From Fear to Acceptance: Supporting Young Women’s Reproductive Choices…

From Fear to Acceptance: Supporting Young Women’s Reproductive Choices in Rural India

Komal, a 16-year-old girl from a remote village in Assam, faced a daunting challenge when she found out she was pregnant. In her village, abortion is highly stigmatized due to fear of judgment, gossip, and social ostracization. For unmarried girls like Komal, the pressure is even more intense. Her family, concerned about their reputation, insisted she ends the pregnancy, but Komal had no clear path to safe abortion services, a struggle many young women in rural India face.

Adolescent girls and young women across the country face numerous barriers when seeking abortion services. These challenges are rooted in a complex mix of socio-cultural, economic, and structural factors that create a complex and often hostile environment for those seeking to terminate a pregnancy. In India, unsafe abortion remains the third leading cause of maternal mortality in India.   

Peer-Led Support and Community-Based Solutions for Reproductive Health 

Komal found hope during a sexual and reproductive health (SRH) education session at her school in Assam’s Mamudpur village led by Pallabi, a youth leader trained by Ipas Development Foundation (IDF). Pallabi, who had been trained to educate adolescents and young women on SRH, was approached by Komal for help. Pallabi provided compassionate support by talking to Komal’s parents, offering reassurance, and guiding her through the process. She accompanied Komal to a nearby government health facility supported by IDF, where Komal received the care she needed in a safe and confidential manner. 

IDF’s innovation focuses on creating a sustainable ecosystem to improve access to SRH services including contraception and safe abortion. This approach integrates system strengthening with community-level interventions to build a robust SRH ecosystem. System strengthening involves providing technical support to public health departments in four states to expand and decentralize abortion care, aligned with the 2021 amended abortion law. 

Additionally, a youth-focused model introduced in selected parts of two states educates young women and their partners on SRH rights and access. A critical part of this model is on SRH issues – preventing and managing unintended pregnancies, offering referrals and support for safe SRH services like abortion, and empowering them to uphold their agency and challenge several restrictive socio-cultural norms. They also help navigate public health facilities and challenge restrictive socio-cultural norms. 

To address mobility challenges, the initiative decentralizes services to lower-level health facilities and strengthens community-based contraceptive distribution and counseling through health intermediaries. 

Expanding Access to Reproductive Health Services and Changing Lives 

Youth leaders have emerged as dynamic leaders, championing an understanding of sexual and reproductive health within their communities. These empowered leaders are central to the innovation providing young women and men with SRH knowledge and life skills essential for informed decision-making. They guide young women through the complex process of accessing abortion care and actively work to challenge and change restrictive socio-cultural norms within their communities.  

“Earlier I had no experience in this field, but now my understanding of sexual and reproductive health has increased. I feel empowered by the opportunity to work with young women and help them make informed choices about their health.” — Arjina Ahmed, Youth Leader, Assam

So far IDF reports the following results from the two intervention states:

• Youth leaders mentored by the innovation have reached out to over 100,000 young women and 90,000 young men with messages on SRH including abortion and contraception.  
• Over 5,400 young women and men benefitted from the referral support provided by these youth leaders. 
• The innovation has expanded the provider base for abortion services in public health facilities through training of 1,422 providers across four states, resulting in more than 150,000 women receiving abortion services.
• Assistance in the establishment of 72 Medical Boards (under the amended abortion law) has significantly improved access to late-term abortion services for cases involving congenital anomalies, simplifying the need for women to seek court intervention.
• Strengthening youth-friendly health services has enabled over 88,000 adolescents and young women to access SRH services at intervention health facilities in two states. 

“The intervention has really created a strong social capital in rural communities. Our youth leaders are equipped to inform and guide young women seeking abortions and other reproductive health services. The referral and accompaniment support are a big boon and we know that it is playing a critical role in care seeking. We believe the young workforce we will leave behind in communities will go a long way in improving the health and lives of women and girls” — Moumita Sarkar, Ipas Development Foundation

“During my 4-day training with IDF, I gained essential knowledge about contraception, safe abortion, and the MTP Act Amendments. It also enhanced my counselling skills and provided tools to better support clients with their reproductive health needs. With this expertise, I now confidently offer appropriate advice, contributing to informed contraception choices in my community. Thanks to the education sessions and referral support from the IDF Youth Leader, more young couples are now coming to my health facility for contraception” — Rexona Begum, Community Health Officer, Chotogiripar Health and Wellness Center, Assam.

“Pallabi Didi’s support was crucial in helping me to come out of the immense state of guilt and fear enabling me to regain my health  and move forward with my life. Her assistance not only provided me with the necessary services but also fostered a supportive environment for acceptance within my family. I first met Pallabi Didi in my school where she was conducting a session on sexual and reproductive health, our rights, and available SRH services. The session allowed us to openly discuss topics often considered taboo in my village. Through these discussions, we got correct information dispelling the myths about abortion, contraception, and menstruation, and I got the confidence to share my personal issues and seek support.” — Komal, Village Mamudpur, Assam

 

This story is shared by Ipas Development Foundation.

Names of individuals in the story have been changed to protect their privacy.

 

Safe Abortion Within Reach: How Telemedicine is Transforming Reproductive…

Safe Abortion Within Reach: How Telemedicine is Transforming Reproductive Health in Rural Colombia

Reina, a 24-year-old woman from Istmina, in the heart of Chocó, Colombia, was overwhelmed when she discovered she was pregnant. The news was compounded by her unemployment, the precariousness of her daily life, and her economic dependence on her father, an unemployed provider. In a region where poverty is a constant reality, access to safe abortion seemed like an unattainable option. 

Chocó,  long plagued by violence, neglect, and poverty, faces significant gaps in health services, particularly for sexual and reproductive rights. For young women, these barriers are even more pronounced, with socioeconomic and gender inequalities severely limiting their autonomy. Reina’s struggle to access her rights reflects the broader difficulties faced by women in this underserved region. 

Reina’s situation was dire: “My period didn’t come, and I didn’t have the means to take a pregnancy test, so I borrowed money. I couldn’t believe it when I saw those two red lines; I felt the worst chill of my life.” Her biggest fear was that the pregnancy would erase her chances of finding a job to help her father. 

Amid this adversity, telemedicine emerged as a crucial solution. Through a Facebook ad, Reina accessed a chat where she could receive guidance and support. This channel connected her with qualified health personnel, transforming her situation. 

Telemedicine Innovation:  Bridging Gaps in Remote Areas 

The telemedicine program developed by Oriéntame with the support of the OPTions Initiative has broken down barriers of distance and addressed the shortage of healthcare providers in Istmina. Thanks to this innovation, Reina was able to access a safe abortion from her home. After receiving counseling, she was sent the “Kit Alas,” which contains everything needed to ensure a safe abortion. This kit, designed to reach the most remote areas of the country, ensures that legal abortion is truly within everyone’s reach. 

“I am so grateful for the support I received to pay for my care. In my home, when we have money for breakfast, there isn’t enough for lunch. This gave me my life back. I would never have been able to afford such high-quality care. In my desperation, I made the call, and everything was real; they made me feel calm about the decision I was making for my future” Reina shared. 

The telemedicine program’s impact extends beyond Reina, benefiting many women in similar situations. By providing quality healthcare, it enhances women’s autonomy and supports their reproductive rights, even in regions where such rights are frequently denied. 

A New Path Forward: The Broad Impact of Telemedicine 

“The most gratifying thing is knowing that we are reaching the women who need it most, even in the most remote places in Colombia. Our goal is simple: to ensure that no woman is left without safe and dignified care, no matter where she lives“, explained one of the program’s leaders. 

Currently, this innovative program is being replicated in other rural and vulnerable regions of Colombia, with the goal of expanding its reach and ensuring that more women can benefit from it. With continued support from sponsors and allies, the program is building a solid network that is changing the landscape of sexual and reproductive health in the country. 

For Reina, the future now seems brighter. Free from the worries of an unwanted pregnancy, she can focus on building a better life for herself and her family. “I received excellent care. Here, where I live, everything is of poor quality, and it’s hard to get an appointment. This service was easy; I didn’t have to leave my house. Today, I feel like I can decide about my life and my body. I want all women to know that they have the right to that freedom, and that they are not alone”, she says with hope. 

Despite challenges such as connectivity and the digital divide, telemedicine has become an alternative for hundreds of women who, for various reasons, cannot access healthcare services. 

When Oriéntame staff is asked why they work on this initiative, they always remember the words of Cristina Villarreal, former director of Oriéntame: “How could we not do it?” The Oriéntame team’s passion is to ensure that women and all people that can get pregnant have autonomy over their bodies and lives. That is why Oriéntame invites everyone to support this cause because solidarity in tackling unsafe abortion will never be too much.

 

Learn more about the innovator here.

This story is shared by Fundación Oriéntame.

Names of individuals in the story have been changed to protect their privacy.

From Stigma to Solidarity: A Journey in Transforming Abortion…

From Stigma to Solidarity: A Journey in Transforming Abortion Care

“They label me as the doctor who performs abortions”, reflects a dedicated gynecologist working in the rural south of Mexico.

Sabrina, based at a public hospital, faced significant challenges due to restrictive abortion laws that permit abortions only under narrow exceptions, such as in cases of rape. During her medical training, she received no education on abortion care. Although involved in the public Safe Abortion Program, Sabrina was initially unaware of the broader abortion movement or the existence of acompañantes—feminist activists who support self-managed abortion through a holistic model, thus enhancing access to safe abortion in the region.

In Mexico, access to safe abortion is still limited, especially for the most marginalized and vulnerable people. Social stigma and laws criminalize both those who have abortions and providers, which acts as one of the principal barriers to safe abortion. Being a pro-choice physician in Mexico often means feeling stigmatized, unsafe, and isolated, there being a gap between peers as well as between the medical sector and the wider abortion movement.

The Mexican Network of Prochoice Female Physicians: Building Support and Expanding Access 

To address these issues, the Mexican Network of Prochoice Female Physicians [Red de Médicas por el Derecho a Decidir – México] was established as the first nationwide network dedicated to uniting and supporting female physicians who are abortion providers and/or advocates. The Network also links these physicians with the broader abortion movement. This innovative Network offers peer support and training to its members and fosters collaborations with acompañantes, thereby enhancing access to safe abortion in Mexico.

Since forming part of the RMDD, Sabrina feels that she is no longer alone. She feels supported, knowing there are other physicians like her as well as abortion activists, with whom she can exchange experiences and knowledge. This strengthened her work as a gynecologist in the public sector and allowed her to expand her practice to abortion provision, for example, at advanced gestational age, becoming one of the only physicians in the state to do provide such services. She now collaborates with local acompañantes who refer people in need of medical care to her, while she refers to them for personalized accompaniment which can´t be provided within the health system.

 

Increased Confidence and Expanded Care 

“When I started as an abortion provider, I entered the world of safe abortion with fear, with ignorance of many things, with many stigmas, hiding… Now, I have gained a lot of confidence, thanks to all the training, to everyone I have met, to all the women in the Network. Having a support network, (…) has made me not be afraid, to act, to know for sure that I am protected, that women are protected, that it is safe. Yes, the truth is that much has changed, I am no longer afraid to talk about the subject.”

The Network´s peer-support and training has reduced stigma, increased knowledge, resilience, perceived personal safety, and openness about their pro-abortion stance in its members, whilst fostering collaborations with acompañantes. This empowered the more than hundred physicians in the Network to engage as abortion advocates and/or providers, thereby increasing access to safe abortion in Mexico.

“The stigmatization and isolation of pro-choice physicians has historically limited their impact on safe abortion access. Uniting these professionals has allowed them to support each other and combine their strengths, which opened possibilities for advocacy, service provision, and collaborations that were previously unimaginable”.

The Network´s innovative model is now being shared with organizations and institutions in Mexico and other Latin American countries, where it may serve as a successful example of organizing pro-choice physicians and provides the methods to foster interactions between medical professionals and accompaniment networks. Funding for this innovation allows for the dissemination of the Network´s successful example.

For Sabrina, forming part of the Network has changed her life. She no longer feels guilty or afraid. She feels strengthened in her actions as an abortion provider and her belief that she is doing the right thing: improving women’s health and wellbeing: “I sometimes felt alone in the world, because it is difficult to work as a doctor in public hospitals. Now I feel part of something bigger, and that there are many women with me. I would like to work more with acompañantes, because they can contribute something else than I can. I think that different knowledge, different opinions, different eyes, can contribute something.

Learn more about the innovator here.

This story is shared by CISIDAT.

Names of individuals in the story have been changed to protect their privacy.

Innovating Safe Abortion Access for Women with Disabilities

Innovating Safe Abortion Access for Women with Disabilities

A young, queer Kenyan woman living with a disability faced a harrowing challenge when she discovered she was pregnant. Sally, a 23-year-old, struggled to access safe abortion services in a country where unsafe abortion is a major cause of maternal health issues and deaths.  In Kenya, according to the African Population and Research Centre, the rate of unintended pregnancies increased from 34% in 2014 to 42% in 2020, and unsafe abortions account for up to 14% of pregnancies, leading to approximately 2,600 deaths annually. With a maternal mortality ratio of 362 per 100,000, women aged 25-39 face a significant portion of these deaths and severe complications, with up to 17% potentially linked to induced abortion. 

Breaking Barriers in Unsafe Conditions  

In Kenya, abortion is heavily restricted, leading many women to seek unsafe methods from unqualified providers or through dangerous home remedies. Sally’s situation was compounded by her economic dependence on her father and a lack of family support. “I’ve been grappling with significant emotional pain and a lack of support from my family, particularly from my father, who disowned me when I was 11 years old. I found myself in a constant struggle to get their approval but only ended up disappointed with low self-esteem as they neither acknowledged me nor supported me in any way. I got involved with a man who gave me financial assistance to support my siblings and I,” Sally recounted.  

She further explains, “I got pregnant. I had not planned for the pregnancy, and I felt that I was not ready to carry it through. Moreover, the man denied the pregnancy. Being a lesbian brought its own set of challenges because I could not tell my friends in the community because I feared that they would ostracize me. I really did not know what to do.” 

Women Spaces Africa’s Innovative Response  

Amid her struggles, Sally reached out for help: “I finally found the courage to tell a friend who introduced me to Celine, a disability champion from Women Spaces Africa who lived near my village. Celine asked me a set of questions. She needed to know when was the first day of my last menstrual cycle and unfortunately, I could not remember. She said she could give me abortion pills and I could have the abortion at home without anyone involved but since I am not sure of the exact dates of my last cycle, Celine had to refer me to a doctor. She offered to accompany me during and after the procedure. She kept her word, and I got an abortion for free.”  

Women Spaces Africa (WSA) is a feminist, disability led non-governmental organization that is working towards achieving sexual and reproductive health rights for girls and women with disabilities. Through support from the OPTions Initiative, WSA works to eliminate the barriers facing girls and women with disabilities in accessing to safe abortion by putting pills in their hands alongside the needed information and guidance and making direct referrals to affordable abortion providers whenever it is necessary.  

Many sexual and reproductive health interventions do not include girls and women with disabilities, and those that do fail to offer disability friendly services. This intervention is responding to the unmet need for safe abortion among girls and women with disabilities by delivering pills directly and providing referrals to affordable providers. Their innovation includes a safe, judgement-free abortion accompaniment service for women with disabilities in Nairobi’s informal settlements. Trained disability champions offer support, administer pills, and facilitate referrals to trained abortion providers who offer disability-friendly services at subsidized costs. 

Phylis Mbeke, the Executive Director at WSA emphasizes that the self-care model for girls and women with disabilities is crucial as this addresses their accessibility needs while accessing abortion services.  According to the World Health Organization, self-care interventions have the potential to increase choice, where they are accessible and affordable, and they can also provide more opportunities for individuals to make informed decisions regarding their health and health care. Consequently, self-care interventions represent a significant push towards new and greater self-efficacy, autonomy and engagement in health for self-carers and caregivers. 

As a result of this innovation, 298 women with disabilities have been supported to have safe abortions both through direct provision of pills and referrals to abortion service providers. In addition to that, 39 public health facilities have been trained on the World Health Organization abortion protocols and disability friendly abortion service provision. They have displayed positive attitude towards women with disability and their right to abortion. Some of the providers offer subsidized rates while others offer free abortion services to girls and women with disabilities as a result of the intervention.  

The innovation will be scaling up to reach a wider number of girls and women with disabilities with continued focus in Nairobi and a new area in Mombasa. WSA is bringing in women led disability organizations to adopt the innovation.  

A follow up on Sally after the abortion revealed that she is positive and happy and has since set up a small hair salon. “It has been two months since I had an abortion and I feel relieved. I still have long conversations with Celine, who remains a steady and understanding presence. I also find solace in journaling and creating art. I am determined to make my life better and become independent financially. With support from Celine and Women Spaces Africa, I have started engaging as an advocate for reproductive health rights and LBTQ+ issues by sharing my story to help other girls and women with disabilities to feel less alone in their abortion journey,” shared Sally.  

Sally points out that, “for individuals with disabilities, the right to choose abortion is not just about personal freedom; it’s about ensuring that every individual has the opportunity to live a life that aligns with their own capacity and aspirations. Women with disabilities should be able to access acceptable standards of abortion services at an affordable cost, without judgement”.

 

Learn more about the innovator here.

This story is shared by Women Spaces Africa.

Names of individuals in the story have been changed to protect their privacy.