April 8, 2018 Kathryn Andersen Ipas

Putting Women at the Center: Training abortion service providers

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Women are central to families and communities, and their well-being is essential to global health and stability. Yet each year, 25 million unsafe abortions put women and girls at great risk of injury or even death.

These deaths and injuries are entirely preventable. That’s why organizations like Ipas focus on making safe, high-quality abortion care and contraception available to anyone, whenever and wherever it is needed, as part of the full continuum of sexual and reproductive care.

An essential element of achieving this goal is ensuring the availability of skilled, trained providers. But here’s the catch: Most unsafe abortions take place in developing countries in Africa, Asia and Latin America—precisely the regions of the world where the shortage of physicians and other health professionals is most acute. This means that training midlevel health workers, such as midwives and nurses, is a crucial part of expanding the base of abortion providers.

But to be effective, training strategies must be woman-centered. They must be built around women’s needs and how best to support them both through clinical and non-clinical aspects of care.  At Ipas, our approach to training is also contextually specific and requires providers — from an ob/gyn working in a primary health care clinic in Nigeria to an auxiliary nurse midwife working in a health post in Nepal — to adhere to World Health Organization clinical recommendations and to ensure that services meet each woman’s needs and circumstances.  

Take, for example, the role of auxiliary nurse midwives (ANMs) in Nepal. Although abortion has been legal in Nepal since 2002, reproductive health care remains difficult to access for women in remote and rural areas. By training ANMs, already certified as skilled birth attendants to provide medical abortion, or abortion with pills, Ipas has been able to expand access to abortion care in rural and geographically remote areas. Between 2011 and 2013, Ipas trained 463 ANMs in delivering abortion care services to 25,187 women living in 25 districts.

We know that decentralized services translate into more health-care options for women. We also know that individual women who may not be able to forego their daily activities to get from one health clinic to another benefit directly from the comprehensive abortion care training received by ANMs. Since ANMs are less likely to be transferred to different health facilities than physicians, they maintain close connection with the communities and thus offer more consistency in making safe abortion services available to women living in those communities.

Training should not need to stop at midlevel providers if we want to continue expanding our reach in delivering quality reproductive healthcare. In Nepal, Ipas has also trained thousands of female community health volunteers (FCHVs) to share information on medical abortion and to determine a woman’s eligibility. Extending training to FCHVs, who are trusted members of the community, brings care closer to women, reaching them where they live.  Beyond expanding access to important care, these programs can also normalize abortion.

 A woman who is treated with respect by a provider or trusted community health worker, and who is offered options for safe abortion services and contraception, will share with others in her family or extended community information about how and where to safely access reproductive health care. It puts us one step closer to having everyone — no matter who they are and where they live —able to have universal access to sexual reproductive health services.

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