Table 1 Examples of SA activities by country
Country | Stage 1 | Examples of Stage 2 and 3 activities | |
|---|---|---|---|
Bangladesh | Year initiated | 2002 | • Developed menstrual regulation guidelines. • Used information, education, and communication materials to disseminate information through fieldworkers. • Focused on policy reform and securing funding for menstrual regulation kits and commodities. |
Assessment team | 11 members. | ||
Stakeholders involved | Physicians and social scientists. | ||
Technical support | WHO | ||
Assessment sites | Fieldwork was conducted in 5 districts and at the central level. | ||
Ghana | Year initiated | 2005 | • Developed and disseminated standards and guidelines and trained mid-level HCPs to increase quality and availability of services. • Registered Medabon®, a co-packaged mifepristone-and-misoprostol product for medical abortion, which is approved for use by physicians in both public and private facilities. • Created a fixed price for abortion services in public facilities with a fee-sharing provision for abortion providers to discourage clandestine provision of services. • Conducted sensitization training for HCPs, members of the media, lawyers, police officers, and community leaders on legal indications for abortion, the incidence and impact of unsafe abortion, and ways to prevent it. • Conducted a nationwide maternal health study with emphasis on abortion. • Updated national monitoring system to improve the monitoring and evaluation on CAC. • Initiated scale up of CAC and family planning services, mainly through international partners, although some districts and regions raised their own funds. |
Assessment team | 17 members | ||
Stakeholders involved | Policymakers, program managers, HCPs, and reproductive rights and women’s health advocates. | ||
Technical support | Ipas and WHO | ||
Assessment sites | Fieldwork was conducted in 6 administrative regions. | ||
Guinea | Year initiated | 2009 | • Country stakeholders were unable to secure funding or technical support to move beyond Stage 1. |
Assessment team | 18 members | ||
Stakeholders involved | Health professionals and representatives from NGOs, government agencies, research centres, and community organizations. | ||
Technical support | WHO | ||
Assessment sites | Fieldwork was conducted in 4 regions and the country’s capital. | ||
Kyrgyzstan | Year initiated | 2011 | • Developed new health strategy and provided training on new health strategy. • Increased access to family planning services and contraception. • Improved sexuality education. • Conducted medical abortion operations research study and trained midwives to improve access to medical abortion in rural areas. |
Assessment team | 14 members | ||
Stakeholders involved | Clinical and research experts. | ||
Technical support | UNFPA, UNICEF, and WHO | ||
Assessment sites | Fieldwork was conducted in 3 regions. | ||
Macedonia | Year initiated | 2007 | • Developed national strategy for sexual and reproductive health, which was adopted by the MOH in 2011. • Allocated funding in the national program budget for the operation of a youth counselling centre that provides free contraceptives and education materials. |
Assessment team | 13 members | ||
Stakeholders involved | MOH and government agencies, community and clinical organizations, and NGOs. | ||
Technical support | UNDP, UNFPA, and WHO | ||
Assessment sites | Fieldwork was conducted in 6 regions. | ||
Malawi | Year initiated | 2009 | • Conducted study to understand complications of unsafe abortion and cost to the health system. • Focused on increasing provider-level capacity and facility-level equipment to improve PAC. • Formed a local civil society coalition to advocate for legal reform. |
Assessment team | 24 members | ||
Stakeholders involved | Government agencies, human rights groups, and NGOs. | ||
Technical support | Ipas and WHO | ||
Assessment sites | Fieldwork was conducted in 10 districts. | ||
Moldova | Year initiated | 2005 | • Developed standards and guidelines for safe abortion services and trained HCPs. • Increased access to contraceptives for youth and socially vulnerable groups through insurance system coverage. • Piloted CAC at 4 model centres and subsequently included 2 more model centres. |
Assessment team | 23 members | ||
Stakeholders involved | MOH, clinical organizations, legal organization, researchers, NGOs, HCPs, and mass media. | ||
Technical support | East European Institute of Reproductive Health in Romania, Ipas, and WHO. | ||
Assessment sites | Fieldwork was conducted in 9 administrative units and 2 municipalities. | ||
Mongolia | Year initiated | 2003 | • Developed national standards and guidelines for abortion and the national pre-service training curriculum was harmonized with the new guidelines. • Registered Mifepristone and Misoprostol for first and second trimester abortion and included these drugs in the National Drugs Registry in 2006. • Established 3 model CAC units to provide high quality services and used these units as training centres for HCPs. • Focused on improving national facility infrastructure and upgrading diagnostic and treatment centres. |
Assessment team | 19 members | ||
Stakeholders involved | Public health institute, research centres, youth organizations, and HCPs. | ||
Technical support | WHO, Population Council (Bangkok), Ipas | ||
Assessment sites | Fieldwork was conducted in 6 provinces and the nation’s capital. | ||
Romania | Year initiated | 2001 | • Developed standards and guidelines and improved infrastructure in several hospitals to provide high-quality abortion services. • Improved access to contraceptive services by making them available from family physicians (not just gynecologists as was previously done). • Pilot-tested free contraceptives intervention in 3 rural districts and scaled up to 42 districts to make contraceptives available to vulnerable groups of the population. |
Assessment team | 19 members | ||
Stakeholders involved | MOH, clinical organizations, government agencies, NGOs, and HCPs. | ||
Technical support | WHO and Ipas | ||
Assessment sites | Fieldwork was conducted in 8 administrative units and the county’s capital. | ||
Russian Federation | Year initiated | 2009 | • Revised regulatory documents and developed national guidelines, standards, and protocols according to WHO recommendations. • Trained obstetricians and gynecologists on revised guidelines through post-graduate education. • Conducted local operations research on safe practices of induced abortion in the first trimester. • Increased accessibility to abortion services. |
Assessment team | 25 members | ||
Stakeholders involved | Researchers, community organizations, and health care professionals. | ||
Technical support | WHO | ||
Assessment sites | Fieldwork was conducted in 3 regions | ||
Senegal | Year initiated | 2010 | • Formed an advocacy task force, which conducted awareness-raising workshops with parliamentarians, religious leaders, journalists, and civil-society groups. • Discussed a draft bill that includes all indications for abortion stipulated by the Maputo Plan of Action during a workshop in June 2011. • Developed a national dialogue about unsafe abortion and the need for legislative changes and country stakeholders have been advocating for these changes. • Initiated plans to improve sexual and reproductive health education, family planning, and PAC services. |
Assessment team | 28 members | ||
Stakeholders involved | MOH, civil society, government agencies, and NGOs. | ||
Technical support | Ipas | ||
Assessment sites | Fieldwork was conducted in 10 regions. | ||
Sierra Leone | Year initiated | 2011 | • Ongoing efforts to revise the abortion law resulted in the country’s members of parliament voting unanimously in favour of legislation that would legalize abortion at up to 12 weeks of pregnancy in December 2015. However, amidst religious protests, the country’s president declined to sign the bill. In February 2016, rights groups urged the president to give the bill assent. The bill has been referred to the constitutional review committee, which is currently reviewing the country’s constitution. |
Assessment team | 27 members | ||
Stakeholders involved | MOH, health professionals, NGO, and legal professionals. | ||
Technical support | Ipas and WHO | ||
Assessment sites | Fieldwork was conducted in 12 health districts. | ||
Ukraine | Year initiated | 2007 | • Implemented Comprehensive Care for Unwanted Pregnancies project (CCUP), which resulted in 5 new model clinics supported with capacity building activities on CCUP provision. • Implemented new training curriculum on CCUP for obstetricians and gynecologists. • Monitored and evaluated CCUP services in pilot regions. • Developed scaling-up strategy for CCUP, which has been distributed to all the regions of Ukraine for implementation. |
Assessment team | 32 members | ||
Stakeholders involved | MOH, government agencies, higher educational establishment, and professional associations. | ||
Technical support | WHO and Ipas | ||
Assessment sites | Fieldwork was conducted in 2 regions. | ||
Vietnam | Year initiated | 1997 | • Formed National Technical Working Group on Abortion to finalize national technical guidelines for abortion services and included abortion-related policy recommendations in a national reproductive health strategy. • Conducted the Comprehensive Abortion Care project from 2001 to 2009 and set up national abortion care guidelines for all health care levels to use modern abortion techniques. |
Assessment team | 12 members | ||
Stakeholders involved | MOH, clinical and community organizations, and physicians. | ||
Technical support | WHO | ||
Assessment sites | Fieldwork was conducted in 6 provinces. | ||
Zambia | Year initiated | 2008 | • Developed and disseminated CAC standards and guidelines to increase quality and availability of services. • Conducted action research to introduce medical abortion drugs in 20 health facilities. • Registered Medabon® and the government has begun to allocate funds for purchasing medicines/equipment for abortion services. • Conducted a pilot program for distributing contraceptive injections through community-based workers. |
Assessment team | 17 members | ||
Stakeholders involved | Academics, program managers, HCPs, researchers, and women’s health advocates. | ||
Technical support | Ipas and WHO | ||
Assessment sites | Fieldwork was conducted in 5 provinces. | ||