Innovations

Transforming Safe Abortion Access in Rural Mexico: The Solidarity Pharmacies Model

In Mexico, women and people with the capacity to gestate who live in rural communities face barriers to accessing safe abortions. Despite legal reforms, social surveillance of women’s bodies and abortion stigma persist, leading to a pact of silence that limits access to information and services. 

Sara, a 23-year-old woman living in a rural Michoacán, a conservative state where abortion is criminalized, faced an unplanned pregnancy she did not want to continue. In her community, there is little information about pregnancy prevention, and abortion is not discussed. She sought help from the local shop owner, known for offering contraceptive advice and distributing free condoms. The shop owner informed her about using misoprostol and directed her to a pharmacy that sells it discreetly. 

Pharmacies play a crucial role in these communities, often acting as a primary point of care when public health services are lacking. However, when misoprostol is dispensed for self-managed abortions, pharmacists often struggle to provide accurate information on how to use it.  

The Solidarity Pharmacies Model 

Solidarity Pharmacies for Safe Abortion is a model that centers on first-contact healthcare providers (pharmacists) to facilitate access to misoprostol, along with accurate information, for people in communities where access to safe abortion services is limited or non-existent. Solidarity Pharmacies for Safe Abortion is a comprehensive model that includes a program to train pharmacists at the counter to sell the medication without a prescription, providing correct information about its use within the framework of respect for human rights. 

Women in the communities are also trained as abortion companions. They help identify unplanned pregnancies, provide information on how to use misoprostol, and refer individuals to a Solidarity Pharmacy. Additionally, young people in the community are trained to carry out activities that promote anti-stigma messages, which are the result of participatory research processes, aiming to influence the local context. These actions contribute to building an ecosystem that makes it easier for people to access information and purchase the medication with the assurance that pharmacy staff will not judge them and will respect their right to confidentiality. 

Community Transformation  

“I felt very safe and confident from the moment I started talking to her about my situation. I liked the idea that they don’t make you reflect on whether you really want to have it or not; they don’t touch on that topic. It’s more like, ‘Of course, I’m here to support you, no problem.’ And I had her support. She gave me her number, we stayed in contact, she would also message me, checking in on how I was doing and how the process was going. She gave me the address of a pharmacy to buy the medication. 

The pharmacist said: ‘We are a pharmacy that has been trained so that we understand, because we didn’t know before, and now we can help the women who come to us.'” Sara shares. 

After Sara’s experience, she became a community companion. Now, she shares contacts and resources with friends and acquaintances, believing every woman should have access to this information. Through training, she supports women during their abortion processes and refers them to the Solidarity Pharmacy. 

Solidarity Pharmacies operate through community members who become agents of change, including pharmacists, companions, and peer educators. This approach helps reduce community stigma, as peer educators encourage open conversations about abortion and provide accurate information. Women and individuals with the capacity to bear children can consult companions for pregnancy tests, guidance on using medication, and access to pharmacies where they can safely purchase it. If further assistance is needed, trained staff are equipped with materials to offer clear and supportive information. 

This innovative model addresses the urgent need for stigma-free information in communities where abortion is still penalized, or in others where, despite changes in legislation, the community continues to criminalize it. It allows women to manage their abortions safely, with the support of trained community members. The model contributes to reducing complications and maternal mortality, which disproportionately affect those living in the most vulnerable conditions. 

Community-Driven Outcomes and Lasting Change  

Between 2021 and 2023, Mexfam reports that 616 women received information and misoprostol at the Solidarity Pharmacies, while 798 were referred by companions, leading to 1,414 successful safe abortions.  

The innovation works because it involves community members in its implementation, not only as beneficiaries but also as community health promoters. These agents become allies of Mexfam, which facilitates community work by reducing resistance to the issues we address, increasing awareness of the organization, and ensuring the safety of field teams. 

The proof of concept allows to validate the intervention, develop support materials validated by the target population, and create a toolkit. With these resources, we initiated a first scale-up phase, training Mexfam staff in other states of the country. 

Now, Sara has become a promoter of sexual and reproductive rights in her community. Not only does she provide information for others to safely self-manage their abortions, but she also offers information on contraceptive methods, violence, sexually transmitted infections, and more.  She has gained new skills, like public speaking and negotiating with local authorities, and has become a trusted health resource for her community. 

This story is shared by Mexfam.

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

Te Acompaño, a Confidential Digital Companion for Migrant Women in Need of Reproductive Health Support

In her poem “Home”, Warsan Shire writes that “no one leaves home unless home is the mouth of a shark”. And no one knows this better than Elizabeth, who fled from her home in Honduras because of her violent father.

The mother of two knew that leaving was her only option.

“My family and I left home because we were experiencing all types of abuse from our own father. When my daughter was born, I said: enough, this is not possible. I will not allow my daughter and son to go through the same thing that I have experienced because they are children who are just starting their lives,” she explains.

The Harsh Reality of Migration and Vulnerability

Elizabeth represents the millions of migrants who flee their homes from Latin America and the Caribbean every year. Violence from family members, gangs, climate change, and economical constraints are some of the major reasons for migration.

According to the Inter-American Dialogue, each year five million migrants– nearly half of them women – undertake this perilous journey. Adolescents, women, and girls make up this population. Unfortunately, they face sexual violence, gender-based violence and institutional violence upon arrival or transit through Mexico, where xenophobia is also rife.

“We face men who want to abuse us, men who treat us poorly, who want to beat us just because we are women, because they see us as sexual objects,” says Elizabeth.

This vulnerable group is at risk of unintended pregnancies and other sexual health challenges. This risk, together with the lack of knowledge about their rights and how to access services, makes them extremely vulnerable.

Innovative Solutions Supporting Women Through Technology

To address these challenges, Ipas Latin America and the Caribbean (Ipas LAC) partnered with federal, state, and local organizations and institutions in Mexico to create Te Acompaño, a chatbot for sexual violence and safe abortion for migrants. It is the first Spanish-language chatbot aimed at the migrant population that offers information about sexual violence, access to abortion, and community support.

Te Acompaño was built using the women-centered design methodology, gathering the interests, inputs, and information from the population and its needs.

“If we want to know about sexual and reproductive health, we can do so, in a safe manner, where we can feel reassured and won’t be exposed,” says Elizabeth.

Among other features, it provides information about sexual and reproductive health and rights (SRHR) services, abortion support groups, and facilitates connections with civil society organizations supporting access to SRHR. Additionally, it involves the participation of local organizations, shelters, refugees, and governmental institutions defending migrants, which contribute to its dissemination and expansion. This tool addresses the SRHR needs of migrants and respects the multiple paths individuals take to access abortion. It allows for continuous conversation about abortion 24 hours a day, 7 days a week, and offers the option to access information completely anonymously.

A Beacon of Hope Transforming Lives

“I feel very reassured and heard when I use Te Acompaño. It reassures us that, as women, we’re free and fully entitled to choose what to do with our own bodies and to feel protected. The tools also are useful for having a safe abortion and making sure that our health is not at risk,” explains Elizabeth.

Since its launch, Te Acompaño has recorded over 8,545 interactions, providing crucial support to migrant women, healthcare professionals, and individuals from several countries, including Mexico, the United States, Guatemala, Argentina, Ecuador, Brazil, and Canada. The most frequently accessed resources include information on misoprostol sales points, organizations that provide support and guidance for safe abortions, public services for addressing violence, and sites for migration regularization.

María Teresa Hernández Bocanegra, the Secretary of Health of the State in Mexico, says the chatbot has enabled migrant women to know what to do and where to go in case of rape, where they can go to find abortion services.

“I think it is especially useful because along the way they also share this information with those who are in other countries. And what I heard in a talk that a woman from Ecuador was saying, no, this is not legalized in my country, but you are now in Mexico, safe abortion in Mexico is legal and these are your rights, right?” says Bocanegra.

“It is a very good, user-friendly automatized tool, where they listen to you and where you are free to express yourself, and they will provide you with the care that you require and deserve at that time,” adds Elizabeth.

Te Acompaño has supported Elizabeth to make better reproductive care choices for herself and family.

“I do not want my children or my sister to repeat my story, and I know that one day I will feel proud for having rescued them. We are women and not slaves to pain. That is my motto, that we can move forward after so many difficulties,” Elizabeth concludes.

Learn more about Ipas Mexico here.

This story is shared by Ipas Mexico.

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

L’avortement sécuritaire à portée de main : comment la télémédecine transforme la santé reproductive dans les zones rurales de Colombie

Reina, une jeune femme de 24 ans originaire d’Istmina, au cœur du Chocó, en Colombie, a été bouleversée lorsqu’elle a découvert qu’elle était enceinte. Cette nouvelle a été aggravée par le fait qu’elle est en chômage et par la précarité de sa vie quotidienne et sa dépendance économique à l’égard de son père, un fournisseur de soins lui-même au chômage. Dans une région où la pauvreté est une réalité constante, l’accès à un avortement sécuritaire semblait être une option inaccessible.

Le Chocó, depuis longtemps marqué par la violence, la négligence et la pauvreté, connaît de sérieuses lacunes en matière de services de santé, notamment pour ce qui est des droits sexuels et reproductifs. Pour les jeunes femmes, ces obstacles sont encore plus prononcés, les inégalités socio-économiques et de genre limitant considérablement leur autonomie. La lutte de Reina pour faire valoir ses droits reflète les difficultés plus larges auxquelles sont confrontées les femmes dans cette région mal desservie.

La situation de Reina était dramatique : « Mes règles n’étaient pas arrivées et je n’avais pas les moyens de faire un test de grossesse, alors j’ai emprunté de l’argent. Je n’arrivais pas à y croire quand j’ai vu ces deux lignes rouges; j’ai ressenti le pire frisson de ma vie. Sa plus grande crainte était que la grossesse n’annule ses chances de trouver un emploi pour aider son père.

Au milieu de cette adversité, la télémédecine est apparue comme une solution cruciale. Grâce à une publicité sur Facebook, Reina a accédé à un chat où elle pouvait recevoir des conseils et du soutien. Ce canal l’a mise en contact avec du personnel de santé qualifié, ce qui a transformé sa situation.

Innovation en télémédecine : combler les lacunes dans les zones reculées

Le programme de télémédecine développé par Oriéntame avec le soutien de l’Initiative OPTions a fait tomber les barrières de la distance et a remédié à la pénurie de prestataires de soins de santé à Istmina. Grâce à cette innovation, Reina a pu accéder à un avortement sécuritaire depuis son domicile. Après avoir bénéficié de conseils, elle a reçu le « Kit Alas », qui contient tout ce dont elle avait besoin pour pratiquer un avortement sécuritaire. Cette trousse, conçue pour rejoindre les zones les plus reculées du pays, permet vraiment de mettre l’avortement légal à la portée de toutes les femmes.

« Je suis tellement reconnaissante du soutien que j’ai reçu pour payer mes soins. Chez moi, quand on a de l’argent pour le petit-déjeuner, il n’y en a pas assez pour le déjeuner. Cela m’a redonné vie. Je n’aurais jamais pu m’offrir des soins d’une telle qualité. Dans mon désespoir, j’ai passé l’appel, et tout était réel; ils m’ont apaisée quant à la décision que je prenais pour mon avenir », a précisé Reina.

L’impact du programme de télémédecine va bien au-delà de Reina, bénéficiant à de nombreuses femmes qui se trouvent dans des situations similaires. En fournissant des soins de santé de qualité, il renforce l’autonomie des femmes et soutient leurs droits reproductifs, même dans les régions où ces droits sont fréquemment niés.

Une nouvelle voie à suivre : l’impact général de la télémédecine

« Ce qui est le plus gratifiant, c’est de savoir que nous rejoignons les femmes qui en ont le plus besoin, même dans les endroits les plus reculés de la Colombie. Notre objectif est simple : faire en sorte qu’aucune femme ne soit laissée sans soins sécuritaires et dignes, peu importe où elle vit », d’expliquer l’une des responsables du programme.

À l’heure actuelle, ce programme novateur est reproduit dans d’autres régions rurales et vulnérables de la Colombie, dans le but d’en élargir la portée et de faire en sorte qu’un plus grand nombre de femmes puissent en bénéficier. Avec le soutien continu de parrains et d’alliés, le programme bâtit un réseau solide qui change le paysage de la santé sexuelle et reproductive dans le pays.

Pour Reina, l’avenir semble maintenant meilleur. Libérée des soucis d’une grossesse non désirée, elle peut se concentrer sur la construction d’une vie meilleure pour elle-même et sa famille. « J’ai reçu d’excellents soins. Ici, là où j’habite, tout est de mauvaise qualité, et il est difficile d’obtenir un rendez-vous. Ce service était facile d’accès; je n’ai pas eu à quitter ma maison. Aujourd’hui, j’ai l’impression que je peux décider de ma vie et de mon corps. Je veux que toutes les femmes sachent qu’elles ont droit à cette liberté, et qu’elles ne sont pas seules », dit-elle avec espoir.

Malgré des défis tels que la connectivité et la fracture numérique, la télémédecine est devenue une alternative pour des centaines de femmes qui, pour diverses raisons, ne peuvent pas accéder aux services de santé.

Lorsqu’on demande aux membres du personnel d’Oriéntame pourquoi ils travaillent sur cette initiative, ils se souviennent toujours des paroles de Cristina Villarreal, ancienne directrice d’Oriéntame : « Comment pourrions-nous ne pas le faire? » La passion de l’équipe d’Oriéntame est de faire en sorte que toutes les femmes et personnes qui peuvent tomber enceintes aient l’autonomie sur leur corps et leur vie. C’est pourquoi Oriéntame invite tous et chacun à appuyer cette cause, car la solidarité dans la lutte contre les avortements à risque ne sera jamais superflue.

Cette histoire est partagée par la Fundación Oriéntame.

Les noms des personnes dans l’histoire ont été modifiés pour protéger leur vie privée.

Innover dans l’accès à l’avortement sécurisé pour les femmes handicapées

Une jeune femme kényane queer vivant avec un handicap a été confrontée à un défi déchirant lorsqu’elle a découvert qu’elle était enceinte. Sally, une jeune femme de 23 ans, a eu du mal à accéder à des services d’avortement sécuritaire dans un pays où les avortements non sécuritaires sont l’une des principales causes de problèmes de santé et de décès parmi les femmes. Au Kenya, selon le Centre africain de recherche sur la population, le taux de grossesses non désirées est passé de 34 % en 2014 à 42 % en 2020, et les avortements non sécuritaires représentent jusqu’à 14 % des grossesses, entraînant environ 2600 décès par an. Avec un taux de mortalité maternelle de 362 pour 100 000, les femmes âgées de 25 à 39 ans comptent pour une part importante des cas de décès et de complications graves, dont jusqu’à 17 % sont potentiellement liés à des avortements provoqués.

Briser les barrières dans des conditions non sécurisé

Au Kenya, l’avortement est fortement restreint, ce qui conduit de nombreuses femmes à rechercher des méthodes non sécuritaires auprès de prestataires non qualifiés ou à prendre des remèdes maison dangereux. La situation de Sally était aggravée par sa dépendance économique vis-à-vis de son père et le manque de soutien familial. « Je suis aux prises avec une douleur émotionnelle importante et un manque de soutien de la part de ma famille, en particulier de mon père, qui m’a reniée quand j’avais 11 ans. Je me suis retrouvée dans une lutte constante pour obtenir leur approbation, mais j’ai fini par être déçue, avec une faible estime de moi-même car ils ne me reconnaissaient ni ne me soutenaient de quelque manière que ce soit. Je me suis liée à un homme qui m’a aidée financièrement pour que je puisse subvenir à mes besoins et à ceux de mes frères et sœurs », de raconter Sally.

Elle explique en outre : « Je suis tombée enceinte. Je n’avais pas prévu cette grossesse et je sentais que je n’étais pas prête à la mener à bien. De plus, l’homme a nié ma grossesse. Être lesbienne a apporté son lot de défis parce que je ne pouvais pas en parler à mes ami/e/s dans la collectivité parce que je craignais qu’ils ne m’ostracisent. Je ne savais vraiment pas quoi faire.

Réponse innovante de Women Spaces Africa

Devant ces difficultés, Sally a demandé de l’aide : « J’ai fini par trouver le courage d’en parler à une amie qui m’a présenté Céline, une championne des personnes handicapées de Women Spaces Africa qui vivait près de mon village. Céline m’a posé une série de questions. Elle avait besoin de savoir quand était le premier jour de mon dernier cycle menstruel et malheureusement, je ne pouvais pas m’en souvenir. Elle m’a dit qu’elle pouvait me donner des pilules abortives et que je pouvais avorter à la maison sans que personne ne soit impliqué, mais comme je n’étais pas sûre des dates exactes de mon dernier cycle, Céline a dû me référer à un médecin. Elle a proposé de m’accompagner pendant et après l’intervention. Elle a tenu parole et j’ai pu me faire avorter gratuitement.

Women Spaces Africa (WSA) est une organisation non gouvernementale féministe dirigée par des personnes handicapées qui s’efforce de faire respecter les droits à la santé sexuelle et reproductive des filles et des femmes handicapées. Grâce au soutien de l’Initiative OPTions, WSA s’emploie à éliminer les obstacles auxquels sont confrontées les filles et les femmes handicapées pour accéder à un avortement sécuritaire en leur donnant des pilules ainsi que l’information et les conseils nécessaires et en les orientant directement vers des prestataires d’avortement abordables chaque fois que cela est requis.

De nombreuses interventions en santé sexuelle et reproductive n’incluent pas les filles et les femmes handicapées, et celles qui le font n’offrent pas de services adaptés à ces personnes. Cette intervention répond à des besoins non satisfaits en matière d’avortement sécuritaire parmi les filles et les femmes handicapées en leur fournissant directement des pilules et en les orientant vers des prestataires abordables. Leur innovation comprend un service d’accompagnement à un avortement sûr et sans jugement pour les femmes handicapées des quartiers informels de Nairobi. Des championnes formées pour défendre les personnes handicapées offrent du soutien, remettent des pilules et facilitent les références vers des prestataires d’avortements formés qui offrent des services adaptés aux personnes handicapées à des coûts subventionnés.

Phylis Mbeke, directrice exécutive de la WSA, souligne que le modèle de soins de santé autonomes pour les filles et les femmes handicapées est indispensable car il répond à leurs besoins d’accessibilité lorsqu’elles utilisent des services d’avortement. Selon l’Organisation mondiale de la santé, les interventions axées sur les soins autonomes ont le potentiel d’accroître le choix, lorsqu’elles sont accessibles et abordables, et elles peuvent offrir à ces personnes plus d’occasions de prendre des décisions éclairées concernant leur santé et leurs soins de santé. Par conséquent, les interventions axées sur les soins autonomes représentent un progrès important vers une auto-efficacité, une autonomie et un engagement en matière de santé nouveaux et accrus pour les personnes qui se soignent elles-mêmes et les aidants naturels.

Grâce à cette innovation, 298 femmes handicapées ont reçu de l’aide afin de pouvoir avorter dans des conditions sûres, en leur fournissant directement des pilules et en les

orientant vers des prestataires de services d’avortement. En outre, 39 établissements de santé publique ont été formés aux protocoles d’avortement de l’Organisation mondiale de la santé et à la prestation de services d’avortement adaptés aux personnes handicapées. Elles ont démontré une attitude positive à l’égard des femmes handicapées et de leur droit à l’avortement. Certains fournisseurs pratiquent des tarifs subventionnés, tandis que d’autres offrent des services d’avortement gratuits aux filles et aux femmes handicapées à la suite de l’intervention.

L’innovation sera déployée pour desservir un plus grand nombre de filles et de femmes handicapées, en continuant de cibler Nairobi et une nouvelle zone à Mombasa. WSA s’adresse à des organisations de personnes handicapées dirigées par des femmes pour qu’elles adoptent cette innovation.

Un suivi de Sally après l’avortement a révélé qu’elle était positive et heureuse et avait, depuis, ouvert un petit salon de coiffure. « Cela fait deux mois que j’ai avorté et je me sens soulagée. J’ai encore de longues conversations avec Céline, qui reste une présence constante et compréhensive. Je trouve aussi du réconfort dans la tenue d’un journal et la création artistique. Je suis déterminée à améliorer ma vie et à devenir indépendante financièrement. Avec le soutien de Céline et de Women Spaces Africa, j’ai commencé à m’engager en tant que défenseure des droits à la santé reproductive et des questions LGBTQ+ en partageant mon récit pour aider d’autres filles et femmes handicapées à se sentir moins seules dans leur parcours d’avortement », a dit Sally.

Sally affirme que, « pour les personnes handicapées, le droit de choisir l’avortement n’est pas seulement une question de liberté personnelle; il s’agit de s’assurer que chaque personne ait la possibilité de vivre une vie qui corresponde à ses propres capacités et aspirations. Les femmes handicapées devraient pouvoir accéder à des services d’avortement de qualité acceptables à un coût abordable, sans jugement.

Cette histoire est partagée par Women Spaces Africa.

Les noms des personnes dans l’histoire ont été modifiés pour protéger leur vie privée.

Pionnier de la SSR accessible au Pakistan

Ulfat, une mère de 30 ans originaire de Lyari, au Pakistan, vit dans un pays où le taux d’avortement est l’un des plus élevés au monde. Beaucoup de ces procédures sont effectuées dans des conditions dangereuses, plaçant les femmes comme Ulfat dans des situations périlleuses. Issue d’une famille pachtoune conservatrice, Ulfat a été confrontée à de graves difficultés. Mère de trois filles et d’un fils, elle a subi des années de violences physiques et psychologiques de la part de son mari, qui rejette la planification familiale et lui reproche d’avoir des filles. Son désir incessant d’avoir plus d’enfants mâles, associé à son refus de subvenir aux besoins de base de ses filles, a laissé Ulfat dans un état constant de peur et de désespoir. Luttant pour s’occuper de ses enfants, elle compte souvent sur la charité pour subvenir à leurs besoins quotidiens.

La pression s’est intensifiée lorsqu’Ulfat a découvert qu’elle était enceinte de son cinquième enfant. Submergée et terrifiée par de multiples grossesses rapprochées, elle s’est retrouvée dans une situation critique avec une santé qui se détériorait, ne sachant pas comment poursuivre, notamment sous l’immense pression d’avoir un fils. Sa situation n’est pas unique; au Pakistan, de nombreuses femmes se heurtent à d’importants obstacles culturels et sociaux pour accéder à des services de santé reproductive.

Dans un moment de grand besoin, Ulfat a trouvé de l’espoir grâce à Saira, une Sitara Baji (agente de santé communautaire) dévouée du programme de reproduction de Greenstar. Au cours d’une visite porte-à-porte, la Sitara Baji Saira a fourni à Ulfat des conseils cruciaux sur les besoins en matière de soins autonomes et lui a présenté le misoprostol, une option médicamenteuse sûre et abordable qui garantit le confort, la sécurité et la confidentialité de la cliente. Saira lui a non seulement donné des conseils sur la santé, mais elle l’a également aidée à entrer en contact avec le médecin de Greenstar, qui a supervisé l’ensemble du processus. Le médecin lui a expliqué les signes et les symptômes et a fait un suivi auprès d’Ulfat pour s’assurer qu’elle se sentait guidée et soutenue. Cette approche novatrice a sauvé Ulfat d’une autre grossesse non désirée et a atténué la pression sociétale liée au fait de porter une autre fille.

Avec le soutien de l’Initiative OPTions, Greenstar a formé et déployé 10 Sitara Bajis, établissant 10 maisons Sitara – des environnements sécuritaires où les femmes reçoivent des services et des conseils essentiels en santé reproductive.

Chaque Sitara Baji a atteint l’indépendance financière tout en fournissant des services cruciaux. Depuis le lancement du programme, plus de 44 000 femmes ont reçu des

conseils en matière de santé reproductive, notamment sur l’auto-administration du misoprostol. ‘’octobre 2022 à juin 2024, plus de 6 283 femmes ont eu accès à des avortements médicamenteux grâce à cette initiative.

« Sitara Baji, Saira et Greenstar ont fait plus que me fournir des options d’interruption de grossesse, ils m’ont donné la force de me défendre. Ce service était plus qu’un simple soutien médical. C’était une bouée de sauvetage qui m’a permis de reprendre le contrôle de mon corps et de mon avenir », confie Ulfat avec de la gratitude dans sa voix.

L’impact de ce programme est profond : 94 % des femmes des zones de desserte des Sitara Houses sont désormais informées sur l’avortement autogéré. Les taux de satisfaction des clientes des Sitara Houses sont exceptionnellement élevés (99,9 %), dépassant de loin ceux des autres fournisseurs (73 %). Ce succès est attribué à l’accent mis par le programme sur l’abordabilité, le respect et la facilité d’accès. De plus, l’initiative a permis d’améliorer de 58 % les connaissances en matière de santé reproductive dans la collectivité, ce qui souligne l’effet transformateur de cette approche communautaire innovante.

« Cette intervention transforme notre collectivité en fournissant des services de santé reproductive accessibles et respectueux », a déclaré un représentant de Greenstar. « Elle donne aux femmes les moyens de prendre des décisions éclairées concernant leur santé et leur avenir. »

Ulfat a retrouvé l’espoir et est déterminée à façonner un avenir meilleur pour elle-même et ses enfants. « Maintenant, je rêve d’un avenir où mes filles grandiront dans un monde où leurs choix seront respectés et leurs voix entendues », a-t-elle affirmé.

Cette histoire est partagée par Greenstar Social Marketing Pakistan.

Les noms des personnes dans l’histoire ont été modifiés pour protéger leur vie privée.

Le parcours de résilience et d’espoir de Mercy

Le parcours de Mercy a commencé par une grossesse non désirée à un jeune âge à Livingstone, en Zambie. À seulement 16 ans, elle a été confrontée aux dangers d’une tentative d’avortement en utilisant la médecine traditionnelle, ce qui a entraîné de graves infections et un traumatisme émotionnel important.

« Si seulement ce programme avait été disponible plus tôt, je n’aurais pas enduré autant de souffrances. » confie Mercy, dont la vie a été profondément affectée par un avortement non sécuritaire.

Son expérience souligne le besoin urgent d’une éducation complète en matière de santé sexuelle et reproductive (SSR) et d’un soutien pour les adolescentes, une lacune critique dans de nombreuses collectivités.

Dans sa collectivité, le manque d’éducation et de soutien appropriés en matière de SSR a conduit à de nombreux cas d’avortements non sécuritaires et de grossesses non désirées chez les adolescentes, ce qui a affecté leur santé et leurs perspectives d’avenir.

Le système de soutien complet du projet FAI

Pour relever ces défis, le projet FAI a mis en place un réseau de soutien complet, qui comprend des rencontres dans un espace sûr et la ligne d’assistance téléphonique Aunty Tasha. Ces initiatives fournissent des informations essentielles sur la prévention des grossesses non désirées, les options d’avortement sécuritaire et l’accès à des services de santé appropriés.

En éduquant les adolescentes et en leur offrant un système de soutien solide, le projet FAI leur permet de prendre des décisions éclairées. Ce soutien a changé la vie de Mercy. Elle a été en mesure de revenir sur ses expériences passées et de prévenir les défis futurs grâce aux conseils et aux soins qu’elle a reçus du projet.

Un avenir d’espoir et de confiance

« Je suis incroyablement reconnaissante du soutien que j’ai reçu du projet FAI. Cela m’a appris à prévenir les grossesses non désirées et à demander de l’aide en toute sécurité », affirme Mercy.

Le coordonnateur du projet ajoute : « Notre initiative répond à un besoin crucial en fournissant une éducation et un soutien essentiels en matière de SSR. Nous avons observé une réduction significative des avortements non sécuritaires et des améliorations notables du bien-être de nos bénéficiaires. Le succès de ce programme réside dans sa capacité à offrir un espace sûr et sans jugement où les adolescentes peuvent chercher de l’aide et de l’information. Cette approche soutient non seulement les personnes, mais contribue aussi à l’amélioration de la collectivité et de la santé.

À mesure que le projet FAI s’étend à d’autres écoles et collectivités, il sera essentiel d’augmenter le financement pour s’assurer que davantage d’adolescentes reçoivent le soutien dont elles ont besoin. La vie de Mercy a été profondément transformée par le projet FAI. Elle se sent maintenant habilitée avec les connaissances et le soutien nécessaires pour affronter son avenir avec optimisme.

« Le projet FAI a vraiment changé ma vie. J’ai maintenant les outils et le soutien nécessaires pour prendre de meilleures décisions, et j’espère que ce programme continuera d’aider d’autres personnes qui se trouvent dans des situations similaires », a déclaré Mercy.

Cette histoire est partagée par Contact Trust Youth Association.

Les noms des personnes dans l’histoire ont été modifiés pour protéger leur vie privée.

De la stigmatisation à la solidarité : un voyage dans la transformation des soins d’avortement 

« Ils me qualifient de médecin qui pratique des avortements », confie une gynécologue dévouée qui travaille dans le sud rural du Mexique. 

Sabrina, qui travaille dans un hôpital public, a été confrontée à d’importants défis en raison des lois restrictives sur l’avortement qui n’autorisent l’avortement que dans des cas d’exception limités, comme un viol. Au cours de sa formation médicale, elle n’a reçu aucune éducation sur les soins d’avortement. Bien qu’elle soit impliquée dans le programme public d’avortement sécuritaire, Sabrina n’était initialement pas au courant du mouvement plus vaste en faveur de l’avortement ou de l’existence des acompañantes, militantes féministes qui soutiennent l’avortement autogéré par le biais d’un modèle holistique, améliorant ainsi l’accès à l’avortement sécuritaire dans la région. 

Au Mexique, l’accès à un avortement sécuritaire est encore limité, en particulier pour les personnes les plus marginalisées et les plus vulnérables. La stigmatisation sociale et les lois criminalisent à la fois les personnes qui se font avorter et les prestataires de soins, ce qui constitue l’un des principaux obstacles à l’avortement sécuritaire. Être un médecin pro-choix au Mexique signifie souvent se sentir stigmatisé, en danger et isolé; il y a un fossé avec ses pairs et entre le secteur médical et le mouvement plus large en faveur de l’avortement. 

Le réseau mexicain des femmes médecins pro-choix : renforcer le soutien et élargir l’accès 

Pour résoudre ces problèmes, le Réseau mexicain des femmes médecins pro-choix [Red de Médicas por el Derecho a Decidir – Mexique] a été créé en tant que premier réseau national dédié à l’unification et au soutien des femmes médecins qui sont des prestataires et/ou des défenseures de l’avortement. Le Réseau relie également ces médecins au mouvement plus large de l’avortement. Ce réseau innovant offre un soutien par les pairs et des formations à ses membres et favorise les collaborations avec les acompañantes, améliorant ainsi l’accès à l’avortement sécuritaire au Mexique. 

Depuis qu’elle fait partie du RMDD, Sabrina sent qu’elle n’est plus seule. Elle se sent soutenue, sachant qu’il y a d’autres médecins comme elle ainsi que des militants de l’avortement, avec qui elle peut partager des expériences et des connaissances. Cela a renforcé son travail de gynécologue dans le secteur public et lui a permis d’étendre sa pratique à la prestation d’avortements, par exemple, à un âge gestationnel avancé, devenant ainsi l’une des seules médecins de l’État à fournir de tels services. Elle collabore désormais avec des accompagnatrices locales qui dirigent vers elle des personnes ayant besoin de soins médicaux, tandis qu’elle les oriente vers un accompagnement personnalisé qui ne peut pas être fourni dans le cadre du système de santé. 

Confiance accrue et soins étendus 

« Quand j’ai commencé comme prestataire d’avortements, je suis entrée dans le monde de l’avortement sécuritaire avec crainte, avec l’ignorance de beaucoup de choses, avec beaucoup de stigmates, en me cachant… Maintenant, j’ai acquis beaucoup de confiance grâce à toutes les formations, à toutes les personnes que j’ai rencontrées, à toutes les femmes du Réseau. Avoir un réseau de soutien, (…) m’a permis de ne pas avoir peur, d’agir, de savoir avec certitude que je suis protégée, que les femmes sont protégées, que c’est sécuritaire. Oui, la vérité est que beaucoup de choses ont changé, je n’ai plus peur de parler de ce sujet. 

Le soutien et la formation par les pairs du Réseau ont permis de réduire la stigmatisation, d’accroître les connaissances, la résilience, la sécurité personnelle perçue et l’ouverture de ses membres sur leur position pro-avortement, tout en favorisant les collaborations avec les acompañantes. Cela a permis à plus d’une centaine de médecins du Réseau de s’engager en tant que défenseurs et/ou prestataires de l’avortement, augmentant ainsi l’accès à un avortement sécuritaire au Mexique. 

« La stigmatisation et l’isolement des médecins pro-choix ont toujours limité leur impact sur l’accès à un avortement sécuritaire. L’union de ces professionnels leur a permis de se soutenir mutuellement et d’unir leurs forces, ce qui a ouvert des possibilités de représentation, de prestation de services et de collaboration auparavant inimaginables ». 

Le modèle novateur du Réseau est maintenant partagé avec des organisations et des établissements au Mexique et dans d’autres pays d’Amérique latine, où il peut servir d’exemple réussi d’organisation de médecins pro-choix et fournit des méthodes pour favoriser les interactions entre les professionnels de la santé et les réseaux d’accompagnement. Le financement de cette innovation permet de diffuser l’exemple de réussite du Réseau. 

Pour Sabrina, faire partie du réseau a changé sa vie. Elle ne se sent plus coupable ni craintive. Elle se sent renforcée dans ses actions en tant que prestataire d’avortement et dans sa conviction qu’elle fait ce qu’il faut : améliorer la santé et le bien-être des femmes : « Je me suis parfois sentie seule au monde, car il est difficile de travailler comme médecin dans les hôpitaux publics. Maintenant, j’ai l’impression de faire partie de quelque chose de plus grand, et qu’il y a beaucoup de femmes avec moi. J’aimerais travailler davantage avec des acompañantes, car elles peuvent apporter quelque chose de plus que moi. Je pense que des connaissances différentes, des opinions différentes, des yeux différents, peuvent apporter quelque chose. 

Cette histoire est partagée par CISIDAT.

Les noms des personnes dans l’histoire ont été modifiés pour protéger leur vie privée.

De la peur à l’acceptation : Soutenir les choix reproductifs des jeunes femmes en Inde rurale

Komal, une jeune fille de 16 ans originaire d’un village reculé de l’Assam, a été confrontée à un défi de taille lorsqu’elle a découvert qu’elle était enceinte. Dans son village, l’avortement est fortement stigmatisé en raison de la peur du jugement, des commérages et de l’ostracisme social. Pour les filles célibataires comme Komal, la pression est encore plus intense. Sa famille, inquiète pour sa réputation, a insisté pour qu’elle interrompe sa grossesse, mais Komal n’avait pas de voie claire vers des services d’avortement sécuritaire, un problème auquel sont confrontées de nombreuses jeunes femmes dans les régions rurales de l’Inde.

Les adolescentes et les jeunes femmes de partout au pays font face à de nombreux obstacles lorsqu’elles cherchent à obtenir des services d’avortement. Ces défis sont enracinés dans un mélange complexe de facteurs socioculturels, économiques et structurels qui créent un environnement difficile et souvent hostile pour les personnes qui cherchent à interrompre une grossesse. En Inde, l’avortement à risque reste la troisième cause de mortalité maternelle. 

Soutien par les pairs et solutions communautaires en santé reproductive

Komal a trouvé l’espoir lors d’une séance d’éducation à la santé sexuelle et reproductive (SSR) dans son école du village de Mamudpur, en Assam, dirigée par Pallabi, une jeune leader formée par la Fondation pour le développement Ipas (IDF). Pallabi, qui avait été formée pour éduquer les adolescentes et les jeunes femmes sur la santé sexuelle et reproductive, a été approchée par Komal pour obtenir de l’aide. Pallabi a apporté un soutien compatissant en parlant aux parents de Komal, en la rassurant et en la guidant tout au long du processus. Elle a accompagné Komal dans un établissement de santé public voisin soutenu par l’IDF, où elle a reçu les soins dont elle avait besoin de manière sûre et confidentielle.

L’innovation de l’IDF se concentre sur la création d’un écosystème durable pour améliorer l’accès aux services de SSR, y compris la contraception et l’avortement sécuritaire. Cette approche intègre le renforcement du système avec des interventions au niveau communautaire pour construire un écosystème solide de SSR. Le renforcement du système consiste à fournir un soutien technique aux services de santé publique de quatre États afin d’étendre et de décentraliser les soins d’avortement, conformément à la Loi modifiée sur l’avortement de 2021.

En outre, un modèle axé sur les jeunes introduit dans certaines parties de deux États permet d’éduquer les jeunes femmes et leurs partenaires sur les droits et l’accès à la SSR. Une partie essentielle de ce modèle concerne les questions de SSR – prévenir et gérer les grossesses non désirées, offrir des références et un soutien pour des services sûrs de SSR comme l’avortement, et leur donner les moyens de défendre leur capacité d’action et de remettre en question plusieurs normes socioculturelles restrictives. Il aide également à interagir avec les établissements de santé publique et à défier les normes socioculturelles restrictives.

Pour relever les défis de la mobilité, l’initiative décentralise les services vers les établissements de santé subalternes et renforce la distribution des contraceptifs et les conseils en la matière en milieu communautaire par le biais d’intermédiaires de santé.

Élargir l’accès aux services de santé reproductive et changer des vies

Les jeunes leaders sont devenus des leaders dynamiques, défendant une compréhension de la santé sexuelle et reproductive au sein de leurs collectivités. Ces leaders autonomes sont au cœur de l’innovation, fournissant aux jeunes femmes et hommes des connaissances et des compétences de vie en matière de SSR essentielles à la prise de décisions éclairées. Elles guident les jeunes femmes à travers le processus complexe d’accès aux soins d’avortement et travaillent activement à remettre en question et à changer les normes socioculturelles restrictives au sein de leurs collectivités.

« Auparavant, je n’avais aucune expérience dans ce domaine, mais maintenant ma compréhension de la santé sexuelle et reproductive s’est améliorée. Je me sens mobilisée par l’occasion de travailler avec des jeunes femmes et de les aider à faire des choix éclairés concernant leur santé. — Arjina Ahmed, jeune leader, à Assam.

Jusqu’à présent, l’IDF rapporte les résultats suivants dans les deux États d’intervention :

• De jeunes leaders encadrés par l’innovation ont contacté plus de 100 000 jeunes femmes et 90 000 jeunes hommes avec des messages sur la SSR, y compris l’avortement et la contraception.
• Plus de 5 400 jeunes femmes et hommes ont bénéficié de l’aide fournie par ces jeunes leaders.
• L’innovation a élargi la base de prestataires de services d’avortement dans les établissements de santé publique grâce à la formation de 1422 prestataires dans quatre États, ce qui a permis à plus de 150 000 femmes de recevoir des services d’avortement.
• L’aide apportée à la création de 72 conseils médicaux (en vertu de la Loi modifiée sur l’avortement) a considérablement amélioré l’accès aux services d’avortement tardif dans les cas d’anomalies congénitales, simplifiant ainsi le besoin pour les femmes de demander l’intervention d’un tribunal. 
• Le renforcement des services de santé adaptés aux jeunes a permis à plus de 88 000 adolescentes et jeunes femmes d’accéder à des services de SSR dans des établissements de santé d’intervention dans deux États.  

« L’intervention a vraiment créé un fort capital social dans les collectivités rurales. Nos animateurs jeunesse sont équipés pour informer et guider les jeunes femmes qui veulent avorter et avoir accès à d’autres services de santé reproductive. Le soutien à la référence et à l’accompagnement est un grand avantage et nous savons qu’il joue un rôle essentiel dans la recherche de soins. Nous sommes convaincus que la jeune main-d’œuvre que nous laisserons derrière nous dans les collectivités contribuera largement à améliorer la santé et la vie des femmes et des filles. 

« Au cours de ma formation de quatre jours avec l’IDF, j’ai acquis des connaissances essentielles sur la contraception, l’avortement sécuritaire et les modifications à la loi MTP. Cela m’a également permis d’améliorer mes compétences en matière de counseling et d’obtenir des outils pour mieux soutenir les clients en matière de santé reproductive. Grâce à cette expertise, j’offre maintenant en toute confiance des conseils appropriés, contribuant ainsi à des choix éclairés en matière de contraception dans ma collectivité. Grâce aux séances d’éducation et au soutien des responsables jeunesse de l’IDF, de plus en plus de jeunes couples viennent maintenant dans mon établissement de santé pour la contraception » — Rexona Begum, responsable de la santé communautaire, Centre de santé et de bien-être Chotogiripar, Assam.

« Le soutien de Pallabi Didi a été crucial pour m’aider à sortir du profond état de culpabilité et de peur, ce qui m’a permis de retrouver la santé et d’avancer dans ma vie. Son aide m’a non seulement apporté les services nécessaires, mais a également favorisé un environnement propice à l’acceptation au sein de ma famille. J’ai rencontré Pallabi Didi pour la première fois à mon école, où elle a animé une session sur la santé sexuelle et reproductive, nos droits et les services de santé sexuelle et reproductive disponibles. Cette session nous a permis d’aborder ouvertement des sujets souvent considérés comme tabous dans mon village. Grâce à ces discussions, nous avons obtenu des informations exactes qui dissipent les mythes sur l’avortement, la contraception et les menstruations, et j’ai acquis la confiance nécessaire pour relater mes problèmes personnels et chercher de l’aide. — Komal, village de Mamudpur, Assam. 

Cette histoire est partagée par la Fondation de développement Ipas. 

Les noms des personnes dans l’histoire ont été modifiés pour protéger leur vie privée. 

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.

“Las Warmis”: ICT and audio technology innovation to enhance women’s access to safe information on medical abortion

  Colectiva por la Libre Información para las Mujeres                  Peru

Colectiva por la Libre Información para las Mujeres (CLIM) de-stigmatizes and de-medicalizes access to safe abortion information in Peru by developing and testing a feminist audio collective focused on this topic. Women from local grassroots organizations will be trained in audio production content during seven-day audio collective workshops held in three regions. Additionally, CLIM will develop short testimony-based radionovelas, short audio messages and 30-minute talk show programmes. All recordings will be available on the internet and Spotify, and will be shared free-of-charge through WhatsApp and Telegram groups.

Medical abortion by telemedicine or standard care in South Africa: A randomized controlled non-inferiority trial 

  University of Cape Town                     South Africa

University of Cape Town is conducting a randomized clinical non-inferiority trial in South Africa to compare the efficacy, safety and acceptability of a telemedicine option for medical abortion to standard abortion care. Participants will be women requesting an abortion early in gestation. They will either receive standard care, which includes an ultrasound and in-person counselling, or telemedicine counselling through Women on Web´s online application SafeAbortion with no ultrasound provided. In both groups, the community health centers will provide the basic physical exam, the abortion medication, and the success of the abortion will be confirmed with a clinical symptom list and pregnancy test.

Medicinal Plants with Abortifacient Activity from Ayurvedic Medicine

   RoshniAgriBiotech                       India

RoshniAgriBiotech assesses medicinal plants used in India as traditional Ayurvedic medicine with potential to induce abortions. RoshniAgriBiotech will first review the literature to identify the medicinal plants. The use of these plants as abortifacients will be further assessed by interviewing folk medicine practitioners, and a shortlist of the five most promising candidates will be investigated. Standardized extracts of these plants will be assessed for their medicinal profile by using various laboratory techniques, and those showing potential abortifacient properties will be further tested. The ultimate goal of the project is to develop a pill from medicinal plants that is scientifically validated, cost-effective and acceptable to marginalized rural women in India.

Opportunities and early access to abortion services in Profamilia, Colombia

  Asociación Pro-bienestar de la Familia Colombiana (Profamilia)                       Colombia

Profamilia uses the International Planned Parenthood Federation’s social franchise toolkit to improve access to safe abortion care for women in conflict-affected Colombia. This includes: (i) developing a quality-assured network of health care providers trained in medical abortion and manual vacuum aspiration, stigma reduction, and legal training; (ii) dissemination of information on safe abortion services amongst people in these communities; and (iii) community empowerment education activities.

At the Reach of Women

  Fundación Oriéntame                      Colombia

Innovator Story: Safe Abortion with Reach: How Telemedicine is transforming Reproductive Health in rural Colombia  

Fundación Oriéntame implements and tests a telemedicine service to provide access to sexual and reproductive health (SRH) services, including safe and legal medical abortion, for women and girls in remote areas of Colombia. This will be facilitated by a registered nurse based in a rural area of Colombia under the remote assistance of a physician from the Oriéntame Clinic. The nurse will use an information and communications technology platform to communicate with the physician, therefore meeting the local requirement that abortion medication be prescribed by a physician. In addition to medical abortion, the team will provide contraceptive counselling and screening for sexually transmitted infections.

CHOICE: Communicating to HER Options via Information, Care Coordination & Empathy

  DoctHERs                      Pakistan

doctHERs provides personalized information and guidance around safe abortion services to underserved women in Pakistan, including female factory workers across rural and peri-urban village communities. doctHERs will deploy trusted up-skilled frontline care coordinators, who will use tablets with 4G internet connectivity to connect with marginalized women and girls. The care coordinators will refer them to a nationwide network of established safe abortion providers and family planning services via HD video-consultation.

Addressing barriers to young people access to MR/PAC services and De-stigmatizing Uterine Evacuation/Post Abortion Care (PAC)

  Rahnuma – Family Planning Association of Pakistan                     Pakistan

Family Planning Association of Pakistan provides menstrual regulation and post-abortion care services to women and girls at five clinics in semi-urban areas of Pakistan and through monthly mobile camps. The clinics will provide safe uterine evacuation/post abortion care (PAC) services including counseling, medical and surgical uterine evacuation, treatment of complications, and post-abortion contraceptive services. To reduce stigma related to these services, service providers at the clinics and youth peer educators will be trained on value clarification and attitude transformation and de-stigmatization. The trained youth peer educators will then organize sensitization sessions with local youth and with community members.

Improving Access to Abortion in Georgia

  Center for Information and Counseling on Reproductive Health – Tanadgoma
   Georgia

Tanadgoma improves access to abortion for women in Georgia by implementing and testing a simplified one-visit service delivery model, as opposed to three visits typically required to have an abortion. The only visit to a health facility will be for pregnancy diagnosis and counselling. Meeting local legal requirements, five days later, the health provider will receive remote confirmation from the patient about whether they are still seeking an abortion. The provider will then mail medical abortion pills and two urine pregnancy tests to the patient. As such, the medical abortion can be self-administered, and the success can be confirmed without an in-person assessment.

Teenage and Youth Refugee’s Abortion Care Project

  Rwanda Youth Organization for Development                     Rwanda

Rwanda Youth Organization for Development provides friendly abortion care services for women and adolescents in five refugee camps in Rwanda. This will be facilitated through (i) focus groups on safe abortion, misoprostol, and contraceptive use; (ii) an android application, Menyapplication, to disseminate information on safe abortion and sexual and reproductive health and rights; (iii) a documentary film that will be developed and shown in the camps. Public boxes for access to misoprostol and contraceptives will be established across the camps. One camp with particularly high need will also receive monthly training on the clinical management of abortion complications.

Menstrual Regulation and Post Abortion Care on Outreach

  Marie Stopes International                   Bangladesh

Marie Stopes International (MSI) tests efforts to provide Menstrual Regulation (MR) services and post-abortion care through outreach programs across government Family Welfare Centers (FWCs) in three remote districts in Bangladesh. Trained MSI paramedics will rove between the centers to provide this care. Family Welfare Assistants will be trained on values clarification and outreach information provision, and providers at FWCs will be trained on the management of medical emergency cases that may arise. The paramedics will follow up with patients by phone and provide follow-up care at FWCs, including post-abortion family planning and cervical cancer screening to ensure comprehensive care.

Medical abortion via telemedicine for women and adolescents in rural Moldova: breaking barriers with technology

  Reproductive Health Training Center                  Moldova

Reproductive Health Training Center uses a novel service delivery model for women and girls in rural Moldova that allows self-management of medical abortion (MA) with remote guidance from a provider. Women seeking MA will receive counselling from an obstetrician/gynecologist via a videoconference and will subsequently obtain medication at a participating pharmacy. Follow-up to confirm MA success and assess satisfaction with the service will also be remote. Upon demonstrating the feasibility, effectiveness and acceptability of telemedicine MA services in Moldova, Reproductive Health Training Center will seek to integrate the model into the national public healthcare system.

Mifepristone 50 mg as a Contraceptive

  Women on Web                 Georgia

Women on Web International Foundation’s innovation is a non-inferiority clinical trial in Georgia, comparing the contraceptive use of weekly mifepristone with the daily use of desogestrel, an alternative non-estrogen contraceptive. The trial aims to establish the efficacy, safety and side-effects of mifepristone as a weekly contraceptive. The long-term goal of the innovation is to register and market mifepristone as a contraceptive and to have this indication included on the World Health Organization Essential Medicines List.

Novel mHealth solution for self-managed abortions for Venezuelan women

  Vitala Global Foundation               Venezuela

Vitala Global Foundation develops and tests an integrated mobile health tool that can facilitate self-management of medical abortion for Venezuelan women living in a fragile setting. The goal of this tool is to guide women through self-assessment of abortion eligibility and abortion success, send automatic text messages to provide support, and include information for referral clinics if needed. Following the principles of user-centered design, Vitala Global Foundation will (i) facilitate interviews with target beneficiaries, engage community-based organizations, abortion experts and mobile application developers; (ii) conduct usability testing for potential designs/prototypes; and (iii) conduct a study with Venezuelan women to evaluate the mobile tool.

HER VOICE: Augmenting vulnerable Kenyan girls and women with disability access to safe abortion services through a disability friendly mobile outreach model and home based support services

  Women Spaces Africa               Kenya

Innovator Story: Innovating Safe Abortion Access for Women with Disabilities

Women Spaces Africa develops and tests an outreach strategy that trains community health workers with disabilities in Nairobi to become peer educators. The peer educators will conduct community outreach and home visits to women and girls with disabilities and will engage the women and girls in training on sexual and reproductive health and rights (SRHR), specifically medical abortion. The training will also integrate economic empowerment skills, and group lending will be established to support income-generating activities. Furthermore, the women and girls with disabilities will design materials for a disability-friendly text hotline and braille educational communication materials on medical abortion and SRHR. These materials will be distributed to resource centers for people with disabilities, and health care providers will also be trained on disability-friendly medical abortion.

Missed Period Pill: Expanding access to fertility control in Senegal

  Gynuity              Senegal

Gynuity Health Projects explores the feasibility of and develops a strategy for a new user-controlled method to help women and girls manage missed menses. Gynuity will also explore the possibility of expanding access to combipacks through the indication of early pregnancy loss.

Mobile Connect – An integrated mHealth intervention to address unsafe abortion among female sex workers in Vietnam

  Center for Promotion of Advancement of Society             Vietnam

Center for Promotion of Advancement of Society delivers sexual reproductive health education to female sex workers in Vietnam using technology and by delivering peer-provided services. Mobile Connect, will provide interactive short messaging services (SMS) and tele-counseling to share information on unwanted pregnancy, safe abortion, stigma reduction, and safe services. Trained peer educators will provide the women interested in participating with education, counseling and referrals to specialist abortion services when needed. Center for Promotion of Advancement of Society will also develop and test digital counseling tools for providers to deliver friendly abortion care.

Development of new abortion medications by using existing medications in new ways

  Gynuity            United-States​

Gynuity Health Projects assesses existing medications to identify alternative safe and effective abortifacients. Gynuity will conduct a comprehensive literature review of each medication to assess the potential effectiveness, the possible barriers to development and the likelihood to fill market gaps. In consultation with an advisory group, Gynuity will then conduct a preliminary dosing and safety study with the most promising candidate.