Professor Hassan Shehata is the Senior Vice President for Global Health at the RCOG. As the RCOG’s Making Abortion Safe Programme moves into its final six months, he reflects on its major activities and impact and considers the vital role that healthcare providers can play in advocating for increased access to quality abortion care.
The global challenge
Over the past three years, the RCOG has been implementing a multi-country programme to advocate for improved access to quality abortion care. Unintended pregnancies are common and affect people of all backgrounds around the world. Between 2015 and 2019, there were approximately 121 million unintended pregnancies per year, with 73 million of these ending in abortion [1]. For a variety of reasons, pregnant women, pregnant people and girls also require abortion care for intended pregnancies.
Quality and safe abortion care is a WHO-listed essential health service, and it should be effective, efficient, accessible, acceptable/patient centred, equitable and safe. However, access to quality abortion care remains contingent on legal, regulatory, policy, socio-economic and socio-cultural systems. As a result, an estimated 45% of all abortions between 2010–2014 were unsafe[2].
Our goal is to change this, and enable women and girls to control their own fertility, which would result in 70,000 fewer pregnancy and childbirth related deaths per year[3].
Where does the Making Abortion Safe Programme come in?
The RCOG has a track record in setting standards for women’s health and professionalising sexual and reproductive health (SRH) services and recognises that obstetricians, gynaecologists, and affiliated health professionals, are uniquely placed as advocates to improve services for the women and girls that they serve, providing a respected and legitimate voice to both policy makers and communities. As such they can be instrumental in identifying and developing strategies to help address barriers to care.
Through the Making Abortion Safe programme we have partnered with 60+ Sexual and Reproductive Health and Rights “Champions”, healthcare professionals from across Rwanda, Zimbabwe and Nigeria, Sudan and Sierra Leone. Champions have been supported to develop and implement advocacy plans with the aim of improving women’s and girls’ access to quality and safe abortion and/or post-abortion care.
Additionally, in collaboration with Champions, professional societies and NGOs, we have used our platform to amplify healthcare provider voices at national, regional and international levels to advocate for quality abortion care, which is centred on evidenced- based best practice and real world experience.
Impact to date
Over the last three years the Making Abortion Safe programme has supported healthcare providers to recognise and capitalise on the vital role they can play in advocating for improved and expanded access to safe, quality abortion services. This has included:
- Working with 60+ SRHR Champions, professionals from across five countries in Africa, to support the development of their skills as advocates for safe abortion
- Funding and supporting the design and delivery of advocacy plans in Nigeria, Rwanda and Zimbabwe which have focused on: raising awareness of legal acts and orders; updating national guidance to be aligned with latest evidence and international standards; working with medical students; advocating for the inclusion of abortion care in curricular; and researching and advocating on the issue of stigma towards healthcare professionals working in abortion care
- Enabling, to date, 1,797 healthcare professionals to learn about abortion advocacy and update their clinical knowledge on quality abortion/post abortion care through access to our new, free online learning resources
- Promoting excellence in abortion care by updating and developing new Best Practice Papers in abortion, post-abortion care, telemedicine abortion and post-abortion contraception which have been accessed through our website 2,800+ times
- Supporting the adaptation of Best Practice Papers by Champions in Rwanda, Nigeria, Tanzania, South Africa, Kenya, Zambia, Pakistan and Bangladesh in collaboration with their respective ministries of health to expand their reach and ensure that healthcare professionals can provide quality abortion and post abortion care, in line with global standards
- Expanding the evidence base on stigma experienced by healthcare professionals through a global survey of 1,675 providers of abortion and post abortion care from 77 countries, highlighting the importance of work to address this global issue
- Producing guidance for professional societies and other organisations to reduce and manage the stigma experienced by professionals providing abortion care
- Partnering with Africa Research Excellence Fund to deliver a research grant-writing skills workshop series for early career researchers in Africa and providing small grants to two research projects in post-abortion care in Sierra Leone
- Used our platform to advocate for self-managed abortion, to condemn restrictive abortion care measures, to advocate for buffer zones around abortion clinics and established the Coalition of UK Health Professional Bodies and Royal Colleges for SRHR, to advocate for the UK Government to prioritise SRHR within its international development programmes and funding
The RCOG’s global call to action
We are extremely proud of the achievements of the Making Abortion Safe programme and honoured to have worked with such dedicated and talented healthcare professionals, but we know there is still so much more to do. We ask you to join us in continuing to advocate for improved access to abortion care for women and girls globally:
- Use and disseminate our range of resources amongst your networks:
- Abortion Care training Know what the law allows in your country, be clear about the circumstances where abortions are legal, and ensure women coming in to your care are empowered through this knowledge to access care if desired.
- Do not allow personal beliefs to delay access to abortion care, providing referrals for women to access the care they seek when you are unable to provide this yourself
- Raise awareness about the health and social impacts that restrictive abortion laws cause to the lives of women and girls
- Raise up and support your colleagues who are providing these essential services, ensuring they can work free from stigma and harassment
- Join us in committing to advocating for safe abortion care globally for everyone who needs it.
- To stay up to date with the work of the Making Abortion Safe programme and other global health initiatives at the RCOG, please visit our website or join our mailing list here.
[1] Bearak J et al., Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019, Lancet Global Health, 2020, 8(9), http://www.thelancet.com/journals/langlo/article/ PIIS2214-109X(20)30315-6/fulltext
[2] Dr Bela Ganatra, MD, Caitlin Gerdts, PhD, Clémentine Rossier, PhD, Brooke Ronald Johnson Jr, PhD, Özge Tunçalp, MD, Anisa Assifi, MPH et al, Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model, The Lancet https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31794-4/fulltext
[3] https://www.guttmacher.org/report/unmet-need-for-contraception-in-developing-countries