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Manual Vacuum Aspiration

Manual vacuum aspiration, or MVA, is a safe, effective method of uterine evacuation which uses a hand-held plastic aspirator. MVA can be used for surgical abortion, post-abortion care (PAC), and endometrial biopsy.

Unit of interventionper manual vacuum aspiration service provided

For more information about how PSI is increasing access to safe abortion services to improve health and save lives, visit our website at:
http://www.psi.org/health-area/maternal-health/safe-abortion/

Model Overview

PSI’s manual vacuum aspiration impact model is based on the Lives Saved Tool (LiST). LiST is used to estimate the number of deaths averted with complete coverage of safe abortion services in select countries, representing the projected impact of manual vacuum aspiration. This number of deaths averted at the population level is translated to deaths averted per service provided for manual vacuum aspiration, using parameters such as the number of live births per year, abortion incidence ratio, and under five mortality rates. Once we have deaths averted per manual vacuum aspiration service provided, we apply data from the 2010 Global Burden of Disease study to estimate the corresponding number of DALYs averted.

Model Outputs (impact metrics)

Estimates of DALYs averted, deaths averted, CYPs provided, and unintended pregnancies averted represent the projected health impact of the intervention. It is projected because it has not been directly measured.

Examples based on provision of manual vacuum aspiration in Myanmar in 2015 Statement of modeled results, examples:

In 2015 an estimated 4 deaths and 232 DALYs would be averted if 10,000 manual vacuum aspiration services were provided in Myanmar over the effective life of the intervention.

For more details about how PSI models manual vacuum aspiration impact, see below.

Model Details

Step 1: Running a projection in the Lives Saved Tool (LiST)LiST is a multi-cause mortality model developed by Johns Hopkins Bloomberg School of Public Health that estimates the number of deaths averted (or lives saved) through the scale up of maternal and child health interventions.

PSI begins by running a projection in LiST for select countries. We use “safe abortion services” in LiST as a proxy for our manual vacuum aspiration. In this projection, safe abortion services are increased from the current, country-specific baseline to 100%. LiST then projects the number of deaths averted among women seeking abortion by this increased level of coverage.

Step 1 Output:
Number of additional deaths averted (or lives saved) if coverage of manual vacuum aspiration is increased from baseline to 100% in select countries

Step 2: Estimating deaths averted per manual vacuum aspiration service providedPSI uses the step 1 output (deaths averted at 100% coverage of manual vacuum aspiration) to estimate the number of deaths averted by a single manual vacuum aspiration service provided. To do this, we divide the number of deaths averted at 100% coverage by the number of manual vacuum aspiration services provided that are needed to reach 100% coverage among women seeking abortion.

PSI estimates the number of manual vacuum aspirations services provided that are needed to reach 100% coverage using a number of parameters, including baseline coverage of manual vacuum aspiration access and mortality rates.

Step 2 Output:
Deaths averted coefficient for manual vacuum aspiration

Step 3: Estimating DALYs averted per manual vacuum aspiration service provided A DALY (or disability adjusted life year) includes two components: years of life lost due to premature death (YLL) and years lived with disability (YLD). DALYs averted are in turn comprised of YLLs averted and YLDs averted or, put simply: death and disability that is prevented by PSI interventions.

To estimate YLLs averted per manual vacuum aspiration service provided, PSI first estimates the number of years of life lost per death due to unsafe abortion in select countries. This is equal to the life expectancy at the average age of death from unsafe abortion. Age specific life expectancies are taken from the 2010 Global Burden of Disease study (GBD 2010). The number of years of life lost per unsafe abortion death is then multiplied by the number of deaths averted per manual vacuum aspiration service provided (deaths averted coefficient), calculated in step 2 above for a selected country. This gives us the YLLs averted per manual vacuum aspiration service provided.

To estimate YLDs averted per manual vacuum aspiration service provided, we use a YLD/YLL ratio, based on the 2010 GBD. This ratio represents the relative number of years lived with disability for every year lost due to death from unsafe abortion. We apply this ratio to the number of YLLs averted per manual vacuum aspiration service provided to estimate the number of YLDs averted per manual vacuum aspiration service provided.

Finally, YLLs averted and YLDs averted are added together to estimate the number of DALYs averted for manual vacuum aspiration.

Step 3 Output:
DALYs averted coefficient for manual vacuum aspiration