The Postabortion Care Family Planning (PAC-FP) Project

EngenderHealth leads a global project of implementation research, technical assistance, and policy support, funded by the United States Agency for International Development (USAID), that demonstrates what works in postabortion care (PAC) programs. The project places special emphasis on strengthening postabortion care family planning (FP) services by expanding the FP method mix for PAC clients to include long-acting reversible contraceptives (LARCs), such as the intrauterine device and the hormonal implant, and permanent methods. Knowledge generated will guide global efforts to accelerate the elimination of preventable maternal and child deaths by scaling up PAC, including good practices for strengthening FP as an integral component of these programs

PAC is one of the only integrated service delivery models in global public health that combines emergency and preventive services for maternal and child survival and FP. The model that is commonly drawn upon internationally for starting PAC programs was developed by USAID and includes three core components: emergency treatment, FP counseling and provision, and community empowerment through awareness and mobilization. By preventing unintended pregnancy and subsequent abortions, PAC contributes to ending preventable child and maternal deaths and is therefore considered as a high-impact practice (Curtis, Huber, & Moss-Knight, 2010; Gemzell-Danielsson, Kopp Kallner, & Faúndes, 2014; Smith et al., 2009).

The PAC-FP Project works to strengthen global capacity to deliver and support the scale-up of PAC, emphasizing the importance of FP methods to women after receiving PAC (LARCs particularly). The following principles guide its approach: empowerment and capacity building of local and national stakeholders; evidence generation; and examination of strategies for expanding the coverage and impact of FP-strengthened PAC models. The project simultaneously implements the following interrelated elements to promote the expansion of global initiatives to support the scale-up of PAC, emphasizing the critical role of PAC-FP.

• Empowerment and capacity building of stakeholders by eliciting their participation in assessing their capacity to strengthen the FP component of PAC services, collect and interpret data on performance, and apply lessons learned to design strategies for quality improvement and scale-up
• High-quality evidence and process documentation aimed at understanding what approaches merit replication in terms of their feasibility and effectiveness, and recognition as “good practices” of PAC-FP

• Strategic dissemination and knowledge translation at the global, regional, national, and subnational levels that is aimed at sharing findings about what works for strengthening FP within PAC services and using what is learned to generate tools that facilitate this during scale-up

PAC-FP will pursue this agenda of repositioning FP in the context of scaling up high-quality PAC services that will contribute to ending preventable maternal and child deaths.

Objectives of the PAC-FP Project

The PAC-FP Project will generate high-quality evidence and guidance to influence strategic investments in strengthening the delivery of PAC programs by emphasizing the role of providing a wide range of contraceptive methods, including LARCs and, as requested, permanent methods. The project is organized around four themes:

1. Demonstrate effective approaches for strengthening the organization and quality of PAC services, and facilitate the delivery of FP counseling and services prior to discharge from the facility, emphasizing the provision of LARCs and permanent methods.
2. Assess a range of interventions at the local government and/or facility levels to strengthen the FP component of PAC services, including conducting implementation research to document good practices and guide scale-up.
3. Understand the effectiveness of clinical and community-based approaches aimed at addressing the latent demand for contraception among women who use PAC services.
4. Translate knowledge of the above to inform initiatives that build capacity and strengthen policies and programs to scale up high-quality PAC, emphasizing access to a wide range of FP methods for PAC clients.

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