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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 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 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

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.

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

“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

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..

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.

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.

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.

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.

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.

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.

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.

Creating a Community Based Self Sustaining Ecosystem for Improving Abortion Access

  Greenstar Social Marketing Pakistan         Pakistan

Innovator Story: Pioneering Accessible SRHR in Pakistan 

Greenstar Social Marketing Pakistan aims to decentralize abortion care and create an enabling environment that is safe and accessible for clients through community health workers (Sitara Baji) houses – a designated confined home-based solution. The Sitara Baji’s home will be converted to a Sitara House and become a community health hub for women and girls. The Sitara Bajis will be recruited and trained to deliver a holistic self-care package, including medical abortion, family planning, menstrual health and hygiene, mental health awareness, breast self-examination and pregnancy testing. The homes will as well offer primary health education and screening (such as health communication materials, weighing scales, blood pressure monitors and pregnancy testing kits) and be stocked with misoprostol, emergency contraceptive pills, condoms and sanitary pads. Tablets with 24/7 connectivity to a physician will be provided to Sitara Bajis, in case needed to help guide misoprostol administration and education on self-care packages. Additionally, Sitara Bajis will engage in outreach activities with community members and stakeholders to increase awareness and generate trust.

Setting the stage for regional scaling up of medical abortion via telemedicine in Eastern Europe and Central Asia

  Reproductive Health Training Center           Armenia, Azerbaijan, Kazakhstan, Kyrgyz Republic, Uzbekistan, and Moldova

Reproductive Health Training Center aims in the current project to conduct formative research to assess the feasibility of extending the use of telemedicine medical abortion services to five Eastern European countries (Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, and Uzbekistan). The telemedicine model has been successfully implemented in Moldova and is now seeking scale-up and implementation in the surrounding countries to increase access for abortion services. Working groups in each country were formed and helped to identify and collect data from relevant stakeholders related to MA service delivery barriers and the potential for MA telemedicine provisions. The innovation is now in process to operationalize the provision of MA via telemedicine in Kyrgyzstan, one of the five target countries.

Accelerating abortion self-care through digital direct-to-consumer models

  Reproductive Health Network Kenya             Kenya

Reproductive Health Network Kenya, in partnership with Ipas Africa Alliance, seeks to build on the successes of the ‘Nurse Nisa’ digital application to upgrade the platforms to include three new features to increase access to medical abortion further.
1. Connecting users with qualified-service providers and pharmacists to provide online or in-person prescriptions offer electronic payment options and the ability to mail medical abortion drugs within a 24 hours dispatch period to clients.
2. Integrate the WHO gestational age calculator for pharmacists and clients to support the confirmation of gestational age and decision-making
3. Integrate a digital accompaniment tool to provide step-by-step information on medical abortion self-care administration and psychosocial support through personalized conversations.
The innovation is in partnership with Ipas Africa Alliance, the developers of the ‘Nurse Nisa’ platform.

Using Machine Learning to improve access to safe abortion services among vulnerable populations

  William J Clinton Foundation              India

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

The William J Clinton Foundation seeks to reduce the incidence of unsafe abortions by equipping Community Health Workers – public sector Accredited Social Health Activists (ASHAs) – with the tools to identify and target at-risk women to increase their awareness of safe abortion methods and SRH. To identify at-risk women, a risk tool powered by AI and data will be developed in partnership with Surgo Venture. ASHAs will be provided with a paper-based format of the tool to help them assess women in their catchment areas on abortion risk factors. Following the identification of women from high-risk segments, ASHAs will be trained to provide tailored messages, aided by printed IEC material, to address knowledge gaps and unsafe behaviours.

Sailing the Boat, Sailing the Hope: SRHR counseling and information

  OPTions 6           Indonesia

OPTions 6 addresses the challenge of access to sexual and reproductive health information and services for women and girls in remote islands of Indonesia. OPTions 6 conducts educational workshops for women and girls on sexual and reproductive health. OPTions 6 also trains healthcare and community health providers to involve in a referral system supported by their hotline. This referral system links girls and women to services including counseling on sexual and reproductive health care. In cases of emergency, women and girls can access transportation to primary healthcare facilities by a boat owned and managed by local community women.

Increasing early access to SRHR through rights-based user centred approaches at the community level

  The Population Council            Kenya

The Population Council’s innovation increases early access to quality sexual and reproductive health services and rights through rights-based user centered approaches at the community level.

Confidential

  SOLIDARITE DES JEUNES FILLES POUR L’EDUCATION ET L’INTEGRATION SOCIOPROFESSIONNELLE, SOJFEP             Democratic Republic of the Congo

Confidential innovation.

Advancing Community Based Access to safe abortion in urban slums, Nigeria

  OPTions 3             Nigeria

OPTions 3 decreases unsafe abortion for Adolescents Girls and Young Women (AGYW) in urban slums in Nigeria by engaging them in high-quality confidential peer counselling and increasing access to reproductive health services. OPTions 3 trains project operatives comprised of AGYW, female artisan clubs, shop owners, and female headed maternity homes to provide peer-to-peer counseling in dedicated safe spaces, as well as safe abortion and other reproductive health services. Working with public and private suppliers of abortion products and contraceptives, OPTions 3 strengthens community-wide capacity to stock and dispense these products. To ensure sustainability of the intervention and as an incentive to participate, OPTions 3 trains one in four project operatives in entrepreneurship and supports these individuals to operate as mobile money agents as a means of diversifying their revenue stream.

Developing new methods and devices for later abortion

  Consultants in Obstetric and Gynecologic Ultrasonography and Surgery, PLLC
Ethiopia, United States, and Mexico

The Dupont Clinic innovation evaluates three devices in different countries to improve the provision of later safe abortion. Three provider sites in Mexico, Ethiopia, and the United States will develop and implement these new methods: Lidocaine for fetal demise, DuPont Cannula, and a novel cervical dilation device. Patient and provider feedback will be provided by the sites, and will cover a range of facility sizes and patient populations. The combination of these technologies will make later abortion safer, simpler, and more feasible in most settings.

Improve health for ethnic minority women and girls through enabling access to safe, friendly abortion services at community level in Vietnam

  Microfinance and Community Development Institute               Vietnam

Microfinance and Community Development Institute (MACDI) implements community and school-based awareness campaigns and uses a new mobile app to increase women and girls’ knowledge and access to safe abortion in Vietnam. The mobile app will provide safe abortion information as well as chat-enabled safe abortion advice and referrals from health care experts. The app also integrates a micro-loan function for health-related purchases including safe abortion, health insurance and health examinations, and to enable access mobile phones. MACDI will also conduct training for health workers at both public and private health facilities.

Validation of a novel device for the provision of humane pain control during manual vacuum aspiration

  Nyanza Reproductive Health Society                 Kenya

Nyanza Reproductive Health Society’s innovation is a novel, reusable, low-cost syringe extension device (Chloe SED) that provides pain relief during Manual Vacuum Aspiration (MVA). This device enables the provision of local anesthesia to a woman’s uterus and cervix, and is easy to sterilize even in austere clinical settings. A trial with 210 women seeking MVA will determine whether the pain control from this device is better or equal to the currently used spinal needles. Women will be consulted when developing pain control protocols to ensure the product meets their needs and preferences.  Based on the results of the trial, the prototype will be refined in preparation for pre-market clearance and scale up.

Mobile Safe Abortion Care Clinic Project (MSACCP)

  LET US STAY ALIVE (LUSA)                 Democratic Republic of the Congo

Let Us Stay Alive (LUSA) uses a mobile clinic model to decentralize safe abortion care services for women and girls in the Democratic Republic of Congo. Working closely with partners including the Ministry of Health, LUSA trains community health workers, nurses and midwives to use cellular communication to refer women to one of the three mobile clinics. Women seeking an abortion schedule an appointment in a mobile clinic or in their homes. Women experiencing complications from unsafe abortion are transferred to health centers for care. Awareness of these services and safe abortion is raised through TV/radio campaigns and educational sessions.

Win-Win Innovation

  University of Nairobi                  Kenya

The Win-Win innovation assesses unproven herbal decoctions provided for abortion by traditional herbalists in Kenya to discover novel molecules that can potentially be developed into a next generation pregnancy termination medication. These herbal remedies, decoctions and their molecules, will be tested for their ability to induce safe abortion using an array of scientific methods, while comparing them to the performance of current abortion medications. To complement laboratory research, a behaviour change communication intervention will be implemented to educate women and girls in rural Kenya about the risks of using these decoctions while steering them towards safe and legal abortion care services. Herbalists are also sensitized to the potential harmful effects of their products and the need to refer clients to evidence-based abortion care.

Breaking The Cycle

  Fight AIDS Malawi (FAM)                 Malawi

Fight Aids Malawi (FAM) implements several approaches to expand and decentralize access to safe abortion services and sexual and reproductive health and rights (SRHR) information for women and girls living in rural villages of Malawi. These include: 1) a new informational online interactive forum, 2) outreach clinic visits to villages and schools by trained health workers and peer counsellors, 3) community education initiatives which address abortion related stigma and ensure that the innovation’s progress is sustained, and 4) improvements to the capacity of rural health facilities through the provision of abortion service equipment as well as training in care provision and supply chain management. FAM will use the evidence generated from this project to advocate for increased resource allocation from local government for SRHR and safe abortion projects.

Increased access to safe abortion in Armenia

  Armavir Development Center                 Armenia

Armavir Development Center is developing a mobile application for all types of cell phones to provide individualized and confidential consultations for women in rural communities of Armenia seeking safe abortion. Through the app, women connect to a call center which links them to gynecologists for safe abortion care, psychologists for mental health support, and/or legal specialists for advice and assistance, depending on their needs. Women seeking an abortion have the choice of visiting a clinic or waiting for medical staff to visit their village. Doctors follow-up with patients through phone calls and the app to confirm the success of the abortion. The innovation will roll out in 100 rural communities and will reach women who were previously out of reach and underserviced.

Building a network of Solidary Pharmacists for safe abortion in rural communities of Oaxaca, Michoacán and Guerrero

  Fundación Mexicana para la Planeación Familiar, A.C. (Mexfam)               Mexique

Mexfam trains and sensitizes pharmacists in Oaxaca, Michoacán and Guerrero to be frontline providers of abortion care. The training program enables pharmacists to directly provide accurate information on the use of misoprostol for safe abortion and to improve attitudes towards women seeking abortions. To support women seeking these services, Mexfam trains women in the communities to be “companions” who accompany women to participating pharmacies. They provide information about safe abortion, in conjunction with youth peer educators who communicate anti-stigma messages throughout their communities, which increases awareness and demand for these services.

Community Self-managed menstrual regulation with pills in Sindh Pakistan

  Peace Foundation                Pakistan

Peace Foundation addresses the supply and demand of self-administered safe menstrual regulation options in 120 rural villages. To improve supply, Peace Foundation trains and equips sellers at sales outlets with medication, information, counselling aids, and referral mechanisms for safe menstrual regulation and self-injected methods for family planning. These outlets are established at grocery stores, women-run shops and by donkey cart vegetable sellers. Health service providers and pharmacists assist women and girls with more complicated cases referred by the sellers, and are also involved in improving the supply of medications to local chemist shops. Peace Foundation will simultaneously address demand by disseminating information on misoprostol to women and girls, sensitizing village leaders, and conducting edutainment activities.

Frontline actors initiative (FAI)

  Contact Trust Youth Association (CTYA)               Zambia

Innovator Stories: Mercy’s Journey of Resilience and Hope

Contact Trust Youth Association (CTYA)’s innovation increases knowledge and awareness of safe abortion services among 1500 adolescent girls and young women in 10 schools in rural Zambia. CTYA trains teachers to provide safe abortion information and to support pregnant students who choose to access safe abortion and counseling services by linking these students to CTYA’s helpline and to service providers. Additionally, CTYA trains pharmacists and health care providers to deliver adolescent-friendly sexual and reproductive health services. The ultimate goal is for wide scale integration of safe abortion teacher training into the Ministry of Education’s Comprehensive Sexuality Education curriculum.

Pilot End-to-End Referral System to Increase Female Migrant Workers’ Access to Comprehensive Abortion Care

  The Planned Parenthood Association of Thailand Under the Patronage of Her Royal Highness the Princess Mother (PPAT)               Thailand

PPAT’s innovation establishes a community-based end-to-end referral system for comprehensive abortion care and other sexual and reproductive health services for female migrant workers in Thailand. This includes a hotline call center operating in three migrant languages for referrals to safe abortion care as well as roundtrip transportation services from the migrant sites to safe abortion clinics in Bangkok. After receiving abortion care, trained migrant community health volunteers and medical staff work together to follow up with the women and girls through a home visit or telephone calls. Additionally, an educational outreach program aims to dispel stigma and improve knowledge and awareness of safe abortion services amongst migrant worker communities.

The ‘SAFE NEST’ PROJECT- “Enabling Safe Self-Managed Abortion for Transgender Youth through facebook messenger bot”

  Women Promotion Centre                 Kenya

Women Promotion Centre uses technology to facilitate abortion service delivery for transgender youth. Through a secure online platform called Safe Nest, the innovation provides safe, non-judgmental, self-managed abortion services and information. Trained volunteer Trans* Connectors work hand-in-hand with service providers to create awareness and provide referrals and direct distribution of medical abortion medications. After youth’s self-managed abortion, medical personnel follow up with them remotely to ensure that the treatment was successful. Additionally, Trans* Connectors refer youth to trans youth-friendly providers of other reproductive health services.

Acompañando a las mujeres: legal and safe self-managed abortion

  FUNDACION PRO BIENESTAR SEXUAL Y REPRODUCTIVO (PROSER)               Colombia

PROSER will introduce the legal sale of mifepristone through pharmacies in 10 municipalities in central Colombia to provide a legal, affordable and safe option for self-managed abortion. The project is supported by a network of medical professionals who prescribe abortion medication (mifepristone/misoprostol) after a health risk assessment. With a prescription, women can access the medication at their local pharmacy in person or by delivery. After taking the medication, the doctor follows-up via telephone to verify the result of the treatment. Information on abortion care is also disseminated though educational materials, including information on this new option of legal self-managed abortion.

Induced Luteal Regression as a Novel Approach for Pregnancy Termination

  Oregon Health and Science University                      United States

Oregon Health and Science University seeks a novel medical abortifacient by identifying gene targets to block progesterone production during the first trimester. This will be conducted through database and laboratory research exploring existing medications which act on these targets. The ultimate goal of the project is to identify a new low-cost and accessible abortion method option.