September 28, 2020

Now Is the Time to Scale Up Postabortion Family Planning for Young People in Senegal

By: Ndeye Fanta Camara, Head Midwife, Mbacké Health Center, Senegal

Between September 2018 and July 2019, the Evidence to Action (E2A) project, led by Pathfinder International, with support from USAID, and in close collaboration with IntraHealth International’s Neema Project, supported Senegal’s Ministry of Health and Social Action to implement and plan for the scale-up of postabortion family planning for adolescents and youth. Below, a valued local partner and Head Midwife at Mbacké Health Center shares her experience.

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A 13-year-old girl was in distress. She arrived at our health facility struggling to describe her situation. She said she was unmarried—and that she couldn’t be pregnant. It soon became clear this girl recently recently had an abortion.

Like other young clients I’ve encountered as a health provider, this girl needed educational counseling free from judgement. She needed quality postabortion care—including management of any postabortion complications and counseling and the provision of voluntary family planning—tailored to her needs as an adolescent. Most of all, she needed to be treated with understanding, so she could better understand herself.

It is true that postabortion family planning care for youth remains a sensitive issue in Senegal’s Diourbel region—and in our country overall. Young postabortion care clients like this girl generally have little decision-making power.

We are working to change this.

I Want to Save Women’s Lives

In general, postabortion care is not new to Senegal. Our country introduced and extended postabortion care to regional hospitals in 1997 and health centers in 2003.

However, within our health facilities, we faced a lot of challenges that made it hard to sustain this early progress. As a midwife I can tell you—postabortion care was provided, but it was not effective.

We lacked dedicated spaces to provide counseling. Sometimes we were really overloaded with work, which kept us from being able to devote enough time to our clients or to follow all the steps required for respectful postabortion care, including providing counseling and voluntary family planning.

Senegal had the highest number of postabortion care clients, the lowest counseling rate, and lowest rate of clients who chose contraception of four West African countries evaluated by the E2A project between 2008 and 2012.

And what about young people? The provision of adolescent- and youth-friendly postabortion family planning was almost nonexistent.

Complications from unsafe abortion are a major cause of mortality for Senegal’s women and girls. If we want to contribute to a reduction in maternal mortality, we need to expand access to comprehensive postabortion care, including voluntary family planning for young people.

I want to save women’s lives. That is why I participated in this project—

Pioneering Postabortion Family Planning for Adolescents and Youth in Senegal

With support from USAID, E2A, and the Neema project, our health center’s providers took part in trainings on adolescent and youth-friendly postaboration family planning services. We enhanced our youth-friendly counseling.

“[This project] has changed our approach to the care of adolescent girls/young people. They are a vulnerable population that needs understanding and discretion. Prior to the training, PAC clients were allowed up to the eighth day postabortion to take contraception. After the training, they are provided with care immediately after PAC to allow them to leave the facility with a family planning method.” —A fellow Mbacké provider

Through the project, we set up a youth-friendly room. We developed sensitization materials—posters and flyers—on the benefits of adopting postaboration family planning. We reinforced these messages by involving decision-makers, such as partners and other relatives.

The project helped us improve our use of tools for more effective management of postabortion care. I played a coaching role, and the project supported my team by monitoring our activities and periodically collecting data and providing feedback on our progress.

I am really encouraged by the results.

Within 9 months, our health center saw a 78% family planning adoption rate among postabortion care clients, compared to just 17% at the start of the project.

I am especially proud of the uptake in long-acting reversible contraceptives among young people.

When I look at these results, I think of the 13-year-old girl who arrived at our doorstep in distress. Thanks to this project, we knew exactly how to help her.

We were able to find the right words to help her understand her situation. We counseled her on postabortion family planning. We discussed with her the risks she faced and the prospects she had for her future. We did all this while treating her with dignity and ensuring confidentiality. When she finally left the facility, she was reassured. And she had chosen to use a long-acting, reversible contraceptive method.

All women and girls in Senegal must have access to these lifesaving options.

Planning to Sustainably Reach More People in More Places

Through the project, I had the opportunity to participate in a strategic scale-up process of our pilot project. As a provider, this experience motivated me. I was glad to see how much focus was put on the importance of effective management of postabortion care.

Now we need to stay focused.

All providers will need to be trained in postabortion family planning—with a focus on young people’s special needs. I’d also like to see more integrated services, such as sexually transmitted infections and gender-based violence included in the training package, which was covered in our training.

We need to continue to improve data collection on postabortion family planning counseling. And we need to create more safe spaces for young people.

The lives of many Senegalese women and girls depend on it.

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