From guidelines to implementation: increasing access to quality abortion care

International non-governmental organizations (INGOs) play a significant role in the global movement to address the many barriers to quality abortion care. In 2022, the World Health Organization (WHO) updated its Abortion care guideline significantly broadening its scope to include evidence-based recommendations and best practices in legal, regulatory, policy and service-delivery aspects of abortion care. INGOs have been instrumental in translating these recommendations into action.

These stories highlight how three INGOs have implemented diverse programmes to improve access to abortion care that is safe, non-discriminatory and respectful of individuals' rights. Each story offers a unique view of how evidence-based recommendations have been applied and adapted to local contexts. The narratives highlight lessons learned, especially responding constructively to challenges. By illustrating the practical application of the WHO Abortion care guideline in real-world settings, these stories offer valuable insights for others aiming to implement similar efforts.

1. Expanding access to quality uterine evacuation technologies in Central America

Dr Patricio Sanhueza Smith of DKT LATAM NORTE training doctors in Guatemala City on how to use mifepristone in conjunction with misoprostol for miscarriage management. © DKT LATAM NORTE

DKT International is a social marketing entity that plays an important role worldwide in preventing unsafe abortions and enabling access to comprehensive abortion care. Their regional office, DKT Latin America North (DKT LATAM NORTE) has successfully introduced safe uterine evacuation products to markets in Central America. Their implementation strategy focused on the life-saving potential of expanding access to quality uterine evacuation technologies. DKT LATAM NORTE's applications to register WHO-prequalified mifepristone, misoprostol and manual vacuum aspiration emphasized their potential to reduce maternal mortality.

DKT LATAM NORTE's successes to date include the first-ever instances of mifepristone being registered and legally available in Guatemala and Nicaragua. In addition, a new misoprostol brand has been registered in the Dominican Republic, El Salvador, Guatemala, Honduras and Nicaragua.

A key implementation lesson learned was that providers who have worked mainly underground had uneven knowledge and competencies around the newly available technologies. DKT LATAM NORTE's training for these providers incorporated WHO recommendations, which lent legitimacy and credibility and ensured alignment with globally recognized, evidence-based practices.

2. Accelerating access to self-managed abortion in Zambia

Group photo during sensitization workshop on self-managed abortion for community health volunteers in Chilanga district, Lusaka province, Zambia. © FIGO

The International Federation of Gynaecology and Obstetrics (FIGO) is working with national professional societies of obstetrics and gynaecology to improve access to self-managed abortion. Despite legal provisions for abortion in Zambia, rates of unsafe abortion remain high. In partnership with the Zambia Association of Gynaecologists and Obstetricians (ZAGO), FIGO aimed to fast-track the uptake of self-managed abortion by identifying and addressing barriers. The year-long project leveraged ZAGO's well-established relationships with stakeholders countrywide, including the Ministry of Health, community health volunteers and youth associations.

Baseline and endline data were collected from health providers and associated volunteers at 30 health facilities in three high-priority provinces. Bespoke interventions were devised to address the barriers related to knowledge, skills and resources revealed by the baseline data. Using this approach, the project achieved significant progress in a short period of time, including robust increases in health providers' awareness and application of national guidelines on self-managed abortion. Among community health volunteers, the proportion trained to provide health education on self-managed abortion increased from 25% to 93%.

3. Ensuring access to surgical abortion where legally permissible globally

MSI Ghana sexual and reporductive health care provider in Kumasi, Ghana. © MSI

MSI Reproductive Choices (MSI) is committed to providing a full range of abortion services across its facilities. As demonstrated by the story from Zambia, the availability of medical abortion is rapidly expanding with growing investment. However, surgical abortion needs to remain an option, not only for post-abortion and second-trimester care, but also for when it is a woman's preference. MSI's global strategy focuses on strengthening the recruitment, training and retention of abortion providers. This approach includes screening to recruit only pro-choice providers and comprehensive professional development, including workshops to help health workers examine their personal beliefs about abortion. MSI also facilitates workshops and private instant messaging groups for providers offering second-trimester services. These peer-supported spaces provide a safe environment to discuss challenges and emotions.

In addition to MSI's own staff, more than 5000 franchised health providers across Africa have received training, which includes legal literacy and communication guides to help build providers' confidence. The organization's internal clinical guidelines that underpin training have been updated to align with WHO recommendations.

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