Making Strides in Postabortion Care Provision in Rwanda

Miscarriages and unsafe induced abortions are a worldwide health problem, resulting in the death of close to 70,000 women each year*. Postabortion care (PAC) is a strategy to address this problem by treating women with complications, providing family planning to prevent unintended pregnancy, and engaging communities to strengthen and create awareness of PAC services.

In Rwanda, dramatic increases in the use of modern contraception—from only 4% in 2000 to 27% in early 2008 (Demographic Health Survey)—are thought to have reduced unsafe abortions and miscarriages. However, anecdotal evidence suggests that providers sometimes refuse to offer postabortion care due to fear that they will be suspected of having performed the procedure. While data on abortion in Rwanda is extremely limited, it can be safely assumed that in many cases of abortion, both induced and spontaneous, women never make it to a health facility due to shame or fear and would risk dying in silence to avoid being accused of having an illegal abortion.

With support from the William and Flora Hewlett Foundation, IntraHealth International is working to improve PAC services in Rwanda, building on the country’s progress in creating a fully supportive environment for population, family planning, and reproductive health through policy development and effective program implementation, including emergency contraception and PAC services.

IntraHealth, through the USAID-funded Twubakane Program and the Capacity Project, trained hospital-based health workers in PAC as part of larger emergency obstetric and neonatal care training in 2008 and 2009. However, due to a shortage of manual vacuum aspirators (MVAs) in the country—essential to PAC services—many providers had not mastered or maintained competent skill levels in postabortion care.

Through support from the Hewlett Foundation, IntraHealth is supporting the procurement of MVA kits for two district hospitals, with plans to expand to two more. Building providers’ skills in both PAC and family planning contributes to the Government of Rwanda’s efforts in improving maternal health and decreasing maternal mortality.

In April and May 2010, IntraHealth conducted orientation sessions in two district hospitals—Byumba in Gicumbi District and Muhima in Nyarugenge District—with hospital directors, department heads, supervisors in charge of maternal health, and emergency obstetric care trainers. During these sessions, the hospital teams developed action plans to ensure greater availability of PAC services, including trainings for hospital staff and strategies to address the ongoing procurement of MVA kits.

Following these orientation and planning sessions, 20 providers from Muhima Hospital and 20 providers from Byumba Hospital were trained in the three]pronged approach to comprehensive PAC: provision of services, provision of family planning, and linkages to communities. Providers learned how to use MVA equipment and prevent and manage possible complications. The training also equipped providers with the ability to offer postabortion family planning services; prevent infections; treat incomplete abortions and miscarriages; conduct follow-up family planning/postabortion visits; and ensure referrals to community health workers. In addition, trainings focused on promoting family planning use in general, including dispelling misconceptions about postabortion and post-miscarriage family planning use.

In the next phase of the project, providers will receive post-training follow-up on MVA use; health center providers will be trained in the two districts, and data will be collected on postabortion care case management in the two district hospitals.

* Guttmacher, Singh S et al., Abortion Worldwide: A Decade of Uneven Process, New York: Guttmacher Institute, 2009.