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.

Hands together in a circle
Photo provided by CISIDAT

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 

ceremony
Photo provided by CISIDAT

“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 event with audience.
Photo provided by Women Spaces Africa

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.

Mercy’s Journey of Resilience and Hope

Mercy’s Journey of Resilience and Hope

Mercy’s journey began with an unintended pregnancy at a young age in Livingstone, Zambia. At just 16 years old, she faced the dangers of attempting an abortion using traditional medicine, which resulted in severe infections and significant emotional trauma.

“If only this program had been available sooner, I wouldn’t have endured so much suffering.” reflects Mercy, whose life was profoundly impacted by an unsafe abortion.

Her experience underscores the pressing need for comprehensive sexual and reproductive health (SRH) education and support for adolescents, a critical gap in many communities.

In her community, the lack of proper SRH education and support has led to numerous cases of unsafe abortions and unwanted pregnancies among adolescents, affecting their health and future prospects.

The FAI Project’s Comprehensive Support System 

To address these challenges, the FAI project established a comprehensive support network, which includes safe space meetings and the Aunty Tasha Helpline. These initiatives provide vital information on preventing unwanted pregnancies, safe abortion options, and accessing appropriate healthcare services.

By educating adolescents and offering a strong support system, the FAI project enables them to make informed decisions. For Mercy, this support was life changing. She was able to navigate her past experiences and prevent future challenges through the guidance and care she received from the project.

A Future of Hope and Confidence

Young people sitting in a circle.
Photo provided by Contact Trust Youth Association

“I am incredibly thankful for the support I received from the FAI project. It taught me how to prevent unwanted pregnancies and seek help safely” shares Mercy.

The Project Coordinator adds, “Our initiative addresses a crucial need by providing essential SRH education and support. We have observed a significant reduction in unsafe abortions and notable improvements in the well-being of our beneficiaries. The success of this program lies in its ability to offer a safe, non-judgemental space where adolescents can seek help and information. This approach not only supports individuals but also contributes to broader community and health improvements.”

As the FAI project expands to more schools and communities, increased funding will be key to ensuring more adolescents receive the support they need. Mercy’s life has been profoundly transformed by the FAI project. She now feels empowered with the knowledge and support to face her future with optimism.

“The FAI project has truly changed my life. I now have the tools and support to make better decisions, and I hope this program continues to help others in similar situations” says Mercy.

 

 

 

Learn more about the innovator here.

This story is shared by the Contact Trust Youth Association.

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

Pioneering Accessible SRHR in Pakistan

Pioneering Accessible SRHR in Pakistan

two women sitting together, one is teaching the other one about sexual and reproductive healthcare options.
Photo provided by Greenstar Social Marketing Pakistan

Ulfat, a 30-year-old mother from Lyari, Pakistan, lives in a country with one of the highest abortion rates in the world.  Many of these procedures are performed under unsafe conditions, placing women like Ulfat in perilous situations. Coming from a conservative Pashtoon family, Ulfat has faced severe hardships. As a mother of three daughters and one son, she has endured years of physical and emotional abuse from her husband, who rejects family planning and blames her for bearing daughters. His relentless desire for more male children, coupled with his refusal to provide basic necessities for his daughters, has left Ulfat in a constant state of fear and desperation. Struggling to care for her children, she often relies on charity to meet their daily needs.

The pressure escalated when Ulfat discovered she was pregnant with her fifth child. Overwhelmed and terrified by multiple closely spaced pregnancies, she found herself in a critical situation with deteriorating health, uncertain of how to move forward, especially under the immense pressure to bear a son.  Her situation is not unique; many women in Pakistan face significant cultural and social barriers in accessing reproductive health services.

In a moment of profound need, Ulfat found hope through Saira, a dedicated Sitara Baji (community health worker) from Greenstar’s reproductive program.  During a door-to-door visit, Sitara Baji Saira provided Ulfat with crucial counseling on self-care needs and introduced her to misoprostol, a safe and affordable medication option that ensures the client’s comfort, safety, and confidentiality. Saira not only offered her health-related advice but also helped

her connect with Greenstar’s doctor, who supervised the entire process. The doctor explained signs and symptoms and followed up with Ulfat to ensure she felt guided and supported. This innovative approach saved Ulfat from another unwanted pregnancy and alleviated the societal pressure of bearing another girl child.

With the support from the OPTions Initiative, Greenstar has trained and deployed 10 Sitara Bajis, establishing 10 Sitara Houses — secure environments where women receive essential reproductive health services and counseling..

Women sitting together learning about SRHR
Photo provided by Greenstar Social Marketing Pakistan

Each Sitara Baji has achieved financial independence while providing crucial services. Since the program’s launch, over 44,000 women have received reproductive health counseling, including on the self-administration of misoprostol. From October 2022 to June 2024, more than 6,283 women have accessed medical abortions through this initiative.

“Sitara Baji Saira and Greenstar did more than just provide me with termination of pregnancy options — they gave me the strength to stand up for myself. This service was more than just medical support. It was a lifeline that empowered me to reclaim control over my body and my future.” Ulfat said with gratitude in her voice.

The impact of this program is profound: 94% of women in the Sitara House catchment areas are now aware of self-managed abortion. Client satisfaction rates at Sitara Houses are exceptionally high (99.9%), far surpassing those of nearby providers (73%). This success is attributed to the program’s focus on affordability, respect, and ease of access. Additionally, the initiative has led to a 58% improvement in reproductive health knowledge in the community, highlighting the transformative effect of this innovative, community-driven approach.

“This intervention is transforming our community by providing accessible and respectful reproductive health services” said a representative from Greenstar. “It empowers women to make informed decisions about their health and future”.

Ulfat has found a renewed sense of hope and is determined to create a better future for herself and her children. “Now, I dream of a future where my daughters grow up in a world where their choices are respected, and their voices are heard,” she said.

 

Learn more about the innovator here.

This story is shared by Greenstar Social Marketing Pakistan.

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

2202-60190

Quality-assured mifepristone as emergency contraception: A next generation option for an existing abortion pill

  Concept Foundation    Argentina, Ethiopia, Ghana, Netherlands, Sweden, Tanzania, Thailand, and Switzerland

Concept Foundation seeks to expand the regulatory pathway of mifepristone an as emergency contraceptive in low- and middle-income countries, exploring pathways to bring mifepristone as a quality-assured, low-cost, over the counter emergency contraceptive to market. Concept Foundation will prepare a data package to demonstrate mifepristone can be registered using existing evidence, supported by an advisory committee. Once the data package is finalized, Concept Foundation will meet with regulatory authorities and agencies to establish pathways to register mifepristone as a quality-assured emergency contraceptive product.

2203-60219

The investment case for a novel letrozole-misoprostol medical abortion combipack

  Concept Foundation     Switzerland

Concept Foundation aims to demonstrate if a quality assured letrozole and misoprostol regimen for MA will serve as an affordable alternative treatment to the existing MA regimens and will increase access to safe medical abortion in low- and middle-income country markets. Concept Foundation will establish an investment case, providing information for decision making towards product development for letrozole as an abortifacient with misoprostol.

2207-54755

Using a platform approach to provide access to safe abortion in Cameroon

  Women for a Change, Cameroon     Cameroon

Women for a Change will adapt the existing digital platform, Tiko, designed by Triggerise to connect women and girls in the Mfoundi department to safe abortion and SRH services and information. Trained peer mobilizers will conduct outreach to engage individuals seeking safe abortion and SRH information and services to assist in enrolling them onto the platform to access information and peer-rated service providers. The platform will connect users to a local provider for subsidized MA and MVA services, post-abortion care and contraception counselling. As users engage with the Tiko platform, they will generate anonymized and confidential data in real-time to introduce a behavioural nudge to motivate positive health-seeking behaviours.

2207-54444

Expanding Access to Abortion Along Key Migration Routes in Latin America and the Caribbean (LAC)

  Ipas Mexico, A.C.      Mexico

Ipas Mexico aims to increase access to SRHR services and information and reduce the communication gap between migrants, civil society organizations, and governmental institutions through a free and confidential chatbot. An existing Spanish-enabled chatbot will be updated to include information catered specifically for migrants on SRHR, including safe abortion, gender-based violence, and a directory of health facilities, accompaniment groups and migrant-serving organizations where SRHR services can be availed. The digital tool will be designed, tested, and evaluated with the input and feedback of migrants, civil society organizations, and public health authorities.

2207-54535

Engaging doctors as agents of change to improve access to safe abortion in Mexico: an innovative network linking supportive physicians with acompañantes

  CONSORCIO DE INVESTIGACIÓN SOBRE VIH SIDA TB CISIDAT, A.C.       Mexico

Innovator Story: From Stigma to Solidarity: A Journey in Transforming Abortion Care

CISIDAT will collaborate with investigators at ECOSUR and activists across Mexico to support the creation of the first nationwide network of female pro-choice physicians in Mexico, engaging them to de-medicalize abortion, enhance interactions with acompañantes, increase access to safe medical abortion, and reduce stigma. Virtual trainings targeting physicians will be conducted to increase awareness on abortion guidelines, local laws, self-managed abortion, de-medicalization of abortion and accompaniment models, as well as establishing goals for the network. In-person workshops for physicians and acompañantes will promote trust, exchange of information and experiences, and promote collaboration with acompañantes. The evidence generated will be shared through open access publications and a book, and will be used to refine and adapt the network and training model for continued expansion in Mexico, and ultimately in other Latin American countries.

2207-54539

Community Based Opportunity desk for Safe Pregnancy Termination services in Bangui

  Voix Pour Les Femmes d’Afrique Centrale (VPFAC)         Central African Republic

VPFAC aims to increase access to safe pregnancy termination information and services (MA and MVA), particularly for women and girls who have experienced gender-based violence. Nurses and midwives will be trained on safe pregnancy termination services, post abortion care and the legal framework governing pregnancy termination. The trained providers will be responsible for operating community-based opportunity desks (sites within existing clinical facilities) to provide safe pregnancy termination services, counselling, post pregnancy termination care and family planning services. Trained community health task force agents will provide education and outreach activities through village based mobile clinics. These activities will include 1:1 education sessions, workshops, community gatherings, and radio shows to raise awareness on available safe abortion services and the abortion legal framework, as well as to break stigma around pregnancy termination. 150 local leaders will also be engaged to support community awareness raising efforts.