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Deborah L. Billings - One of the best experts on this subject based on the ideXlab platform.
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Postabortion Care in Latin America: policy and service recommendations from a decade of operations research. Health Policy Plan 2005;20(3
2015Co-Authors: Deborah L. Billings, Janie BensonAbstract:Unsafe abortion contributes significantly to maternal mortality and morbidity in Latin America. Postabortion Care (PAC) using preferred technologies and a woman-centred approach to treat the complications of unsafe abortion can save women’s lives and improve their reproductive health, as well as reduce costs to health systems. This article reviews results from 10 major PAC operations research projects conducted in public sector hospitals in seven Latin American countries, completed and published between 1991 and 2002. The studies show that following relatively modest interventions, the majority of eligible patients were being treated with manual vacuum aspiration (MVA), a method preferred for safety and other reasons over the method conventionally used in the region, sharp curettage (SC). A number of studies showed improvements in contraceptive counselling and services when these were integrated with clinical treatment of abortion complications, resulting in substantial increases in contraceptive acceptance. Finally, data from several studies showed that, in most settings, reorganizing services by moving treatment out of the operating theatre and reclassifying treatment as an ambulatory Care procedure substantially reduced the resources used for PAC, as well as the cost and average length of women’s stay in the hospital. These studies suggest that comprehensive PAC can and should be available to all women in Latin America. Such efforts should be coupled with work to improve primary prevention, including better contraceptive services to prevent unwanted pregnancy and safe, legal abortion services to reduce the number of clandestine and unsafe abortions. Key words: Postabortion Care, unsafe abortion, manual vacuum aspiratio
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Abortion and Postabortion Care: Ethical, Legal, and Policy Issues in Developing Countries
Journal of midwifery & women's health, 2005Co-Authors: Suellen Miller, Deborah L. BillingsAbstract:This case study of a woman who wants to terminate her pregnancy but does not have access to safe services explores the technical, ethical, and legal effects of the Mexico City Policy (Global Gag Rule) on health Care providers working in developing countries. This woman's self-induced termination resulted in an incomplete abortion, and she sought Care from a midwife. The current Mexico City Policy effectively limits a health Care provider's ability to offer abortion services and counseling, even when these services are legal. The policy has an adverse impact on women's access to safe Care. The provision of comprehensive Postabortion Care, not restricted by the Mexico City Policy, is the key to preventing abortion-related morbidity and mortality.
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Postabortion Care in Latin America: policy and service recommendations from a decade of operations research.
Health policy and planning, 2005Co-Authors: Deborah L. Billings, Janie BensonAbstract:Unsafe abortion contributes significantly to maternal mortality and morbidity in Latin America. Postabortion Care (PAC) using preferred technologies and a woman-centred approach to treat the complications of unsafe abortion can save women’s lives and improve their reproductive health, as well as reduce costs to health systems. This article reviews results from 10 major PAC operations research projects conducted in public sector hospitals in seven Latin American countries, completed and published between 1991 and 2002. The studies show that following relatively modest interventions, the majority of eligible patients were being treated with manual vacuum aspiration (MVA), a method preferred for safety and other reasons over the method conventionally used in the region, sharp curettage (SC). A number of studies showed improvements in contraceptive counselling and services when these were integrated with clinical treatment of abortion complications, resulting in substantial increases in contraceptive acceptance. Finally, data from several studies showed that, in most settings, reorganizing services by moving treatment out of the operating theatre and reclassifying treatment as an ambulatory Care procedure substantially reduced the resources used for PAC, as well as the cost and average length of women’s stay in the hospital. These studies suggest that comprehensive PAC can and should be available to all women in Latin America. Such efforts should be coupled with work to improve primary prevention, including better contraceptive services to prevent unwanted pregnancy and safe, legal abortion services to reduce the number of clandestine and unsafe abortions.
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Midwives and Postabortion Care: experiences, opinions, and attitudes among participants at the 25th triennial congress of the international confederation of midwives
Journal of midwifery & women's health, 2002Co-Authors: Suellen Miller, Deborah L. Billings, Barbara CliffordAbstract:Midwifery practice may not include caring for women experiencing complications from unsafe abortion, despite the importance of this Care for the health and lives of millions of women around the world. This article summarizes data collected from midwives from 41 countries who attended the 25th Triennial Congress of the International Confederation of Midwives in 1999, focusing on their experiences with, and attitudes toward, the provision of Postabortion Care. Barriers to provision of Postabortion Care and factors for changes in Postabortion Care-related policies were explored. Midwives from developing countries, where complications from unsafe abortion present a serious public health problem, were cognizant of the need to authorize, train, and equip midwives in Postabortion Care, including the use of uterine evacuation of incomplete abortion with manual vacuum aspiration. Changes in policy and practice are needed throughout the world so that women will have access to quality, compassionate Postabortion Care services regardless of where they live. Ensuring that midwives are able to provide such services will help to reduce abortion-related morbidity and mortality.
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Community education efforts enhance Postabortion Care program in Ghana.
American journal of public health, 2000Co-Authors: Traci L. Baird, Deborah L. Billings, Bechesani DemuyakorAbstract:As in most countries in the developing world unsafe abortion devastates the health and lives of women in Ghana. It is the highest single contributor to its maternal mortality ratio of 740 deaths per 100000 live births. Although complications of abortion are treatable delays in prompt treatment increase the risk of morbidity and death. To address the problem of unsafe abortion and delays in seeking Care for women a comprehensive operations research project aimed at improving womens access to Postabortion services was implemented in Ghana. Community education was an integral component of the Postabortion Care project implemented under the US Agency for International Developments MotherCare contract. The experiences and lessons that were learned from incorporating community education into the program are presented in the paper. Through this strategy women men adolescents community leaders and the community at large were made aware of the risks and signs of unsafe abortions and its complications and the availability of services by trained midwives. This approach in being both strategic and sustainable directly complements the national Safe Motherhood health education program of Ghana and could be easily integrated into other reproductive health programs in various settings.
Akinrinola Bankole - One of the best experts on this subject based on the ideXlab platform.
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the health system costs of Postabortion Care in senegal
International Perspectives on Sexual and Reproductive Health, 2020Co-Authors: Naomi Lincederoche, Ibrahima Sene, Emma Pliskin, Onikepe Owolabi, Akinrinola BankoleAbstract:Context Unsafe abortion is common in Senegal, but Postabortion Care (PAC) is not accessible to some women who need it, and the cost to the health Care system of providing PAC is unknown. Methods The cost to Senegal's health system of providing PAC in 2016-at existing service levels and if access were hypothetically expanded-was estimated using the Post-Abortion Care Costing Methodology, a bottom-up, ingredients-based approach. From September 2016 to January 2017, face-to-face interviews were conducted with PAC providers and facility administrators at a national sample of 41 health facilities to collect data on the direct and indirect costs of Care provision, as well as the fees charged to patients. A sensitivity analysis was conducted to examine the precision of the results. Results In total, 1,642 women received PAC at study facilities in 2016, which translates to 18,806 women receiving PAC nationally. Public facilities provided nearly all services. The average cost per patient at study facilities was US$26.68; nationally, the estimated cost was US$24.72. The estimated total national cost of providing PAC at existing levels was US$464,928; direct costs accounted for more than three-quarters of the cost. Charges to PAC patients amounted to 20% of all incurred costs. If service provision had been expanded to meet all PAC needs, estimated total costs to the health system would have been US$804,518. Conclusion The annual costs of PAC are substantial in Senegal. Greater investment in ensuring access to contraceptives could lower these costs by reducing the number of unintended pregnancies that often lead to unsafe abortion.
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Estimating abortion incidence among adolescents and differences in Postabortion Care by age: a cross-sectional study of Postabortion Care patients in Uganda
Contraception, 2018Co-Authors: Elizabeth A. Sully, Lynn Atuyambe, Justine Bukenya, Hannah S Whitehead, Nakeisha Blades, Akinrinola BankoleAbstract:Abstract Objectives To provide the first estimate of adolescents' abortion incidence in Uganda and to assess differences in the abortion experiences and morbidities of adolescent and nonadolescent Postabortion Care (PAC) patients. Study design We used the age-specific Abortion Incidence Complications Method, drawing from three surveys conducted in Uganda in 2013: a nationally representative Health Facilities Survey (n=418), a Health Professionals Survey (n=147) and a Prospective Morbidity Survey of PAC patients (n=2169). Multivariable logistic and Cox proportional hazard models were used to compare adolescent and nonadolescent PAC patients on dimensions including pregnancy intention, gestational age, abortion safety, delays to Care, severity of complications and receipt of Postabortion family planning. We included an interaction term between adolescents and marital status to assess heterogeneity among adolescents. Results Adolescent women have the lowest abortion rate among women less than 35 years of age (28.4 abortions per 1000 women 15–19) but the highest rate among recently sexually active women (76.1 abortions per 1000 women 15–19). We do not find that adolescents face greater disadvantages in their abortion Care experiences as compared to older women. However, unmarried PAC patients, both adolescent and nonadolescent, have higher odds of experiencing severe complications than nonadolescent married women. Conclusions The high abortion rate among sexually active adolescents highlights the critical need to improve adolescent family planning in Uganda. Interventions to prevent unintended pregnancy and to reduce unsafe abortion may be particularly important for unmarried adolescents. Rather than treating adolescents as a homogenous group, we need to understand how marriage and other social factors shape reproductive health outcomes. Implications This paper provides the first estimate of the adolescent abortion rate in Uganda. Studies of adolescent abortion and reproductive health must account for sexual activity and marital status. Further, interventions to address unintended pregnancy and unsafe abortion among unmarried women of all ages in Africa should be a priority.
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The impact of Ghana’s R3M programme on the provision of safe abortions and Postabortion Care
Health policy and planning, 2014Co-Authors: Aparna Sundaram, Akinrinola Bankole, Fátima Juárez, Clement Ahiadeke, Nakeisha BladesAbstract:In 2006, in response to the high maternal mortality, driven largely by unsafe abortions, the government of Ghana, in partnership with other organizations, launched the reducing maternal mortality and morbidity (R3M) programme in seven districts in Greater Accra, Ashanti and Eastern, to improve comprehensive abortion Care services. This article examines whether this intervention made a difference to the provision of safe abortion services and Postabortion Care (PAC). We also examine the role played by provider attitudes and knowledge of the abortion law, on providers with clinical training in service provision. Primary data on health Care providers in Ghana, collected using a quasi-experimental design, were analysed using propensity score weighting. Apart from the treatment group, the sample included two controls: (1) Districts in Accra, Ashanti and Eastern, not exposed to the treatment; and (2) Districts from distant Brong Ahafo, also not exposed to the treatment. The findings show that providers in the treatment group are nearly 16 times as likely to provide safe abortions compared with their peers in Brong Ahafo, and ∼2.5 times as likely compared with providers in the other control group. R3M providers were also different from their peers in providing PAC. Associations between provider attitudes and knowledge of the law on both outcomes were either non-significant or inconsistent including for providers with clinical knowledge of abortion provision. Provider confidence however is strongly associated with service provision. We conclude that the R3M programme is helping safe abortion provision, with the differences being greater with control groups that are geographically distant, perhaps owing to lower contamination from movement of providers between facilities. Increasing provider confidence is key to improving both safe abortion provision and PAC.
Vibeke Rasch - One of the best experts on this subject based on the ideXlab platform.
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Unsafe abortion and Postabortion Care - an overview.
Acta obstetricia et gynecologica Scandinavica, 2011Co-Authors: Vibeke RaschAbstract:Forty per cent of the world's women are living in countries with restrictive abortion laws, which prohibit abortion or only allow abortion to protect a woman's life or her physical or mental health. In countries where abortion is restricted, women have to resort to clandestine interventions to have an unwanted pregnancy terminated. As a consequence, high rates of unsafe abortion are seen, such as in Sub-Saharan Africa where unsafe abortion occurs at rates of 18–39 per 1 000 women. The circumstances under which women obtain unsafe abortion vary and depend on traditional methods known and types of providers present. Health professionals are prone to use instrumental procedures to induce the abortion, whereas traditional providers often make a brew of herbs to be drunk in one or more doses. In countries with restrictive abortion laws, high rates of maternal death must be expected, and globally an estimated 66 500 women die every year as a result of unsafe abortions. In addition, a far larger number of women experience short- and long-term health consequences. To address the harmful health consequences of unsafe abortion, a Postabortion Care model has been developed and implemented with success in many countries where women do not have legal access to abortion. Postabortion Care focuses on treatment of incomplete abortion and provision of Postabortion contraceptive services. To enhance women's access to Postabortion Care, focus is increasingly being placed on upgrading midlevel providers to provide emergency treatment as well as implementing misoprostol as a treatment strategy for complications after unsafe abortion.
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Expanding Comprehensive Postabortion Care to Primary Health Facilities in Geita District, Tanzania
African journal of reproductive health, 2009Co-Authors: Karoline Kragelund Nielsen, Grace Lusiola, Joseph Kanama, Juliana Bantambya, Nassor Kikumbih, Vibeke RaschAbstract:A Postabortion Care program was implemented in 11 primary and secondary health facilities in rural Tanzania in order to decentralize comprehensive Postabortion Care to community level by upgrading midlevel providers to perform manual vacuum aspiration (MVA). Information about evacuation procedure and family planning (FP) service provided was obtained from the health facilities. In all, 2025 evacuations had been performed with MVA and DC 13[2]:129-138).
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Expanding comprehensive Postabortion Care to primary health facilities in Geita District, Tanzania : original research article
African Journal of Reproductive Health, 2009Co-Authors: Karoline Kragelund Nielsen, Vibeke Rasch, Grace Lusiola, Joseph Kanama, Juliana Bantambya, Nassor KikumbihAbstract:A Postabortion Care program was implemented in 11 primary and secondary health facilities in rural Tanzania in order to decentralize comprehensive Postabortion Care to community level by upgrading midlevel providers to perform manual vacuum aspiration (MVA). Information about evacuation procedure and family planning (FP) service provided was obtained from the health facilities. In all, 2025 evacuations had been performed with MVA and D&C accounting for 65.6% and 34.4%, respectively. Among the women admitted with abortion complications, 59.8% left with a FP method. The proportion of women offered FP service differed by evacuation procedure, hence the proportion was higher among women evacuated by MVA. Upgrading midlevel providers to perform MVA is an efficient means to address the problem of unsafe abortion in rural areas. However, the sustainability of MVA service provision remains a challenge. Moreover, FP services should be offered to all Postabortion clients regardless of evacuation procedure. L'expansion due soin du post avortement comprehensif vers les etablissements de la sante primaire dans le district de Geita, Tanzanie Un programme du soin du post-avortement a ete mis en oeuvre dans des etablissements de la sante primaire et secondaire dans la Tanzanie rurale afin de decentraliser le soin du post-avortement comprehensif jusqu'au niveau de la communaute par l'augmentation de la performance des dispensateurs moyens pour qu'ils puisement faire l'avortement par aspiration manuelle (AAM). Le renseignement sur la procedure de l'evacuation et sur le service la planification familiale (PF) disponible etait obtenu a partir des etablissements de sante. En tout, 2025 evacuations ont ete faits a travers AAM et le curetage de l'uterus etant responsable pour 65,6% et 34,4% respectivement. Parmi les femmes qui ont ete admises avec des complications de l'avortement, 59,8% sont parties avec une methode de la PF. La proportion des femmes qui ont profite des services de la PF etait differente par la procedure de l'evacuation ; ainsi, la proportion etait plus eleve chez les femmes qui ont subi l'evacuation par l'AAM. L'amelioration de la performance des dispensateurs moyens pour accomplir l'AAM est une maniere efficace de s'occuper du probleme de l'avortement dangereux dans les regions rurales. Toutefois, la capacite pour soutenir la dispensation des services de l'AAM reste un defi. De plus, les services de la PF doivent etre offerts a toutes les clients du post-avortement sans considerer la procedure d'evacuation.
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Report of the Postabortion Care Technical Advisory Panel
2007Co-Authors: Vibeke Rasch, D Huber, E.o AkandeAbstract:Each year 19 million women experience an unsafe induced abortion and 31 million women have a spontaneous abortion (miscarriage). Postabortion Care (PAC) is a package of services for women who experience complications following either type of abortion. Since 1994 the United States Agency for International Development (USAID) has provided more than $24 million in support of PAC programs in more than 40 countries. The PAC model of Care supported by USAID has uniformly included manual vacuum aspiration (MVA) financed by other donors to treat incomplete abortion. This is consistent with international recommendations that vacuum aspiration (VA) - both MVA and electrical vacuum aspiration (EVA) - is preferred to sharp curettage. However in many settings MVA equipment is absent or limited and women are treated with sharp curettage. These women generally do not receive other key elements of PAC such as Postabortion contraception. Given the limited use of MVA globally the current USAID PAC approachwill serve only a small fraction of women with incomplete abortions. The challenge is how to reach more of these women with PAC services and to improve quality of Care. (excerpt)
Colin Baynes - One of the best experts on this subject based on the ideXlab platform.
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The Unit and Scale-Up Cost of Postabortion Care in Tanzania.
Global health science and practice, 2019Co-Authors: Colin Baynes, Grace Lusiola, Erick Yegon, Godfather Kimaro, Justin KahwaAbstract:INTRODUCTION Based on research conducted in 2017, we estimated the cost to the Tanzanian health Care system of providing Postabortion Care (PAC). PAC is an integrated service package that addresses the curative and preventive needs of women experiencing complications from abortion. PAC services include treating complications of miscarriage and incomplete abortion, providing voluntary family planning counseling and services, and engaging the community to reduce future unintended pregnancies and repeat abortions. METHODS Thirty-one public and private health facilities, representing 3 levels of health Care, were selected for data collection from key Care providers and administrators in 3 regions. We gathered data on the direct costs of PAC startup (i.e., training and capital costs), as well as the recurrent costs of medicines, supplies, hospitalization, and personnel, and the indirect costs of PAC provision. We also gathered data to estimate PAC clients' out-of-pocket expenses. Estimates of the average cost per client (i.e., unit cost) were calculated for treatment of routine and severe abortion complications, treatment at different levels of health Care, Postabortion contraception, and various available treatment methods. RESULTS We found that the unit cost of PAC training per provider was US$163.43. The total unit cost was $72.91. The unit recurrent cost of treating routine complications, which included 81% of the cases in our sample, was $36.23. The cost of treating incomplete abortion through manual vacuum aspiration was $22.63, while the cost of treatment with misoprostol was $18.74. The average cost of providing voluntary Postabortion family planning was $11.56. We estimated an average client out-of-pocket expenditure on PAC of $22.96. CONCLUSION We applied our unit cost estimates to those on PAC utilization and provision and unmet need for PAC that were derived from research conducted in Tanzania in 2013-2016, and we estimated an annual national cost of PAC of $4,170,476. We estimated the cost of providing PAC for all women who have abortion complications, including those who do not access PAC, at $10,426,299. Investing more resources in voluntary family planning and PAC treatment of routine complications at the primary level would likely reduce health system costs.
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What contraception do women use after experiencing complications from abortion? an analysis of cohort records of 18,688 Postabortion Care clients in Tanzania.
BMC women's health, 2019Co-Authors: Colin Baynes, Grace Lusiola, Justin Kahwa, F. Mwanga, J. Bantambya, L. Ngosso, M. HizaAbstract:Background The family planning component of Postabortion Care (PAC) is critical, as it helps women to prevent unintended pregnancies and reduce future incidence of life-threatening unsafe abortion. In Tanzania, PAC was recently decentralized from tertiary-level district hospitals to primary health Care dispensaries in four regions of the country. This analysis describes interventions used to improve access to high quality PAC services during decentralization; examines results and factors that contribute to PAC clients’ voluntary uptake of contraception; and develops recommendations for improving Postabortion contraceptive services.
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What contraception do women use after experiencing complications from abortion? an analysis of cohort records of 18,688 Postabortion Care clients in Tanzania
BMC Women's Health, 2019Co-Authors: Colin Baynes, Justin Kahwa, F. Mwanga, J. Bantambya, L. Ngosso, G. Lusiola, M. HizaAbstract:Background The family planning component of Postabortion Care (PAC) is critical, as it helps women to prevent unintended pregnancies and reduce future incidence of life-threatening unsafe abortion. In Tanzania, PAC was recently decentralized from tertiary-level district hospitals to primary health Care dispensaries in four regions of the country. This analysis describes interventions used to improve access to high quality PAC services during decentralization; examines results and factors that contribute to PAC clients’ voluntary uptake of contraception; and develops recommendations for improving Postabortion contraceptive services. Methods This analysis uses service delivery statistics of 18,688 PAC clients compiled from 120 facilities in Tanzania between 2005 and 2014. Results This study suggests that efforts to integrate Postabortion family planning into treatment for incomplete abortion contributed to higher Postabortion contraceptive uptake (86%). Results indicate that variables associated with significant differences in contraceptive uptake were facility level, age, gestational age at the time of treatment, and uterine evacuation technology used. Conclusion The experience of expanding PAC services in Tanzania suggests that integrating contraceptive services with treatment for abortion complications can increase family planning use.
Justin Kahwa - One of the best experts on this subject based on the ideXlab platform.
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The Unit and Scale-Up Cost of Postabortion Care in Tanzania.
Global health science and practice, 2019Co-Authors: Colin Baynes, Grace Lusiola, Erick Yegon, Godfather Kimaro, Justin KahwaAbstract:INTRODUCTION Based on research conducted in 2017, we estimated the cost to the Tanzanian health Care system of providing Postabortion Care (PAC). PAC is an integrated service package that addresses the curative and preventive needs of women experiencing complications from abortion. PAC services include treating complications of miscarriage and incomplete abortion, providing voluntary family planning counseling and services, and engaging the community to reduce future unintended pregnancies and repeat abortions. METHODS Thirty-one public and private health facilities, representing 3 levels of health Care, were selected for data collection from key Care providers and administrators in 3 regions. We gathered data on the direct costs of PAC startup (i.e., training and capital costs), as well as the recurrent costs of medicines, supplies, hospitalization, and personnel, and the indirect costs of PAC provision. We also gathered data to estimate PAC clients' out-of-pocket expenses. Estimates of the average cost per client (i.e., unit cost) were calculated for treatment of routine and severe abortion complications, treatment at different levels of health Care, Postabortion contraception, and various available treatment methods. RESULTS We found that the unit cost of PAC training per provider was US$163.43. The total unit cost was $72.91. The unit recurrent cost of treating routine complications, which included 81% of the cases in our sample, was $36.23. The cost of treating incomplete abortion through manual vacuum aspiration was $22.63, while the cost of treatment with misoprostol was $18.74. The average cost of providing voluntary Postabortion family planning was $11.56. We estimated an average client out-of-pocket expenditure on PAC of $22.96. CONCLUSION We applied our unit cost estimates to those on PAC utilization and provision and unmet need for PAC that were derived from research conducted in Tanzania in 2013-2016, and we estimated an annual national cost of PAC of $4,170,476. We estimated the cost of providing PAC for all women who have abortion complications, including those who do not access PAC, at $10,426,299. Investing more resources in voluntary family planning and PAC treatment of routine complications at the primary level would likely reduce health system costs.
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What contraception do women use after experiencing complications from abortion? an analysis of cohort records of 18,688 Postabortion Care clients in Tanzania.
BMC women's health, 2019Co-Authors: Colin Baynes, Grace Lusiola, Justin Kahwa, F. Mwanga, J. Bantambya, L. Ngosso, M. HizaAbstract:Background The family planning component of Postabortion Care (PAC) is critical, as it helps women to prevent unintended pregnancies and reduce future incidence of life-threatening unsafe abortion. In Tanzania, PAC was recently decentralized from tertiary-level district hospitals to primary health Care dispensaries in four regions of the country. This analysis describes interventions used to improve access to high quality PAC services during decentralization; examines results and factors that contribute to PAC clients’ voluntary uptake of contraception; and develops recommendations for improving Postabortion contraceptive services.
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What contraception do women use after experiencing complications from abortion? an analysis of cohort records of 18,688 Postabortion Care clients in Tanzania
BMC Women's Health, 2019Co-Authors: Colin Baynes, Justin Kahwa, F. Mwanga, J. Bantambya, L. Ngosso, G. Lusiola, M. HizaAbstract:Background The family planning component of Postabortion Care (PAC) is critical, as it helps women to prevent unintended pregnancies and reduce future incidence of life-threatening unsafe abortion. In Tanzania, PAC was recently decentralized from tertiary-level district hospitals to primary health Care dispensaries in four regions of the country. This analysis describes interventions used to improve access to high quality PAC services during decentralization; examines results and factors that contribute to PAC clients’ voluntary uptake of contraception; and develops recommendations for improving Postabortion contraceptive services. Methods This analysis uses service delivery statistics of 18,688 PAC clients compiled from 120 facilities in Tanzania between 2005 and 2014. Results This study suggests that efforts to integrate Postabortion family planning into treatment for incomplete abortion contributed to higher Postabortion contraceptive uptake (86%). Results indicate that variables associated with significant differences in contraceptive uptake were facility level, age, gestational age at the time of treatment, and uterine evacuation technology used. Conclusion The experience of expanding PAC services in Tanzania suggests that integrating contraceptive services with treatment for abortion complications can increase family planning use.