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Sorhaindo AM, Castle S, Flomen L, Lathrop E, Mohagheghpour S, Dabash R, Toedtli FK, Wilkins R, Läser L, Titulaer P, Nyamato E, Dakouo ML, Awadallah A, Shrestha R, Morales M, Rehnström Loi U. Adaptations to comprehensive abortion care during the COVID-19 pandemic: case studies of provision in Bolivia, Mali, Nepal, and the occupied Palestinian territory. Sex Reprod Health Matters 2023; 31:2249694. [PMID: 37747711 PMCID: PMC11003643 DOI: 10.1080/26410397.2023.2249694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
The COVID-19 pandemic impacted comprehensive abortion care provision. To maintain access to services while keeping individuals safe from infection, many organisations adapted their programmes. We conducted a programme evaluation to examine service adaptations implemented in Bolivia, Mali, Nepal, and the occupied Palestinian territory. Our programme evaluation used a case study approach to explore four programme adaptations through 14 group and individual interviews among 16 service providers, facility managers and representatives from supporting organisations. Data collection took place between October 2021 and January 2022. We identified adaptations to comprehensive abortion care services in relation to provision, health information systems and counselling, and referrals. Four overarching strategies emerged: (1) the use of digital technologies, (2) home and community outreach, (3) health worker optimisation, and (4) further consideration of groups in vulnerable situations. In Bolivia, the use of a messaging application increased access to confidential gender-based violence support and comprehensive abortion care. In Mali, the adoption of digital approaches created timely and complete data reporting and trained members of the community served as "interlocutors" between the communities and providers. In Nepal, an interim law expanded medical abortion provision to pharmacies, and home visits complemented facility-based services. In the occupied Palestinian territory, the use of a hotline and social media expanded access to quick and reliable information, counselling, referrals, and post-abortion care. Adaptations to comprehensive abortion care service delivery to mitigate disruptions to services during the COVID-19 pandemic may continue to benefit service quality of care, access to care, routine monitoring, as well as inclusivity and communication in the longer term.
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Affiliation(s)
- Annik Mahalia Sorhaindo
- Technical Consultant, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sarah Castle
- Technical Consultant, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lola Flomen
- Mixed Health Systems Consultant, Population Services International, WashingtonDC, USA
| | - Eva Lathrop
- Global Medical Director, Population Services International, WashingtonDC, USA
| | - Shirine Mohagheghpour
- Senior Technical Advisor for Service Delivery, Population Services International, WashingtonDC, USA
| | - Rasha Dabash
- Senior Technical Consultant, Ipas, Chapel Hill, NC, USA
| | | | - Rebecca Wilkins
- Technical Lead, Abortion, International Planned Parenthood Federation, London, UK
| | - Laurence Läser
- Technical Officer UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Patricia Titulaer
- Technical Consultant, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ernest Nyamato
- Global Associate Director, Quality of Care, Ipas, Nairobi County, Kenya
| | - Mary Lea Dakouo
- Senior Technical Advisor, Population Services International, Bamako, Mali
| | - Ammal Awadallah
- Executive Director, Palestine Family Planning and Protection Association (PFPPA), Jerusalem, Israel
| | - Raman Shrestha
- Global Evidence and Impact Advisor, Marie Stopes Nepal, Baluwatar, Kathmandu, Nepal
| | - Malena Morales
- Country Director Bolivia, Ipas LAC Region, La Paz, Bolivia
| | - Ulrika Rehnström Loi
- Technical Officer, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
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Grossman A, Prata N, Williams N, Ganatra B, Lavelanet A, Läser L, Asmani C, Elamin H, Ouedraogo L, Rahman MM, Conneh-Duworko MJ, Tehoungue BZ, Chanza H, Phiri H, Bhattarai B, Dhakal NP, Ojo OA, Afolabi K, Kabuteni TJ, Hailu BG, Moses F, Dlamini-Nqeketo S, Zulu T, Rehnström Loi U. Correction: Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities. Reprod Health 2023; 20:160. [PMID: 37884974 PMCID: PMC10604516 DOI: 10.1186/s12978-023-01691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Affiliation(s)
- Amy Grossman
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
| | - Ndola Prata
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
- Bixby Center for Population, Health & Sustainability, School of Public Health, University of California, Berkeley, CA, USA
| | - Natalie Williams
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Antonella Lavelanet
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Laurence Läser
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Chilanga Asmani
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Hayfa Elamin
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Leopold Ouedraogo
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | | | | | | | - Harriet Chanza
- World Health Organization, Malawi Country Office, Lilongwe, Republic of Malawi
| | - Henry Phiri
- Ministry of Health, Lilongwe, Republic of Malawi
| | - Bharat Bhattarai
- Department of Drug Administration, Ministry of Health and Population, Kathmandu, Nepal
| | | | | | - Kayode Afolabi
- Reproductive Health, Federal Ministry of Health, Abuja, Federal Republic of Nigeria
| | | | | | - Francis Moses
- Reproductive Health/Family Planning Programme Manager, Ministry of Health, Freetown, Sierra Leone
| | | | - Thembi Zulu
- National Department of Health, Pretoria, Republic of South Africa
| | - Ulrika Rehnström Loi
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
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Grossman A, Prata N, Williams N, Ganatra B, Lavelanet A, Läser L, Asmani C, Elamin H, Ouedraogo L, Rahman MM, Conneh-Duworko MJ, Tehoungue BZ, Chanza H, Phiri H, Bhattarai B, Dhakal NP, Ojo OA, Afolabi K, Kabuteni TJ, Hailu BG, Moses F, Dlamini-Nqeketo S, Zulu T, Rehnström Loi U. Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities. Reprod Health 2023; 20:58. [PMID: 37041543 PMCID: PMC10091522 DOI: 10.1186/s12978-023-01574-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and provider's knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels. METHODS Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020. RESULTS Registration of abortion medicines-misoprostol or a combination of mifepristone and misoprostol-was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone-countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula-no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option. CONCLUSION Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access.
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Affiliation(s)
- Amy Grossman
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
| | - Ndola Prata
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
- Bixby Center for Population, Health & Sustainability, School of Public Health, University of California, Berkeley, CA, USA
| | - Natalie Williams
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Antonella Lavelanet
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Laurence Läser
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Chilanga Asmani
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Hayfa Elamin
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Leopold Ouedraogo
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | | | | | | | - Harriet Chanza
- World Health Organization, Malawi Country Office, Lilongwe, Republic of Malawi
| | - Henry Phiri
- Ministry of Health, Lilongwe, Republic of Malawi
| | - Bharat Bhattarai
- Department of Drug Administration, Ministry of Health and Population, Kathmandu, Nepal
| | | | | | - Kayode Afolabi
- Reproductive Health, Federal Ministry of Health, Abuja, Federal Republic of Nigeria
| | | | | | - Francis Moses
- Reproductive Health/Family Planning Programme Manager, Ministry of Health, Freetown, Sierra Leone
| | | | - Thembi Zulu
- National Department of Health, Pretoria, Republic of South Africa
| | - Ulrika Rehnström Loi
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
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Cassinath N, Titulaer P, Läser L, Lavelanet A, Ahsan S, Kwankam Toedtli F, Mawa S, Rehnstrom Loi U. Disruptions to the procurement of medical abortion medicines during COVID-19: a scoping review. BMJ Open 2022; 12:e064848. [PMID: 36302580 PMCID: PMC9621154 DOI: 10.1136/bmjopen-2022-064848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This scoping review aimed to systematically search, retrieve and map the extent and characteristics of available literature on the evidenced disruptions to medical abortion (MA) medicine procurement caused by the COVID-19 outbreak. DESIGN Scoping review using Arksey and O'Malley's methodology and Levac et al's methodological enhancement with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. DATA SOURCES PubMed, Embase, PMC, Science Direct, the Cochrane Library and Google Scholar were searched from January 2020 to April 2022. ELIGIBILITY CRITERIA We included articles in English that: (1) contained information on MA medicines; (2) included descriptions of procurement disruptions, including those with examples, characteristics and/or statistics; (3) documented events during the COVID-19 pandemic; and (4) presented primary data. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened search results, performed a full-text review of preliminarily included articles and completed data extraction in a standard Excel spreadsheet. Extracted data from was compared for validation and synthesised qualitatively. RESULTS The two articles included are unpublished grey literature demonstrating evidence of short-lived disruptions in sexual and reproductive health commodity procurement, including MA medicines, in sub-Saharan Africa during the early months of the pandemic. Findings from the two included grey literature articles show that in sub-Saharan contexts, emergency preparedness, stockpiling, adaptations and flexibility of key actors, including donors, alleviated COVID-19 disruptions allowing for resumption of services within weeks. CONCLUSION There is a need for increased empirical evidence of MA procurement challenges to understand which barriers to MA procurement may persist and impact continuity of supply while others can fuel resilience and preparedness efforts at the country and subregional levels. The lack of evidence from social marketing organisations and their networks is a significant gap as these actors constitute a vital artery in the distribution of MA commodities in low-income and middle-income countries.
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Affiliation(s)
- Natasha Cassinath
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Patricia Titulaer
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Laurence Läser
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Antonella Lavelanet
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Safia Ahsan
- Reproductive Health Supplies Coalition, Washington, DC, USA
| | | | - Stephen Mawa
- Technical Division, United Nations Population Fund, New York, New York, USA
| | - Ulrika Rehnstrom Loi
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
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