Postabortion care prevents complications that result from miscarriage or unsafe abortions from escalating to severe health outcomes or death. In addition to clinical treatment comprising uterine evacuation, infection management and treatment of injuries resulting from unsafe procedures, postabortion care includes family planning services and other relevant health care.
This fact sheet presents findings from a 2018 study on the availability and methods of postabortion care in Java, Indonesia’s most populous island. It offers suggestions for how Indonesia can expand access to quality postabortion care, including through the introduction of national guidelines that support task shifting and enhanced, standardized training for midwives and general physicians in postabortion care.
Current provision and availability
- Postabortion care in Indonesia is typically administered by obstetrician-gynecologists practicing in hospitals. Other types of providers, such as general physicians and midwives, do not commonly perform uterine evacuation—a core component of postabortion care—thus curtailing the availability of this care.
- Restricting the provision of postabortion care to specialists in hospitals is unusual; in many countries, uterine evacuation for first-trimester postabortion care is routinely offered in public health centers at the primary-care level.
- Only 46% of hospitals in Java offer either basic or comprehensive postabortion care services. Facilities with either service capacity have a sufficient number of obstetrician-gynecologists on staff and offer around-the-clock access to the full set of essential postabortion care services and treatments, including uterine evacuation and provision of uterotonics and intravenous antibiotics.
- Capacity for either basic or comprehensive postabortion care services is concentrated among 86% of the largest referral hospitals; only 53% of maternity hospitals and 34% of local hospitals offer the necessary services, treatments and staffing.
- Because public health centers in Indonesia are staffed by general physicians and midwives—providers for whom postabortion care training and provision guidelines are inconsistent—these centers do not provide uterine evacuation for postabortion care.
- Family planning services are an important component of postabortion care. Currently, 68% of hospitals in Java stock short-term family planning methods, and 77% offer long-acting reversible contraceptives.
Methods of postabortion care
- The World Health Organization (WHO) recommends vacuum aspiration or misoprostol for treatment of incomplete abortion in the first trimester.
- Although 67% of all hospitals in Java possess functioning vacuum aspiration equipment, only 7% of postabortion care patients are treated with vacuum aspiration. Just 4% of patients are treated with misoprostol.