Improving the Quality of Services and Contraceptive Acceptance in the Postabortion Clinic in Three Public Sector Hospitals in Bolivia. Population Council, New York.
EngenderHealth & Centro de Estudios Sociales Y (2003) Los Servicos de Postaborto para los Adolescentes de la Republica Dominicana. EngenderHealth, New York.
Farfan, O. B., Kestler, E. J., Aguilar, A., Mercedes, M., Jarquin, D., Vallecillos, G. et al. (1997) Información y consejería en planificación familiar post-aborto. Experiencia en cuatro hospitales de Centro América. La Revista Centroamericana de Ginecología y Obstetricia (REVCOG) 7, 4656.
Gillespie, D. G. (2004) Whatever happened to family planning, and, for that matter, reproductive health? International Family Planning Perspectives 30, 3438.
Girvin, S. (2004). Postabortion Care for Adolescents: Results from Research in the Dominican Republic and Malawi. EngenderHealth, New York.
Group, Y. F. P. W. (ed.) (2006) Technical Guidance on Youth-Friendly PAC. Postabortion Care Consortium, Washington, DC.
Henshaw, S. K. & Kost, K. (1992) Parental involvement in minors' abortion decisions. Family Planning Perspectives 24, 196207, 213.
Johnson, B. R., Ndhlovu, S., Farr, S. L. & Chipato, T. (2002) Reducing unplanned pregnancy and abortion in Zimbabwe through postabortion contraception. Studies in Family Planning 33, 195202.
Kestler, E., Valencia, L., Del Valle, V. & Silva, A. (2006) Scaling up post-abortion care in Guatemala: initial successes at national level. Reproduction Health Matters 14, 138147.
Leke, R. J. (1989) Commentary on unwanted pregnancy and abortion complications in Cameroun. Supplement International Journal of Gynecology and Obstetrics 3, 3335.
McCarraher, D., Oronoz, A. S., Grey, T., Tucker, H., Chen, M., Bailey, P. E. et al. (2007). Operations Research to Improve Post-Abortion Care (PAC) Services Among Adolescents in the Dominican Republic. Youth Research Working Paper No. 7. Research Triangle Park, NC.
Medina, R., Vernon, R. M. I. & Aquilar, C. (2001) Expansion of Postpartum/Postabortion Contraception in Honduras: Final Report. Population Council, New York.
Miller, R., Fisher, A., Miller, K., Ndhlovu, L., Maggwa, B., Askew, I. et al. (1997) The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services: A Handbook. Population Council, New York.
Miller, S., Lehman, T., Campbell, M., Hemmerling, A., Anderson, S. B., Rodriguez, H. et al. (2005) Misoprostol and declining abortion-related morbidity in Santo Domingo, Dominican Republic: a temporal association. BJOG 112, 12911296.
Miller, S., Tejada, A., Murgueytio, P., Diaz, J., Dabash, R., Putney, P. et al. (2002) Strategic Assessment of Reproductive Health in the Dominican Republic. Population Council, New York.
Olukoya, A. A., Kaya, A., Ferguson, B. J. & AbouZahr, C. (2001) Unsafe abortion in adolescents. International Journal of Gynecology and Obstetrics 75, 137147.
Paiwonsky, D. (1999) Social determinants of induced abortion in the Dominican Republic. In Abortion in the Developing World. World Health Organization, Geneva, pp. 131150.
Pathfinder International, The Futures Group International, Tulane University Health Sciences Center School of Public Health and Tropical Medicine & United States Agency for International Development (2001) FOCUS on Young Adults: Advancing Young Adult Reproductive Health: Actions for the Next Decade End of Program Report 2001. FOCUS on Young Adults, Washington, DC.
Population Council & Macro (2006) Dominican Republic 2002: results from the Demographic and Health Survey. Studies in Family Planning 37, 293298.
Quiterio, G., Molina, M., Miric, M., Vernon, R. & Rivero-Fuentes, M. (2008) Situational Analysis of the Integration of Family Planning in Postpartum, Postabortion, and Prevention of Mother-to-Child Transmission Programs in the Dominican Republic. Frontiers Population Council, Santo Domingo, Dominican Republic.
Rights, C. F. R. (2005) The World's Abortion Laws [updated 2007/03]. URL:
Robles, F. (2007) Raid fuels abortion debate in the Dominican Republic. Miami Herald, 23rd March 2007.
Singh, S. (2006) Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries. Lancet 368, 18871892.
Solo, J., Billings, D. L., Aloo-Obunga, C., Ominde, A. & Makumi, M. (1999) Creating linkages between incomplete abortion treatment and family planning services in Kenya. Studies in Family Planning 30, 1727.
Solo, J., Curtis, C., Malarcher, S. & Leonard, A. (2004) USAID: Post Abortion Care Strategy Paper. Population, Health, and Nutrition Information (PHNI) Project, Washington, DC.
Stuart, G. S. & Grimes, D. A. (2009) Social desirability bias in family planning studies: a neglected problem. Contraception 80, 108112.
Thapa, P. J., Thapa, S. & Shrestha, N. (1992) A hospital-based study of abortion in Nepal. Studies in Family Planning 23, 311318.
World Health, O. (2007). Unsafe Abortion, Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2003. WHO, Geneva.
Youth Friendly P. A. C. Working Group (2006) Technical Guidance on Youth-Friendly PAC. Postabortion Care Consortium, Washington, DC.


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