How did global health adapt Safe Abortion and Post-Abortion Care to COVID-19? This map tells all.

Innovating to Ensure Access to Sexual and Reproductive Health and Rights During the Pandemic

By Dr. Eva Lathrop, Global Medical Director, PSI and Lola Flomen, Technical Learning Consultant, PSI

Meaningful health impact necessitates collaboration. And when it comes to addressing barriers to safe abortion, a multi-sectoral approach that brings together the expertise of many delivers stronger outcomes for all.

Since the start of the COVID-19 pandemic, PSI and other organizations have worked alongside frontline clinical providers, government partners, pharmacies, drug shops, and clients themselves to adapt safe abortion and post-abortion care (PAC) to the realities of life in a pandemic.

Collectively, we’ve innovated — from virtual trainings to telemedicine — to maintain and even advance quality legal abortion and PAC access within and beyond clinic walls. Innovative solutions that place more power and choice in peoples’ hands are key to achieving greater health outcomes.

What adaptations did PSI and other frontline implementers apply to safeguard legal abortion and PAC access during the pandemic? How might learnings support implementers in a post-COVID-19 world? And which innovations should we integrate into routine safe abortion and PAC programming going forward?

The answers are on the map.

Safe Abortion and PAC Programming Adapted for COVID-19

To avert unsafe abortion and its preventable morbidities and mortalities during the pandemic, the Preventing Unsafe Abortion Partners’ Group (PUA Group), comprised of several sexual and reproductive health (SRH) organizations and multilateral agencies, realized that program adaptations to safe abortion and PAC programming were a common theme. Thus, PUA Group developed a story map to digitally capture innovations and learnings across multiple implementers.

This interactive map spotlights critical program adaptations applied by six implementing organizations to ensure access and quality of care during the global pandemic. The map is intended to be a ‘living’ resource for peer-to-peer learning and it tells the stories of innovation and learning, and hints at the possibility of permanent advancements in safe abortion and PAC delivery. And the map enables other implementers to share their adaptations too.

Examples of some of the adaptations captured on the map are shared below.

Sudan Family Planning Association (SFPA): Sexual and Reproductive Health Call Center

To mitigate the devastating impacts of the lockdown and limited access to clinics in Sudan, the Sudan Family Planning Association (SFPA) established a call center as an alternative solution to meet clients’ SRH and PAC needs during the pandemic.

Impact: The call center received 89,000 calls and facilitated 9,900 services, linked clients to providers for 2,600 prescriptions, and aided 3,400 provider follow-up visits. The call center also reached youth (55 percent of client callers were under the age of 24) and male clients (29 percent of callers).

Learnings: The call center increased engagement among key sexual and reproductive health and rights (SRHR) information provision populations, including young girls and male partners. The call center also reached people living with HIV and provided customized SRHR counseling for their concerns. SFPA intends to continue their partnership with telecommunication companies to expand their SMS push messaging approach to direct more youth to the call center.

MSI Reproductive Choices: Telemedicine for Home-Based Safe Abortion Care in South Africa

In South Africa, MSI Reproductive Choices launched telemedicine to protect medical abortion access and expand safe services to rural communities during the COVID-19 pandemic.

Impact: Telemedicine was in high demand and demonstrated a low complication rate: 6,800 clients served as of March 2021. Telemedicine services proved to be affordable and equitable; they were less expensive by $50 and reached eight out of nine provinces, expanding care to previously underserved communities.

Learnings: Telemedicine can decrease average wait times and are just as safe, effective, and acceptable as in-facility care. However, telemedicine is not a panacea. To protect choice, in-person care must still be available for those who would prefer it or need surgical abortions.

Pathfinder: Post-Abortion Virtual Follow-up System in Mozambique

The COVID-19 lockdown in Mozambique created a multitude of challenges to SRH and rights access, including commodity shortages and client concerns about contracting COVID-19 when visiting a health facility. To better serve the post-abortion needs of their clients, Pathfinder launched a provider phone call follow-up system for clients to use when completing a medication abortion regimen. Via phone, providers supported clients to assess the presence of any danger signs and confirm completion of the abortion.

Impact: The virtual follow-up reduces pressure at the clinic service delivery point and provides the opportunity to reinforce post abortion contraception messaging. Moreover, the follow-up system contributed to a decrease in abortion-related complications registered at health facilities, even after the COVID-19 lockdown.

Learnings: Service providers are overwhelmed with the number of calls received from clients. Pathfinder is advocating with provincial and district authorities to hire more medical professionals to staff the phone system.

PSI: Virtual Support to Maintain Quality Safe Abortion Care in Benin

To curb the impact of limited face-to-face provider interactions and lack of physical access to health facilities, PSI Benin switched to virtual platforms (WhatsApp, SMS, and Microsoft Teams) to carry out medical detailing to support providers and pharmacists in their delivery of legal safe abortion and PAC services and information.

Impact: 300+ service providers and pharmacists were guided daily on safe and legal abortion, PAC, as well as medication abortion and contraceptive product information (e.g., proper use, posology). The virtual adaption translated to more than 10 times the number of medical detailing activities in the midst of the epidemic (compared to the same period pre-COVID 19).

Learnings: The majority of medical detailing agents and service providers found it difficult to get stable connectivity to access the Teams and WhatsApp platforms. PSI Benin is in the processes of securing financial resources to build the digital capacity of service providers and medical detailers.

The PUA Group will use the online story map as an advocacy tool and hopes to secure follow-on funding to implement and evaluate COVID-19 adaptations for safe abortion and PAC to advance quality care that clients deserve around the globe.

COVID-19 Safe Abortion Response Map

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