**Postabortion Care (PAC): Meeting Women's Health Care Needs After**

**Miscarriage and Unsafe Abortion**

**The Problem.** Each year approximately 600,000 women die as a direct
result of pregnancy. Complications from abortion resulting from
unplanned pregnancy are a primary cause of these deaths.

Complications can occur after miscarriage or unsafe abortion and may
require access to quality services equipped to provide lifesaving drugs,
transfusions and other interventions. Globally, the highest rates of
unsafe abortion occur among married women between 20 to 24 years of age.
Further, a mother's death from complications of pregnancy and labor is
associated with increased risk of infant and child mortality and other
detrimental effects on her family. For example, data from Bangladesh
suggest that a child who has lost his mother is 10 times more likely to
die before his tenth birthday than a child whose mother is alive.

**PAC is affirmed by the Bush Administration.** The press release
accompanying President Bush's Memorandum of January 22, 2001 restoring
the Mexico City Policy stated that "\[t\]he President's clear intention
is that any restrictions do not limit organization from treating
injuries or illnesses caused by legal or illegal abortion, for example,
post-abortion care." Today USAID funds PAC programs in more than 20
countries in 4 regions.

**What is "postabortion care" (PAC)?**

Postabortion care \[PAC\] reduces maternal mortality and morbidity, and
helps prevent repeat abortion by delivering reproductive health and
family planning services. PAC interventions supported by USAID include:

> 1.      Emergency treatment of potentially life threatening
> complications, including a thorough history, physical examination,
> pelvic examination, and management of complications (which may include
> treatment of hemorrhage, infection and other problems, pain
> management, and  vaccination to prevent tetanus).
>
>  
>
> 2.      Family planning and other counseling and selected services. 
> Family planning helps women to avoid future unplanned pregnancies and
> the associated risk of another unsafe abortion or miscarriage.  Access
> to family planning has consistently been associated with decreased
> rates of abortion.  Furthermore, women receiving emergency care often
> have other reproductive health-related needs, including diagnosis and
> treatment of sexually transmitted infections (STIs), and voluntary
> counseling and testing for HIV/AIDS.
>
>  
>
> 3.      Community awareness and other support to help women get
> emergency treatment, recover and prevent future unplanned
> pregnancies. 
>
>  

**Obstacles to care.** Access to emergency treatment is limited by the
same kinds of factors that inhibit access to care for post-partum
emergencies. Separation of family planning from emergency services is a
principal obstacle in linking post-abortion clients to the services that
can help prevent repeat abortions. Linkages to other services, for
example, HIV/AIDS counseling and testing, are often complicated by the
organization of services.

Program priorities to improve the utilization and impact of PAC services
include the integration of education about PAC services into other
health, community and youth programs and the scaling up of PAC services.

**[Frequently asked questions about PAC]{.underline}**

**1. How are complications including hemorrhage treated?** Treatment
includes pain management, infection prevention and, in the case of
hemorrhage, the removal of any tissue left after a miscarriage or an
unsafe abortion. Providers have relied on dilation and curettage \[D&C\]
to remove uterine tissue. However, in many countries, women who face
life-threatening bleeding are unable to get to clinics with equipment
and trained staff needed to provide such treatment. An effective,
alternative technology to treat hemorrhage is manual vacuum aspiration
(MVA).

**2. What is MVA?** Manual vacuum aspiration \[MVA\] is a method of
suction that is effective in treating post-abortion complications. MVA
can be performed by trained nurses and can be used in settings where
physicians and operating rooms are not available, thus bringing
treatment closer to the women who may need it in emergency situations.

**3. What are the advantages and disadvantages of MVA?** MVA offers
significant advantages over D&C, including reduced risk of complications
and significantly less blood loss. MVA will be unsuccessful in stopping
bleeding in a small percentage of cases. Furthermore, because women do
not need general anesthesia, recovery time is short, allowing the
patient to be treated on an outpatient basis. There is some risk that
MVA may be misused to perform illegal abortions. This risk is comparable
to the risk of misuse of other medical interventions.

4**. Does USAID provide MVA kits?** No. As a matter of policy USAID does
not purchase or distribute MVA equipment for any purpose.

5.  **Is U.S. foreign assistance used to perform or promote abortion as
    a method of family planning?** No. Under the Helms Amendment[^1],
    U.S. foreign assistance is prohibited from being used to perform or
    promote abortion as a method of family planning. "Menstrual
    regulation" and medical abortion \[i.e. RU-486\] are considered
    abortion and are thus activities that are prohibited from receiving
    USAID funding.

6.  **How do we know that groups comply with USAID's abortion policy?**

Strict procedures exist to ensure Agency policies and requirements are
implemented, including:

**Legally binding agreements.** The standard provisions that are
included in all agreements and contracts that receive population funds
specifically prohibit the use of USAID funds to finance, support, or be
attributed to the following activities: procurement of equipment or
distribution of equipment intended to be used for the purpose of
inducing abortions as a method of family planning; special fees or
incentives to women to coerce or motivate them to have abortions;
payment to people to perform abortions or to solicit women to undergo
abortions; information, education, training or communication programs
that seek to promote abortion as a method of family planning; and
lobbying for abortion. Agreements and contracts are legally binding
agreements that can be terminated for noncompliance.

**Close technical monitoring.** Through field visits USAID closely
monitors implementation of its technical activities. With the
restoration of the Mexico City Policy on January 21, 2001, all foreign
NGOs receiving assistance for family planning were prohibited from using
any funds to perform or actively promote abortion as a method of family
planning. US NGOs and foreign governments, while able to use their
non-USAID resources to engage in abortion-related activities where
legal, are required to keep their USAID funds in segregated accounts and
are prohibited from using them to perform or promote abortion as a
method of family planning. Furthermore, recipients are acutely aware
that non-compliance with USAID's abortion policy would jeopardize their
family planning funding and therefore have a powerful incentive to
comply.

**Special monitoring activities.** In 1990 USAID conducted a study of
the implementation of the Mexico City Policy. The review, which included
visits to USAID-supported US NGO and foreign NGO sites, concluded that
"Both the recipients of assistance \[US NGOs\] and their subgrantees
\[foreign NGOs\] were found to be in complete compliance with the
requirements of the Mexico City Policy." More recently, a GAO review
found USAID to be in fully compliance with all restrictions affecting
population funding.

**Regular Audits.** Beyond technical and financial monitoring by USAID
staff, USAID grantees and contractors are required to maintain extensive
documentation of activities and expenditures of foreign partners. They
are subject to regular independent audits to ensure that their funds are
used as intended.

**Office of Inspector General Audits.** When the USAID/OIG audits family
planning activities, the terms of reference include assessing compliance
with all relevant requirements.

7.  **Have any violations of USAID policy regarding abortion ever been
    identified?**

No. Since 1973 internal or independent oversight investigators have
found no violations.

[^1]: See Section 104(f) of the Foreign Assistance Act of 1961, as
    amended, and in the Foreign Operations, Export Financing, and
    Related Programs Appropriations Acts, including, most recently, the
    2003 Appropriations Act (See Title II, Bilateral Economic
    Assistance, Child Survival and Health Programs Fund).