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In developing countries each year more than half a million women die from maternal causes. Nearly all of these deaths could be prevented. Efforts to prevent maternal deaths from one major cause—complications of unsafe abortion—are crucial but inadequate in most of the world. Providing appropriate medical care immediately could save many thousands of women's lives. Offering family planning could prevent many future unintended pregnancies and unsafe abortions.

Unsafe abortions cause 50,000 to 100,000 deaths each year. In some countries complications of unsafe abortion cause the majority of maternal deaths, and in a few they are the leading cause of death for women of reproductive age. The World Health Organization estimates that as many as 20 million abortions each year are unsafe and that 10% to 50% of women who undergo unsafe abortion need medical care for complications. Also, many women need care after spontaneous abortion (miscarriage). In one country, for example, at 86 hospitals an estimated 28,000 women seek care for complications of unsafe or spontaneous abortion each month.

The five main causes of maternal mortality are hemorrhage, obstructed labor, infection, pregnancy-induced hypertension, and complications of unsafe abortion. Many countries are undertaking programs to reduce deaths from the other four causes, but few provide adequate emergency medical care that would reduce maternal deaths from abortion complications. Even fewer provide family planning services and counseling to women treated for abortion complications.

While abortion complications are a common medical emergency in developing countries, care often is provided in a crisis atmosphere. In contrast, a strategic approach to postabortion care anticipates the need for emergency treatment, plans ahead to meet that need, and provides family planning to prevent repeat abortions. An effective postabortion care plan ensures that women receive care that is complete, appropriate, and prompt ("CAP").

• Complete. Many women treated for abortion complications want to avoid pregnancy. Yet fewer than one-third of women receiving care for abortion complications have ever used effective contraception. Family planning services and counseling can best be provided at the same place where women receive emergency postabortion care, yet few facilities provide family planning services and even fewer provide counseling. At two hospitals, for example, fewer than 3% of women received postabortion family planning counseling. Because postabortion care is often a medical and emotional crisis, empathic family planning counseling is especially important to enable women to avoid future unwanted pregnancies—and unsafe abortions.



• Appropriate. Most women seeking emergency care are suffering from incomplete abortion, which, if left untreated, can lead to hemorrhage, infection, and death. Uterine evacuation can be done safely and effectively with manual vacuum aspiration (MVA) using local anesthesia. MVA under local anesthesia is safer and usually less expensive than sharp curettage with general anesthesia, the treatment commonly used in many countries. For example, at one Kenyan hospital the cost of postabortion treatment fell by 66% after MVA replaced sharp curettage, mainly because of dramatically reduced hospital stays.



• Prompt. Often, women do not receive medical treatment soon enough. Delays put their lives at risk. Decentralizing emergency care and establishing a formal referral system can reduce delays by offering some degree of postabortion care at every level of the health system and by helping each woman reach the level of care that she needs in time.