Preventing State Harassment of Abortion Providers: The Work of the Legal Support Network in Latin America and East Africa

Access to safe abortion care is threatened, especially in legally restrictive settings, when providers are harassed or prosecuted on spurious charges. Legal networks have been working with safe abortion providers in Latin America since 2006, and in East Africa since 2010, to short-circuit this intimidation and protect access to quality information and abortion care. Planned Parenthood Global has nurtured these networks, now operating in nine countries. This paper describes this unique, prevention-focused legal strategy, with an eye toward analyzing its effectiveness, sharing the model and lessons learned with an interested audience, and encouraging replication. Prevention-focused legal networks for abortion providers have been effective in reducing police harassment, offering providers the information and skills they need to stand up to intimidation, and keeping safe abortion services available to those who need them. In the few cases of prosecution, providers have access to competent defense counsel through the networks. This model has also enabled better coordination between advocacy efforts on behalf of abortion rights, empowered health care providers, and increased access for women. Providers in other countries might explore whether and how creating local legal networks would offer similar protections.

Building Bridges: A Case for Community Health Worker Provision of Misoprostol-Only Abortion in the First Trimester

INTRODUCTION

The consequences of unsafe abortion are devastating to women, their families, and their communities. Medication abortion presents an important alternative to harmful self-induction practices and surgical intervention under questionable circumstances. In settings where mifepristone is unavailable, the use of misoprostol alone is a safe and effective option for terminating an unwanted pregnancy. Studies have demonstrated the safety and efficacy of administration of misoprostol by community health workers (CHW) for indications such as postpartum hemorrhage and treatment of incomplete abortion.

OBJECTIVES

The current study assesses the safety and efficacy of CHW managing misoprostol-only abortion in the first trimester.

METHODS

A retrospective review of clinical files of women who received abortion services in three countries in Latin America between April 2009 and December 2015 included analysis of 173 cases.

RESULTS

In 94% of cases, the pregnancy was terminated without any further intervention. In the remaining cases, clients were referred for manual vacuum aspiration. In four cases, a complication was reported by the provider. In one, the complication was promptly resolved through referral to a higher level of care; in the remaining three, the complication was resolved directly by the provider. In 98% of cases, women reported being satisfied with the treatment they received.

CONCLUSION

This study demonstrates that CHW are able to provide misoprostol-only abortion services to women effectively and safely. The benefits of this model of care also extend beyond the abortion service: CHW are able to offer women a comprehensive range of quality health services, including contraceptive services, increasing access to vital healthcare in areas with few other options.

Beyond the clinic walls: empowering young people through Youth Peer Provider programmes in Ecuador and Nicaragua

Youth in Latin America experience high rates of teen pregnancy and sexually transmitted infections, but traditional health services are not meeting their health care needs. Youth require access to tailored health care and information to make informed, healthy decisions. To break down barriers to these vital sexual and reproductive health services, Planned Parenthood Global, a division of Planned Parenthood Federation of America, developed a Youth Peer Provider model which has been implemented in Latin America since the early 1990s. The model goes beyond peer education to train Youth Peer Providers under age 20 to provide condoms, oral contraceptive pills, emergency contraception, injectable contraceptives, and sexual and reproductive health information to their peers. Peers with needs beyond Youth Peer Providers' capacity are referred to health professionals offering youth-friendly services. Survey results reveal high levels of contraceptive use among those served by the Youth Peer Providers: 98% of sexually active survey respondents wishing to avoid pregnancy report contraceptive use at least five years after joining the programme. Results of qualitative programme evaluations highlight higher self-esteem, stronger communication and decision-making skills, close relationships with friends and family, more interest in school, understanding of responsibility in relationships, and other positive outcomes among programme participants.