Title: Post-abortion family planning
Course: Level 3 - Family Planning > Section: Overview of postpartum, post-abortion and permanent family planning methods

Women who have just experienced an abortion or who have just been treated after an abortion complications need immediate and easy access to family planning services. Ideally, for post-abortion clients, counselling before the procedure can only be an option if the client is not under stress related to the procedure. This allows the client to receive her method of choice immediately after the procedure (immediate post-abortion) should she choose a postabortion IUD. However, in this case, the stress that the client is experiencing may impair sound decision making. With such clients, the provider has the responsibility to confirm that they are making an informed, voluntary, and sound decision.

The next appropriate opportunity to counsel such a client is after the procedure but before she leaves the facility. At this point, it may be too late to provide some methods (such as the IUD) at the end of the procedure, but this may help ensure that a client gets her method of choice before discharge or returns later to get it at follow-up.

The main factors contributing to repeat unsafe abortions are as follows:

- Lack of recognition of the problem of unsafe abortion and clients' needs for family planning.
- Lack of family planning services for some groups, for example, adolescents.
- Family planning services not integrated with post-abortion emergency service.

Post-abortion counselling

A woman who has had an abortion needs support. A woman who has faced the double risk of pregnancy and unsafe induced abortion especially needs help and support.

Proper counselling gives a post-abortion client much needed support. In particular, the counsellor should:

- Try to understand what the client has been through.
- Treat her with respect and avoid judgement and criticism.
- Ensure privacy and confidentiality.
- Ask if she wants someone she trusts to be present during counselling.

Post-abortion counselling messages

A woman has important choices to make after receiving postabortion care. To make decisions about her health and fertility, she needs to know:

- Fertility returns quickly within 11 days after a first-trimester abortion or miscarriage and within four weeks after a second- trimester abortion or miscarriage. Therefore, she needs protection from pregnancy almost immediately.
- She can choose from among many different family planning methods that can be started at once. Methods that women should not use immediately after giving birth pose no particular risks after abortion.
- She can wait before choosing a contraceptive method for ongoing use, but she should consider using a backup method in the meantime if she has sex. If a woman decides not to use contraceptives at, this time, providers can offer information on available methods and where to obtain them. Also, providers can offer condoms, oral contraceptives, or emergency contraceptive pills for women to take home and use later.
- To avoid infection, she should not have sex until bleeding stops-about 5 to 7 days. If being treated for an infection or vaginal or cervical injury, she should wait to have sex again until she has fully healed.
- She should wait at least six months before trying to become pregnant. Waiting at least six months reduces the chances of low birth weight, premature birth, and maternal anaemia.

When to start contraceptive methods after an abortion?

The following contraceptive methods can be started immediately after an abortion:

- Combined oral contraceptives.
- Progestin-only pills.
- Progestin-only injectables.
- Contraceptive implants.
- Male and female condoms.
- IUCDs if no infections.