Hesperian Health Guides

Saving lives with post-abortion care

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HealthWiki > Health Actions for Women > Chapter 9: Preventing Deaths from Unsafe Abortion > Saving lives with post-abortion care

Abortion done safely by a skilled person rarely causes harm (see What makes an abortion safe or unsafe?). But many abortions are unsafe and lead to serious injuries, infections, and dangerous bleeding. Post-abortion care, also called PAC, is emergency care for these problems.

a woman speaking as she reads a banner that says, "Abortion may be illegal, but post-abortion care is always legal."
I didn’t know that!

Women need emergency care without delay

One of the reasons women die after unsafe abortions is that they or their families wait too long to get help. There are many things a community can do to help or encourage people to seek care without delay.

To learn all the reasons why people in your community are delayed in receiving help for problems after an unsafe abortion, try adapting the discussion guide about the 4 delays.

The following activity, using dramatic stories, can help a group learn about the importance of getting a woman the care she needs quickly if she has any signs of a health problem after an unsafe abortion. It is also a good way for a group to learn more about the danger signs for problems after an abortion and how to help. This is called a "replay drama" because the story is replayed a second time to ask the audience how to save the woman. Also see the activity, "Happy ending" role plays to think about change.

ActivityReplay drama: Saving lives after an abortion

To prepare: Create a dramatic situation for each of the danger signs: bleeding, signs of infection, shock, and injury. Make up situations realistic for your community, but do not use names of real people or examples that seem to be about a real person in the community.

  1. Introduce the activity and review with the group the danger signs after an abortion and what to do about them (see the next section for this information).
  2. Form small groups of 3 or 4 people and give each group a situation to dramatize. Explain that they will dramatize the story twice. The first time, the woman will not get help and will die. The second time, the audience will step in to save her. Remind everyone to treat the women in the dramas with kindness and not to use judgmental or hurtful language.
  3. After the drama about each situation, the actors stop and ask the audience, "What should we have done to save her life?"
  4. Perform the dramas a second time but use the group’s suggestions to save the women’s lives. People in the audience who have ideas can become actors who help carry or treat the woman.
  5. To conclude, ask people what they learned about how to help women with problems after an abortion. You can also ask the group to think about how this could be done in their community.

a woman speaking.
Our group of health promoters performed the dramas for a group of men because when a woman has an emergency, often it’s the men in her family who have the money or make the decision to take her to the hospital.
a group of people putting a woman in the bed of a pickup truck.
Take a woman with any of these danger signs to a clinic or hospital right away!

Danger signs after abortion or miscarriage

The 2 most dangerous problems a woman can have after an abortion or miscarriage are bleeding too much and infection. Both of these problems can happen when tissue from the pregnancy is still inside the womb, or when the womb has been torn or punctured by a sharp tool. Infection of the womb can also be caused when something is put in the woman’s vagina that was not clean enough (sterilized). A woman with signs of these problems can die quickly if she does not get medical help right away. When people know the danger signs, they will be more ready to help women get the care they need.

What to do

When you know the danger signs for each health problem, there are some things you can do while transporting the woman to get medical care.

Heavy bleeding from the vagina: bleeding that soaks more than 2 pads in one hour, and lasts for 2 hours. A slow, steady trickle of bright red blood is also dangerous.

What to do: Help the woman squat and bear down like passing stool. This may help to finish emptying the womb. While transporting the woman, rub her lower belly very hard, just above the pubic bone, while she is lying down or squatting. This may help the womb squeeze itself (contract) and bleed less. See Where Women Have No Doctor.

Signs of infection: fever over 38°C (100.4°F), chills, pain in the belly, bad-smelling discharge from vagina, or weakness.

What to do: Give medicines for womb infection. See Where Women Have No Doctor.

HAW Ch9 Page 266-2.png
Miscarriage and safe abortion usually do not cause health problems, but after a pregnancy ends for any reason, the danger signs are the same.

Signs of shock: cold, pale, or damp skin; fast breathing (more than 30 breaths a minute); a very fast heartbeat (more than 100 beats a minute); unusual weakness, dizziness or lightheadedness, and even confusion or unconsciousness (fainting).

What to do: Help the woman lie down with her feet higher than her head, cover her with a blanket or clothes, and help her stay calm. If she can drink, give her sips of water or rehydration drink. If she is unconscious, lay her on her side with her head low, tilted back and to one side. Make sure her feet are higher than her head.

Signs of injury inside the body: very bad pain in the belly, especially with movement; belly feels stiff or hard, and you can hear no sounds or gurgles inside; fever, nausea, and vomiting; pain in one or both shoulders.

What to do: Do not give the woman anything by mouth — no food, no drink, not even water — if it will take less than 2 hours to get to a health center, where she might need an operation. If a health center is more than 2 hours away, give water or hydration solution, but do not give solid food, because food in the stomach makes surgery riskier.

The sooner a woman gets help for any of these problems, the greater the possibility of saving her life. To learn more about complications of abortion and what to do, see Where Women Have No Doctor or A Book for Midwives. You can also see Other Resources.

a young woman speaking.
Young women are especially likely to have problems that become serious after an abortion, but we are less likely to know about post-abortion care. We need information and support and to be treated with kindness and respect.

a man speaking.
In community meetings to gain support for post-abortion care we discussed the dangers of unsafe abortions, and how this care is not the same as abortion. It took many meetings and discussions to gain the trust of local religious leaders. We began by discussing the benefits of family planning for married couples, and then contraceptive use outside of marriage. This opened the door to discussing unintended pregnancy and the need for emergency care.

Supporting a woman after an abortion

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A woman may have strong feelings after an abortion, even if she knows she made the right decision for herself and her family. Some women feel a mixture of relief, sadness, grief, guilt, shame, anger, and even love. It is also common for women to feel sad and grieve when a pregnancy ends because of miscarriage. These feelings are normal, but having to hide them and pretend nothing has happened can make them worse. Many women find it helpful to talk with other women who have had the same experience.

Creating a ritual to reflect on what happened can also help a woman let go of the experience and move on with life. For example, burying or burning an object related to the abortion can symbolize closure. In some communities, a woman may plant a tree or visit a sacred place and make offerings.