Each year, an estimated 20 million women worldwide have illegal induced abortions, which are often incomplete, unsafe and potentially life-threatening, and millions more have incomplete spontaneous abortions. The September 2003 issue of International Family Planning Perspectives focuses on the medical, technical, social and political barriers these women face in receiving treatment and on the services they need in addition to medical care.

In Essential Elements of Postabortion Care: Origins, Evolution and Future Directions, Maureen R. Corbett of the University of North Carolina and Katherine L. Turner of Ipas outline five essential elements of care for women with abortion-related complications: cooperation between medical service providers and local communities; emotional support and health counseling; medical treatment; contraceptive services; and general reproductive and other health services, either on-site or through referrals to cooperating facilities.

Jill Tabbutt-Henry and Kristina Graff of EngenderHealth further elaborate on the need for counseling in Client-Provider Communication in Postabortion Care. The authors recommend that health care providers offer personalized information and support before, during and after clinical procedures in order to put women at ease and to provide the best possible care. They describe the basic elements of counseling, examine why postabortion counseling is difficult for providers and suggest ways in which policymakers, program planners and supervisors can contribute to an environment that is supportive of counseling.

In Moving from Research to Program-The Egyptian Postabortion Care Initiative, Dale Huntington of the World Bank and Laila Nawar of the Population Council describe the evolution of a project that sought to improve the standard of care for women with abortion complications in a country where abortion is a highly sensitive topic. They report on the problems the project faced as it shifted from a research focus to a national program with a clinical focus-such as the difficulty of building trust and support among clinicians and in the government bureaucracy-and on continuing obstacles, such as government refusal to allow the importation of manual vacuum aspiration instruments needed to treat women presenting with an incomplete abortion.

In Comparing the Quality of Three Models of Postabortion Care in Public Hospitals in Mexico City, Deborah L. Billings of Ipas et al. compare outcomes for women treated for abortion complications at six hospitals in Mexico City. Women whose treatment included individualized health and contraceptive counseling-as opposed to general information on those topics-left the hospital with a better understanding of their health status and their bodies, the clinical procedure involved, follow-up care at home, signs of possible postprocedure complications and where to seek help in case of complications. They were also more likely to accept a contraceptive method before leaving the hospital.

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