I. Objectives
1. Overall goal: To improve the effective contraceptive rate of women after abortion, and to reduce the phenomenon of repeated abortion, especially re-abortion within one year of abortion.
2. Specific objectives: To achieve the above overall objectives, women who undergo abortion should be enabled to meet the following four specific requirements before leaving the surgical institution.
(1) Awareness of the prevention of unwanted pregnancy;
(2) To make an informed choice of a contraceptive method that is appropriate for her;
(3) Access to the contraceptive of their choice or appropriate for their use during the transition period to ensure immediate implementation of contraception;
(4) Confidence and determination to understand and adhere to the correct use of the contraceptive method of choice.
II. Forms of service
A comprehensive overall service should be constructed, i.e., health education, counseling and contraceptive birth control services should be given equal importance. Among them, standardized contraceptive and birth control services are the basis, and the establishment and improvement of counseling services are the focus of work, on which health education is strengthened. The services should especially strengthen the popularization of contraceptive knowledge and the implementation of contraceptive measures for adolescents and high-risk groups after abortion.
The form of post-abortion family planning services should be based on individual counseling, with the implementation of contraceptive distribution.
Collective counseling is not conducive to the implementation of individualized contraceptive services and is therefore only used as an auxiliary form. Under extremely limited conditions, it can be used as a supplement to individual counseling, but it must include all the contents of “1” and “2” in “V. Basic information of counseling” below.
III. Timing of services
The first consultation and the first follow-up visit after abortion are the two most important services.
The first consultation should be conducted before abortion, avoiding the day of abortion, in order to ensure the quality of consultation and to prepare for the implementation of contraceptive measures immediately after abortion. The first follow-up visit should be 1 month after the successful surgical abortion or medical abortion, and the medium and long term follow-up visits should be 3, 6 and 12 months after the successful surgical abortion or medical abortion, which can take the form of follow-up consultation or telephone follow-up.
IV. Service flow and content arrangement
Suggestions for the flow and content arrangement of family planning services after abortion are shown in Table 1, which can be applied flexibly in combination with the existing conditions of each institution.
V. Basic information of consultation
1.Information on the hazards and possible complications of abortion.
(1) Possible complications in the near and distant future.
(2) The effect of repeated abortion on distant fertility (infertility) and future pregnancy outcome (preterm birth, fetal death, placental abnormalities) should be particularly emphasized.
(3) Inform that repeated abortions within 1 year, especially within 6 months, are the most dangerous and are called “high-risk abortions”.
2. Emphasize 3 key messages.
(1) The risk of re-pregnancy after abortion, i.e. ovulation can be resumed 2 weeks after early pregnancy abortion, and if no contraception is used, re-pregnancy is possible before the first menstruation.
(2) Contraception should be implemented immediately after abortion.
(3) Contraceptive methods must be adhered to and used correctly.
3.Analysis of the causes of this unwanted pregnancy.
(1) For those who fail to use contraception, analyze whether it is due to the method itself or incorrect use, and then help them to continue using the original method or recommend other effective methods.
(2) For those who did not use contraception, we should analyze the reasons for not using contraception, give comprehensive consultation, and implement contraceptive measures.
Sixth, follow-up visits
The main purpose of the follow-up visit is to guide women to adhere to the correct use of contraceptive methods.
1.Recent follow-up visit: 1 month after abortion, to understand the recovery of body and menstruation after abortion, assess the use of contraceptive methods, answer questions, replenish contraceptives if necessary, and provide the way to obtain follow-up services.
2. Medium and long term follow up: usually 3, 6 and 12 months after abortion should be given to understand the use of contraceptive methods and compliance, and whether there is another unwanted pregnancy, and to give counseling again if necessary.
VII. Service sites, facilities and daily working documents
1. Place: Individual counseling: there must be a space that can guarantee privacy (such as a door can be closed, at least a curtain should be able to block the view); comfortable; available for both partners to consult at the same time.
Group consultation: preferably with a classroom, but also can use the existing waiting space.
2, facilities: contraceptives physical display; conducive to the explanation of the physiological model, missionary display board; available for distribution of educational materials; free contraceptives; with a lock of the consultation record file storage cabinet. Institutions with conditions can be equipped with audio-visual equipment.
3. Daily working documents: counseling guide; counseling record sheet. Among them, the record sheet should be concise, easy to keep and confidential.
Eight, consulting service personnel
1.Qualification requirements.
The ideal counseling service personnel should be physicians or nurses who are familiar with abortion business; non-medical personnel (such as reproductive health counselors) who are familiar with the abortion service process and have excellent counseling skills can also be selected; there should also be appropriate backup personnel.
2.Skills requirements.
(1) Love for health education and counseling work.
(2) Understanding of the need for women’s voluntary and informed consent.
(3) master the post-abortion service guidelines.
(4) Knowledge of contraception and birth control.
(5) Proficiency in using counseling skills and communication skills.
3. Training.
As post-abortion family planning counseling service personnel, all should receive appropriate training. This includes initial training and additional training before starting work, so that counselors fully understand and master the above skill requirements, as well as being able to understand and implement the daily workflow. Since the counseling process is a two-way communication, not just a one-way statement, the training of communication skills should be emphasized.
4. Performance evaluation.
The person in charge of the service organization at each level should establish a regular assessment and guidance system. For example, regular record sheet audits, on-site monitoring, statistical analysis of available data, and collection of feedback from women after counseling.
IX. Support System and Daily Supervision
The implementation of post-abortion family planning services must rely on the host institution. Daily operation and personnel arrangement, including attendance, assessment, outbound exchange and training, should be integrated into the unified management of the host institution. The institution should provide regular supervision of the counseling service activity to ensure that the activity meets all of the above basic requirements.
The systematic implementation of post-abortion family planning services is a proven initiative to reduce repeat abortions. A reduction in repeat abortions also means a reduction in the overall abortion rate, which is a boost to the improvement of family planning and reproductive health in China.
The development of post-abortion family planning services will certainly be supported by family planning systems and health departments at all levels, as well as by our own unit. As a medical and technical academic group specializing in family planning, the Family Planning Branch of the Chinese Medical Association will continue to advocate and carry out this service nationwide in a sustained manner, develop various codes of practice and standards, provide operational guidance and training, and conduct operational site visits in due course and within a certain scope.