Working to Advance Health Equity in Africa


The Status of Provision of Post Abortion Care Services for Women and Girls in Eastern and Southern Africa: A Systematic Review


Unsafe abortion is a research priority area within HEARD’s Sexual and Reproductive Health and Rights Programme and focuses on the availability, access and uptake of abortion-related services for girls and young women in the Eastern and Southern African (ESA) region. Abortion is highly restricted in most countries in the region and morbidity and mortality from complications due to unsafe abortion are high. In these contexts, ensuring timely access to quality post-abortion care (PAC) services can be the difference between life and death and/or lifetime morbidity with profound impact at an individual, family and societal level.

The sustainable development goals (SDGs) endorse universal access to sexual and reproductive health (SRH) care, including PAC. The majority of countries in the region are signatory to commitments ensuring access to quality PAC services – however, progress remains patchy. In order to understand the current national and regional challenges as well as opportunities for advancing these commitments, HEARD conducted a systematic review of the published scientific literature on the reach, quality and costs of PAC provision in the region.

The review found that there is a considerable knowledge gap on the state of PAC in the region. There was some evidence of efforts being made to introduce PAC at lower level health facilities, to use mid-level providers and to employ less invasive medical techniques. However, weak health systems and social stigma pose serious challenges to widespread provision of PAC and access to quality services, with adolescent girls being a particularly vulnerable and underserved group. Next generation research should aim to understand and learn from inter-regional differences and to inform strategies which normalise PAC as one component of a comprehensive SRH service package.

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