1. Recordkeeping and Reporting: An essential part of good quality Safe Abortion Care (SAC) service delivery

2. Recordkeeping & monitoring: more than just writing it down Why is information about SAC services important? –Helps explain trends over time: o Changes in numbers of women seen may mean change in practices in community o Are more women coming for safe induced abortions or treatment of unsafe abortion complications? –Helps ensure good clinical quality of services: o Is use of recommended UE technologies increasing? o Are more abortion-care clients leaving facility with contraception? –Lets providers and managers know when service quality has improved or worsened

3. Recordkeeping & monitoring: more than just writing it down (continued) –Helps ensure good clinical quality of services: o Is use of recommended UE technologies increasing? o Are more abortion-care clients leaving facility with contraception? –Lets providers and managers know when service quality has improved or worsened

4. What to aim for in recordkeeping & monitoring Record: Accurate & complete recording of all abortion-related cases at your facility Summarize: Regularly compile information into summaries Analyze: Providers & managers routinely analyze summaries

5. What to aim for in recordkeeping & monitoring (continued) – What does the summary information tell us about our services? – What should we do differently? – What should we continue doing the same?

6. Tips for routine SAC recordkeeping Abortion registers/logs should include all SAC categories (see Sample) Abortion logs should be kept in all locations where abortion patients receive care in your facility Important to designate which staff responsible for filling logbooks Logbook entries are needed for all abortion patients

7. Important Logbook Categories For ALL cases (safe induced abortions and treatment of complications) –Uterine size (since last menstrual period – LMP) –Presenting diagnosis/reason for care (safe induced abortion or abortion complications) –Type of UE method used –Provision of postabortion contraception

8. Important Logbook Categories (continued) For women seeking treatment of abortion complications –Presenting complications (serious or moderate)

9. Recording gestation or LMP for abortion complications or safe abortions Uterine evacuation (UE) is performed for treatment of abortion complications and safe legal abortion. The appropriate method of uterine evacuation (UE) is determined mainly by gestation/LMP

10. Recording gestation or LMP for abortion complications or safe abortions (continued) WHO recommends the same methods of UE for treatment of complications and safe abortions

11. Recording a Moderate Abortion Complication If client presents at facility with mild bleeding and dilated cervix (e.g., incomplete abortion) but no other complications (no sepsis, no perforation), this can be considered and recorded as a moderate complication

12. Recording a Serious Abortion Complication Record as a serious complication, if patient arrives at your facility with one or more of following: –shock –severe vaginal bleeding (hemorrhage) –intra-abdominal injury –vaginal/cervical injury, perforated or ruptured uterus

13. Recording a Serious Abortion Complication (continued) –presence of foreign body in genital tract –sepsis –organ failure

14. Recording diagnosis of safe abortion Clients who come to your facility for safe, legal abortion Record “safe abortion” or “safe legal abortion” in logbook

15. Recording “Death” as an Abortion Complication If woman arrives with a serious complication, record “serious complication.” If she later dies of these complications, also record “death” (e.g. in “Comments” column)

16. Recording “Death” as an Abortion Complication (continued) If she arrives at facility deceased, record “death.” All abortion-related deaths & other maternal deaths should trigger a maternal death audit/review in facility.

17. Recording Uterine Evacuation Method The appropriate method of uterine evacuation (UE) is determined mainly by gestation/LMP WHO recommends the same methods of UE for treatment of complications and safe abortions

18. Recommended UE Methods Source: Adapted from WHO, 2003. Safe Abortion: Technical and Policy Guidance for Health Systems

19. Recording Postabortion Contraception Did the client (treated for complications or receiving a safe legal abortion) receive counseling about contraception? yes/no If counseled, did client indicate a desire to use a contraceptive method? yes/no If indicated desire for contraception, did she receive a method? yes/no

20. Recording Postabortion Contraception (continued) If indicated desire for contraception, did she receive a method? yes/no If client received a contraceptive method on site, then record the type of method supplied: injectable, condom, OCP, etc.

21. If she did not receive a method at your facility, (for example, did not want a method) record “none.” If she was referred to another facility for a method, note “referred” (if referred within hospital, follow-up is needed to ensure method receipt). Recording Postabortion Contraception (continued)

22. Recording obstetric complications Emergency obstetric care (EmOC) = care provided in health facilities to treat direct obstetric emergencies Direct obstetric complications (responsible for 75% of all maternal deaths) include: –Ante partum hemorrhage (including placenta previa) –Postpartum hemorrhage (including retained placenta)

23. Recording obstetric complications (continued) –Prolonged /obstructed labor (including CPD) –Ruptured uterus –Postpartum sepsis –Pre-eclampsia/eclampsia –Ectopic pregnancy –Complications of abortion (discussed previously)

24. Good records are key to SAC service quality and improvements! With complete records you can accurately assess if SAC services are adequate With good records you can identify areas for needed improvement