Access to family planning and safe abortion

Helpdesk Query:

What evidence is available for how to increase access to family planning and safe abortion services in Africa, include the need to shift from clinical/hospital based services to increased outreach to reach young people and marginalised populations. What is the evidence of how to increase access to medical abortion, self-injecting contraception and other ‘home based’ care for increasing CYP, additional users?

Summary:

A WHO systematic review looking at the evidence on sexual and reproductive health among adolescents in developing countries finds quality evidence to be lacking in many areas (WHO, 2012). The report includes the following:

  • No evidence was found on the efforts to influence laws and policies though this is recognised as important for increasing access.
  • Efforts at increasing access to contraceptives directed at community leaders is acknowledged as useful but no evidence was eligible. Attribution is particularly difficult in this area. Potential harms of community interventions are noted.
  • Some evidence was found to suggest that health service improvements can improve access. There are no harms in these areas and the panel recommends health service improvement for improving access.
  • Low quality evidence was found to suggest that over-the-counter hormonal contraception improves access. There can be problems with misinformation and lack of follow-up with this type of provision.

Evidence suggests that pills and injectable contraceptives can be safely provided at the community level by community health workers (CHWs) and through the retail sector. Provision of injectables by CHWs has been delivered to as high a standard as provision by nurses and midwives in Uganda according to one study. Technical experts have endorsed safety of the practice also. Research on the provision of injections in pharmacies suggests practices are often unsafe.

Evidence on increasing access to safe abortion includes:

  • A successful programme in Ethiopia has reduced unsafe abortion cases by deploying health extension workers to provide services. Health centres and hospitals also increased services also. The project ensured involvement of women and community leaders.
  • Efforts to increase availability of safe abortion at the University Teaching Hospital, Lusaka, Zambia was found to increase uptake.
  • A study was identified looking at the feasibility of introducing medication abortion in KwaZulu Natal, South Africa.
  • Provision of safe abortion services was successfully increased with the ‘Reducing Maternal Mortality and Morbidity’ (R3M) in Ghana.

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