title: Replacement of dilation and curettage/evacuation by manual vacuum aspiration and medical abortion, and the introduction of postabortion contraception in Pakistan.
abstract: Manual vacuum aspiration (MVA) and medical abortion were introduced to replace dilation and curettage/evacuation for incomplete abortions, and postabortion contraception was provided in 5 selected public hospitals in Pakistan. In the largest hospital, an Ipas MVA training center since 2007, MVA use reached 21% in 2008. After the International Federation of Gynecology and Obstetrics (FIGO) and UNFPA provided MVA kits, MVA use increased dramatically to 70%-90% in 2010-2013. In 2 of the remaining 4 hospitals in which the Society of Obstetricians and Gynecologists of Pakistan trained doctors in May 2012 and January 2013, the target of having 50% of women managed by MVA and medical abortion (MA) was met; however, in the third hospital only 43% were treated with MVA and MA. In the fourth hospital, where misoprostol and electric vacuum aspiration use was 64% and 9%, respectively, before training, an MVA workshop introduced the technique. Postabortion contraception was provided to 9%-29% of women, far below the target of 60%.
authors.affiliation: Ultrasound Clinic and Institute of Ultrasonography, Karachi, Pakistan. Electronic address: z.shahida@gmail.com.
authors.forename: Shahida
authors.initials: S
authors.lastname: Zaidi
authors.affiliation: Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
authors.forename: Haleema
authors.initials: H
authors.lastname: Yasmin
authors.affiliation: Woman's Hospital, Peshawar, Pakistan.
authors.forename: Lubna
authors.initials: L
authors.lastname: Hassan
authors.affiliation: Nishtar Medical College Hospital, Multan, Pakistan.
authors.forename: Mehnaz
authors.initials: M
authors.lastname: Khakwani
authors.affiliation: Sandeman Provincial Hospital, Quetta, Pakistan.
authors.forename: Shehla
authors.initials: S
authors.lastname: Sami
authors.affiliation: Abbasi Shaheed Hospital, Karachi, Pakistan.
authors.forename: Tazeen
authors.initials: T
authors.lastname: Abbas
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000027:Abortion, Incomplete / Q000628:therapy*; D000359:Aftercare / Q000379:methods; D003267:Contraception / Q000379:methods; D004107:Dilatation and Curettage / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000458:organization & administration; D006779:Hospitals, Public; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage*; D009774:Obstetrics / Q000458:organization & administration; D010154:Pakistan; D011247:Pregnancy; D012955:Societies, Medical / Q000458:organization & administration; D014619:Vacuum Curettage / Q000379:methods* / Q000706:statistics & numerical data
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Dilation and curettage; FIGO initiative; Manual vacuum aspiration; Medical abortion; Pakistan; Postabortion contraception; Prevention; Unsafe abortion