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Self-managed Abortion Care in a Legally Restrictive Environment

Updated: 2 days ago


"I don't have a stable job. I don't have a steady income. Since abortion here is legally restricted, even access to medication was quite complicated. Very complicated. The information provided by the Aya Contigo mobile app helped me prepare for the abortion process, and gave me more confidence in what I was doing." User of Aya Contigo .






Lessons Learned


Even in humanitarian contexts, it is possible to apply people-centered research and design thinking to the development and implementation of digital solutions for sexual and reproductive health and rights (SRHR). Using a localized, community-driven approach, it is possible to achieve quality solutions, even for the most stigmatized sexual and reproductive health problems and in the most difficult and legally restrictive contexts.



Working with local partners is essential when designing and developing abortion interventions, especially in complex humanitarian crisis situations where the health system is weak. Large international humanitarian organizations are often present on the ground for a limited time in humanitarian situations. Once their intervention has been carried out and the crisis has been resolved, these organizations often leave the scene. But local grassroots organizations remain and continue to work to improve the health of the people there. They are grounded and knowledgeable about the local situation, with a detailed understanding of the complex ecosystem of the context, including the country-specific social, cultural, political and legal factors that impact SRHR in general and access to abortion care in particular.


Self-managed approaches to comprehensive abortion care cannot exist in isolation. An evidence-based tool that connects people in need of abortion with organizations that facilitate access to safe abortion is a first step in closing the gap between people's needs and the supply of services in the formal health system. However, ensuring safe, respectful and comprehensive abortion care for all women in need, without discrimination, requires functioning and responsive health systems, underpinned by laws and policies that promote and protect human rights and sexual and reproductive health rights.


Tips to Make It Happen


  • Listen to and learn from women and local community organizations. Close collaboration with end-users improves understanding of the gaps and barriers to accessing sexual and reproductive health services, as well as the challenges to implementing these services in real situations. In this way, inclusive and non-fragmented SRHR interventions that scale up and improve existing local initiatives can be supported.

  • Design solutions together with the end users. This approach generates a feeling of ownership, as opposed to externally imposed solutions. The end result is a solution created by the community itself.

  • Have patience in building trust. It is crucially important to take the time to build strong relationships with local grassroots organizations. This process will be strengthened if we base our work on the evidence provided by the WHO guidelines.

  • Be reactive and willing to change plans. Engaging with new stakeholders, exploring alternative approaches and reformulating strategies can help avoid delays in the process. Flexibility is particularly valuable in legally restrictive contexts and in complex humanitarian crisis situations, as well as in unexpected situations such as the emergence of a pandemic.

Background and Context

WHO GUIDELINES AND TOOLS ON ABORTION

HOW THE IMPLEMENTATION WAS CARRIED OUT

REFERENCES

For more information and recent WHO resources on abortion care, see the WHO webpage on abortion.


This story was written by Vitala Global, in collaboration with the IBP Network and the Prevention of Unsafe Abortion (PUA) Unit of the WHO Department of Sexual and Reproductive Health and Research (including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme for Research, Development and Research Training in Human Reproduction [HRP]). This document does not necessarily represent the decisions, policies or opinions of WHO or HRP. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by WHO or HRP in preference to others of a similar nature that are not mentioned.



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