Measuring successes and challenges: Evaluating comprehensive abortion care in Vietnam

Ipas’s comprehensive abortion care project is changing how Vietnamese health-care workers approach abortion care and also how patients experience that care.

In 2001, Ipas, the Vietnamese Ministry of Health and two obstetrics-gynecology (ob-gyn) hospitals launched a comprehensive abortion care (CAC) project in Vietnam’s two leading ob-gyn hospitals and four public health facilities in Dong Nai and Hai Phong provinces.

Evaluations of the project’s impact show marked improvements in the quality of services and women’s abortion-care experiences in CAC sites, which now include provincial, district and commune health facilities. Importantly, CAC sites provided significantly higher quality services than similar facilities that did not take part in the CAC project.

Abortion services have been widely available through the second trimester in the Southeast Asian country since 1960. With contraceptives in short supply and pregnancy termination relatively inexpensive and accessible, many Vietnamese women have relied on abortions to control their fertility.

Today, Vietnam has a disproportionately high abortion rate; in the mid-1990s, research estimated that as many as 1.5 million abortions were performed each year and in 2003, the Ministry of Health reported more than 500,000 procedures.

Though abortion services have been available in Vietnam, quality has varied. But in the Ipas-pioneered CAC model, care is tailored to suit the needs of the individual woman while upholding high health-care standards. It uses internationally recognized abortion technologies, such as manual vacuum aspiration (MVA), and counseling to guide the patient through a process that goes beyond the procedure itself. Essential to this model is counseling to help women choose effective contraceptive methods suitable for their circumstances. Postabortion follow-up is also an important element of the CAC approach, and patients may be referred to other reproductive-health services.

An Ipas evaluation of CAC services at the initial six sites interviewed 103 clients immediately after their abortion experience; judged facilities’ performance on technical and administrative indicators; and polled health-care staff about implementing the model.

The evaluations of sites at all levels have presented valuable insights into successes. Almost all the clients said that they had received medicine to make the abortion procedure less painful and that their provider warned them about the risk of pregnancy before their next menses if they engaged in intercourse without contraception.

Furthermore, 98 percent of the patients reported that they were scheduled for follow-up care and that the abortion provider seemed interested in her health. Among the women polled, almost all (96 percent) reported that they’d been informed about different contraceptive methods, but only 60 percent had received a method at the time of interview.

Yet the fact that multiple contraceptive methods were discussed is, in itself, a distinct improvement. One health facility staffer noted the change: “Before, we often introduced one contraceptive method to the clients and only mentioned the good points and ignored the disadvantages of the method. Now, we tell the clients all advantages and disadvantages of each method and then counsel them to choose the most relevant method. … In the past, we worked as a machine, just provided [the] clinical procedure for abortion and said nothing about contraception.”

In addition to gauging women’s CAC experience, the evaluation also charted the transition from dilatation and curettage (D&C) to less risky termination methods, including MVA or electric vacuum aspiration. Only two women in the sample received D&C, a method associated with higher complication rates than either aspiration technology.

These positive changes translate into better health care for women, but there are still areas that need attention. For instance, counseling about using condoms to prevent HIV or other sexually transmitted infections or recognizing postabortion complications were inconsistent from facility to facility. Stakeholders suggested that training expand to  include adolescent issues, domestic violence and HIV/AIDS.

As part of the CAC project, Ipas and partners trained physicians and other providers on the use of MVA; helped establish guidelines about record-keeping and standard health-care practices, such as preventing infection; and introduced medication abortion and safer second-trimester abortion methods in some settings. With technical assistance from Ipas, the Vietnamese Ministry of Health will expand the CAC model to several more provinces.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258