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Social and health indicators for Senegal suggest a low modern contraceptive prevalence (8.1%) and a high unmet need for family planning (33%) both of which contribute to high rates of unintended pregnancy. Many of these unintended pregnancies end in abortion. Additionally complications from unsafe abortions contribute to the country’s high maternal mortality and take a heavy toll on the lives of Senegalese women particularly in rural areas. According to Ministry of Health (MOH) statistics for 1994 and 1995 the majority of abortion complications including incomplete abortions were reported at sub-regional district-level health sites. To date the majority of efforts to expand post-abortion care (PAC) services have focused primarily on tertiary-level facilities mostly urban hospitals. As a result of operations research (OR) demonstrating the impact of an integrated PAC model on quality of care the MOH proposed to introduce national standards of care for PAC services. Unknown was how these protocols could be applied at lower reference levels (i.e. district health centers and below) particularly outside Dakar where the majority of PAC cases are not handled by doctors but by mid-level providers who have not traditionally been trained to provide PAC treatment services. In response to these needs EngenderHealth in collaboration with the MOH conducted an OR project to examine the feasibility of introducing an integrated three-element model of PAC services in secondary- and primary-level sites in two predominantly rural regions in Senegal. (excerpt)

Taking postabortion care services where they are needed: An operations research project testing PAC expansion in rural Senegal