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Ipas Official Update
Publication Date: 10/06/2015

Ipas provided the following updates on progress in achieving its FP2020 commitments:

Training new cadres of health care workers—4,000 per year—to provide a wider range of sexual and reproductive health services, including post-abortion family planning services: Ipas-supported programs, in partnership with national/regional/state health systems in 17 countries, train clinical providers in safe abortion care and postabortion care, postabortion contraception, including long-acting reversible contraception, and referral for other sexual and reproductive health services.   Depending on country strategies, training may be integrated with other SRH training, such as Emergency Obstetric and Newborn Care, gender-based violence, or postpartum family planning.  

Number of providers clinically trained by Ipas annually since the FP2020 commitment:

  • July 2012 – June 2013: 7,710  
  • July 2013 – June 2014: 5,825
  • July 2014 – June 2015: 7,277 (data pending validation)

Globally, approximately 45% of clinically trained providers are midlevel providers (i.e., nurse-midwives, auxiliary nurse-midwives, clinical officers), with 68% clinically trained providers in Africa being midlevel providers.  Globally, over 75% of the facilities in which clinically trained providers are working are primary level facilities, helping to bring abortion and contraceptive services closer to women in their communities.

From July 2012 – June 2013, 75% of women receiving abortion services received a contraceptive method at the time of care in health facilities to which Ipas provided support and 77% of women received a contraceptive method from July 2013 – June 2014.  Contraceptive service data from July 2014 to June 2015 is currently being validated.

In addition to building the capacity of health systems to train providers and ensure women receive postabortion contraception, in select countries, Ipas-supported programs also train clinical providers to provide contraception for all women needing services in Ipas-supported facilities and/or to provide postpartum contraception.  For example, in Ethiopia, beyond women who receive postabortion contraception, an additional 500,000 women a year receive contraceptive services through an Ipas-supported project.

Supporting research on post-abortion family planning service delivery: Ipas staff conducted extensive research, monitoring and evaluation of post-abortion family planning (PAFP) service delivery in nine countries in Africa and Asia. Completed and ongoing research in this area includes factors that affect acceptance and continuation of long-acting reversible contraceptives (LARC) post-abortion, operations research on interventions to improve PAFP and evaluations of innovative models to improve PAFP using mobile health (mHealth).  Completed and ongoing research is in Ethiopia, Ghana, Kenya, Nigeria, Uganda, Cambodia, Bangladesh, India and Nepal.  All of Ipas’ research studies are listed below.  Some studies utilize Ipas monitoring and evaluation data to better understand women’s experiences with PAFP while other research studies utilize data collected (usually prospectively) to answer specific research and evaluation questions.  Please contact the study authors for additional information.

Global

  • What factors contribute to contraceptive uptake among young women seeking abortion care in health facilities in Africa and Asia? (Authors:  Janie Benson, Kathryn Andersen, Dalia Brahmi, Risa Griffin, Joan Healy, Alice Mark)

Africa

  • Contraceptive method mix in post-abortion family planning (PAFP): Opportunities to address women with unmet need for long-acting reversible contraception (LARC) (Ethiopia) (Authors:  Melaku Samuel, Tewodros Tolossa, Ashenafi Alemayehu)
  • An examination of the characteristics and modern method acceptance of post abortion clients in Ethiopia in 2014 (Authors:  Tamara Fetters, Yohannes Dibaba, Hailemichael Gebreselassie)
  • Post-abortion contraceptive uptake and continuation among abortion clients in primary, secondary and tertiary facilities in Ghana.  (Authors:  Samuel K. Antobam and Heather M. Marlow)
  • Stigma’s impact on post abortion contraceptive uptake: Women’s experiences from high and low incidence of unsafe abortion in Kenya (Author:  Erick Yegon)
  • Evaluation of intrauterine device and implant provision by Ipas-trained providers and their clients in Nigeria (Authors:  Kristen Shellenberg, Sikiratu Kailani, Nkiruku Okwesa, Alice Mark, Amy Coughlin, Risa Griffin)
  • Increasing access to post abortion family planning among women in Eastern Uganda (Author:  Erick Yegon)

Asia

  • Determinants of contraceptive acceptance among Cambodian abortion patients (Authors:  Janna McDougall, Tamara Fetters, Kathryn Andersen Clark, and Tung Rathavy)
  • Predictors of modern contraceptive use four months post-abortion: Findings from a prospective study of uterine evacuation clients in Bangladesh (Authors:  Erin Pearson, Kamal Biswas, Rezwana Chowdhury, Kathryn Andersen, Sharmin Sultana, SM Shahidullah, Michele Decker)
  • Ongoing:  mHealth feasibility study to promote PAFP use (Bangladesh) Findings: Using mHealth is feasible among post-abortion clients.  Need to look into options for low literacy populations, and linking with call center to discuss/receive personalized information.
  • Ongoing:  Using mHealth to support PAFP use: A randomized controlled trial (Bangladesh) Findings: Interactive voice response system preferred by women (this is what is currently being developed), need to focus on information on method women selected so that they see the messages as relevant, identified key barriers to long-acting methods (mainly myths, fear of side effects/infertility, fears about not being able to get LARCs removed)
  • Post-training mentoring support to influence postabortion contraceptive uptake: A critical analysis of 402,096 women who received abortion services in six major states of India (Authors:  Sushanta Kumar Banerjee, Sumit Gulati, Kathryn Andersen, Avindra Mandwal)
  • Lessons learned from the postabortion contraceptive improvement model in Rautahat district of Nepal (Authors:  Indira Basnett, Parash Prasad Phuyal, Mukta Shah, Om Narayan Jha, Erin Pearson)
  • Association between postabortion contraceptive acceptance and sociodemographic, facility and procedure characteristics: Analysis of hospital-based data in Nepal (Authors:  Swadesh Gurung, Deeb Shrestha Dangol, Indira Basnett)

 Advocating for improved medical service delivery protocols: From 2012 to July 2015, Ipas has contributed to 9 national or state standards, guidelines, protocols or national training curricula that include service delivery protocols, incorporating guidance represented in the WHO Safe abortion: technical and policy guidance for health systems, Second edition (2012) and the WHO Clinical practice handbook for Safe abortion.  This includes updated guidance on provision of hormonal contraception at the time of administration of the first pill of a medical abortion regimen.  Most of these national guidance documents include provision of contraceptive information and services at all levels of the health system including community level. Ipas has widely disseminated over 4,000 copies of the WHO Safe Abortion guidance to policymakers, program planners and health care providers in addition to supporting regional dissemination meetings of both documents.  Additionally, Ipas annually updates evidence-based guidance on abortion care and postabortion care, including postabortion contraception, through its Clinical Updates in Reproductive Health.

Promoting increased participation of women and other stakeholders in health policy and decision making: Ipas promotes increased participation of women and other stakeholders, including youth, in a wide range of our initiatives including policy and decision making. Some country-level examples include:

  • Pakistan:  With Ipas’s advocacy and support, the Sindh Government is adopting the consultative policy model of the Punjab Reproductive Health Technologies Assessment Committee (PHRTAC) and will review policies such as RH commodities to be added to the essential drugs list, provider authorizations for certain procedures, and other RH/FP issues.
  • Malawi:  Ipas Malawi serves as Secretariat for the Coalition for the Prevention of Unsafe Abortion (COPUA) through which is has facilitated activities that bring non-traditional voices into the policymaking arena, including young health professions and young people in general, traditional leaders, CBOs, etc.  COPUA engages with parliamentarians and government bodies to highlight and share the perspectives offered by these community stakeholders and will continue to work to link policymakers directly with these public advocates.
  • Nigeria:  Ipas worked with partner NGO Women Aid Collective (WACOL) to conduct a Mock Tribunal on sexual violence that involved the participation of nine direct survivors and two family members of victims of sexual violence and provided an interface between Lawmakers & victims of SGBV and increased the demand for a law that allows comprehensive medical and psychological treatment for victims of rape. The Violence Against Persons Prohibition Act was signed into law in June 2015.
  • Nigeria:  Ipas Nigeria sensitized and built the capacity of several faith-based organizations, including the Federation for Muslim Women Association of Nigeria (FOMWAN), Catholic Women Organization (CWO), Evangelical Church Win All (ECWA), and Young Women Christian Association (YWCA). The nature of this engagement included sensitizing and mobilizing these (and other) faith based groups and professional organizations to support the Violence Against Persons Prohibition bill during its Public Hearing
  • Nigeria:  Ipas Nigeria supported the National President of Medical Women Association of Nigeria to attend meetings on the abducted Girls in Chibok and Borno State Chapter to develop plans to work with Internally Displaced Persons (IDP) and increase access to reproductive health services.
  • Sierra Leone:  Ipas partnered with a number of women’s groups to increase debate about policy change related to comprehensive abortion care, including postabortion family planning.  Examples include Women in the Media, which engaged the public through text messaging and phone-in programs to gather public input about the need and process.  Women Response to Ebola in Sierra Leone conducted an assessment with Ipas support of the impact of Ebola on women and girls, looking at access to abortion and family planning services, among other issues.   At more of a community and institutional policy and practice level, Ipas Sierra Leone brought together community leaders involved in running community health facilities with young people from their communities who joined the facilities’ quality improvement team to bring a youth perspective to service improvements.
  • Zambia:  Ipas Zambia in collaboration with the Zambian Parliament and the Zambia All Party Parliamentary Group on Population and Development (ZAPPD) held a Youth Parliament which brought together Youth Parliamentarians from all the provinces of the country. The Youth Parliamentarians debated comprehensive abortion care, including postabortion family planning, and then urged the GOZ to scale up interventions to address unsafe abortion, and developed resolutions for further debate by the main Parliament. The resolutions were presented to the ZAPPD and the Minister of Youth and Sport who will lead further debate on these resolutions. These resolutions will also form part of the discussion and development of a communique and work plan with the Members of Parliament in the upcoming Youth-Policy Maker Dialogue. 
  • Other: In several countries, we have advocated for removal of barriers to safe abortion care, which includes post-abortion family planning, from laws and policies. Ipas has developed resources for lawyers and policy-makers on removing policy and regulatory barriers to abortion care, specifically addressing adolescents, privacy and confidentiality and who can provide abortion. We launched an online storehouse for lawyers and policymakers on removing legal and policy barriers to abortion.

Increasing support for SRHR, including family planning and the prevention of unsafe abortion, among religious and community leaders: We commissioned a report incorporating a literature review and recommendations on the experiences of Ipas and other organizations in engaging faith-based organizations (FBOs) and religious leaders on sexual and reproductive health issues, particularly abortion. Results from the review and report will inform planning for meetings and country-level work in Asia and Africa that will take place in 2016 and beyond.

Ipas is planning to convene a side meeting on faith, stigma, and abortion at the forthcoming 2015 International Conference on Family Planning. This will include a panel and media event.

In Bangladesh, as part of our community outreach activities, we are engaging with FBLs and other community leaders through stakeholder meetings and community dialogue meetings (CDMs) in two rural districts. In this coming year, Ipas Bangladesh will scale up and intensify local-level FBLs activities through conducting a situation assessment, holding a central level stakeholder meeting of leading Islamic activists and scholars, and engaging local FBLs at girls’ religious schools (private and public madrasas). 

We are planning to hold a regional FBO knowledge sharing meeting in Nairobi in February 2016 of staff from Kenya, Malawi, Ghana, Ethiopia, Nigeria, Sierra Leone, and Zambia to identify current and promising practices for working with faith-based leaders, opportunities for future work, and action planning for individual country teams.

Committing US $10 million per year towards family planning-focused work: This annual amount, recognizing family planning as integral across Ipas programs under our current Strategic Plan, is a good estimate of the annual commitment in our fiscal years 2013 and 2014.  In our immediate past and current fiscal years, we consider that the commitment has increased to be in the range of $12 million annually, based on our continued efforts, expanded budget, and the addition of significant family planning focused projects in Ethiopia, India, and Bangladesh.

Supporting the availability of affordable contraceptives and other products through WomanCare Global (WCG) International: Ipas continues to partner with WCG to make safe, high quality MVA instruments available in over 100 countries around the world.  Ipas and WCG work closely together on a range of issues, from manufacturing and ISO certification, to product registration and distribution.  We maintain a priority on ensuring access to the instruments in low resource settings and actively seek partnerships with donors, governments, distributors, multi-bilateral agencies and others to support and expand these activities.  In addition to ensuring global access to MVA, WCG is currently partnering with the International Contraceptive Access (ICA) Foundation to provide long-acting intrauterine systems (IUS) to trained providers in Kenya, South Africa and Zambia.  

In addition to the collaboration with WCG, Ipas provides technical assistance to health systems to improve the availability of the full-range of contraceptive methods.  Where needed, Ipas provides initial seed stock of contraceptive methods in procedure rooms in Ipas-supported facilities where abortion and postabortion care services are provided and stop-gap supplies where there are method stockouts, to ensure that women are able to receive services until facility supply and distribution channels resolve the issue.  Typically in procedure areas that provide abortion and postabortion care, there are short-acting contraceptive methods available but more limited availability of long-acting methods.   Ipas-supported health facilities under specific programmatic work in 8 countries from July 2012 to December 2013, which included improving the contraceptive method mix, showed an overall increase in availability of IUDs in facilities from 83% to 96% and an increase in implant availability in facilities from 68% to 86%.

Removing policy and regulatory barriers which limit access to family planning and increase recourse to unsafe abortion

  • Globally: Ipas engaged in advocacy at UN global level processes such as ICPD beyond 2014 and Beijing+20 and more recently in post 2015 debates on SDGs to make sure governments recognize that SRHR, including family planning (FP) and safe abortion, is a central component in the global sustainable development agenda.
  • Myanmar:  The basic Health Staff Manual for midlevel providers has been updated with technical content from Ipas on family planning counseling/referral. These documents now standardize the training and provision of services for PAC in the country.
  • Pakistan:  Development of IEC materials for young married couples on post-abortion care-family planning (PAC-FP) includes a poster for awareness regarding family planning and safe Uterine Evacuation/PAC, a desk flip chart for providers, and a take-home hand out/brochure for women.
  • Ethiopia:  New national standards and guidelines for safe abortion care were finalized and issued by government. The new standards authorize health extension workers (HEW) to offer family planning/abortion care education and referrals, which will extend these services to more rural areas. As part of the National FP Technical Working Group, a national platform for continued advocacy for contraceptive commodity security and increased local government funding for family planning supplies and services, Ipas is working to ensure more coordinated planning and increased availability of IUCD and implants at Ipas-supported facilities.
  • Ghana:  Ipas Ghana is providing guidance and recommendations to the ongoing review of the National Reproductive Health Policy to ensure greater access to safe abortion and contraceptive services.
  • Zambia: Ipas was part of advocacy by reproductive health partners with the Ministry of Health that has resulted in an allocation of $11 million for family planning commodities in the GOZ fiscal year 2015.

Increasing the frequency and improving the quality and effectiveness of education and behavior change programs on family planning

Ipas has been systematically strengthening the capacity of our staff and partners to improve social and behavior change communication (SBCC) programs related to abortion and contraception.

  • In late 2012, Ipas dedicated a full-time senior staff position to SBCC to provide a methodological platform upon which Ipas programming can come together in a more holistic and strategic manner in this area. We subsequently held a mini-learning lab pilot in Bangladesh in 2013 followed by more robust learning labs: one for staff and partners in Latin America (Mexico, Bolivia, Nicaragua), one for staff and partners from our West and South Africa programs (Ghana, Nigeria, South Africa); in 2014 one for Nepal and Bangladesh staff, one in Uganda that included a focus on stigma reduction; in 2015 one for India, Myanmar and new colleagues from Nepal, and one for East Africa programs (Ethiopia, Kenya, Uganda, Malawi, and Zambia). Second generation learning labs were held in 2014 in Nigeria and Bangladesh which were tailored to community partners.
  • In learning labs, Ipas meaningfully integrates a human rights-based approach with the commitment to building capacity of staff and partners to get women quality information in a way that is framed from a human rights lens. The process of engagement in Ipas’ SBCC work is in and of itself an opportunity for transforming power dynamics between the seekers of services, the providers and intermediaries. Ipas emphasizes the need to give comprehensive contraception information based on needs of individual women and the range of needs women have that can be met by the method they choose.
  • Ipas also launched an internal knowledge sharing platform on SBCC which is accessible to all of Ipas staff globally which includes SBCC literature, guidance and tools. Efforts are also underway to document and evaluate select interventions being implemented in various Ipas countries.

Integrating advocacy, quality improvement and effectiveness efforts with other sexual and reproductive health and rights programs

In every country where Ipas have presence, the organization works with ministries of health and public sector clinical facilities at every level – tertiary, secondary, and primary.  In most cases, abortion and contraception are provided alongside other maternal and child health services.  In addition, in community-based work, Ipas and partners are implementing activities in a broader SRHR framework.