1.1.12 Abortion: Before and After




Wednesday, November 13, 2013


Eliud Lelerai, International Planned Parenthood Federation
Christopher Agweyu, IPPF Africa Region
Yilma Melkamu, IPPFARO

Title of Abstract/ Titre:

People change: the role of value clarification in expanding access to abortion and family planning services in the Africa Region

Abstract Type / Type de résumé:

Program/Best Practices Abstract

Topic / Sujet:

Family planning and abortion

Significance/background / Importance/contexte:

Despite advances in medical technology unsafe abortion remains to be one of the leading causes of maternal mortality.  Globally about 22 million unsafe abortions are performed resulting in 47,000 deaths. Additionally, 5 million women suffer from immediate and long term disabilities. These complications are preventable and treatable through improved access to contraceptives, safe abortion services, and timely and proper treatment of complications. Majority of the deaths and complications occur in developing countries where access to services is limited because of restrictive laws, poor quality of services and misconceptions and stigma. In countries where laws are liberal, access is largely influenced by commitment and values of decision makers, program managers and service providers. Values and attitudes can be shaped based on misconceptions or insufficient facts. This paper discusses how IPPF used Value Clarification and Attitude Transformation (VCAT) exercise to expand access to Comprehensive Abortion Care (CAC) and Family Planning (FP) Services through its member associations in Africa Region.

Program intervention/activity tested:

Expanding access to CAC is one of the main pillars of IPPF programs across the world. IPPF member associations, together with partners, advocate for policy reform and work to expand access to safe abortion services and postabortion family planning. Member association clinics provide services but hesitations and resistance are observed in some facilities because of misconceptions and values that are based on assumptions informed by incorrect evidences. These can be at top decision making level (governance and management) or at service delivery level. In 2009, IPPF expanded its CAC services in its five member associations in Africa namely Kenya, Ethiopia, Burkina Faso, Cameroun and Ghana. In order to bring all stakeholders at the same level of understanding and for people to make an informed decision about their perception and values regarding abortion, the program started by VCAT excercise by using the Ipas toolkit. The five member associations were providing postabortion services and there was no clear commitment to providing safe abortion services as permitted by national laws.

Methodology / Méthodologie:

IPPF is a volunteer based organization where all member associations are indigenous organizations founded many years ago by nationals who were committed to ensure peoples reproductive choices. The member associations are governed by volunteers who are also responsible for policy formulation, advocacy and resource mobilization. Member associations provide comprehensive sexual and reproductive health services through community and facility based approaches. IPPF identified VCAT as one of the key strategies to integrate CAC services in its member associations to get buy in at all levels. VCAT sessions were organized for member association volunteers (governing body, youth and other volunteers), staff (management, service providers and support staff) and IPPF partners (service providers and advocates). IPPF implemented three models of VCAT:

- Providers only: as an integral part of CAC clinical training
- Providers, management and volunteers together
- Youth alone
IPPF used the Ipas VCAT toolkit which was modified to suit IPPF values, strategic framework and structures

Results/key findings / Résultats/conclusions principales:

VCAT played an important role in integrating CAC services in IPPF member association SRH&R programs. The strategy helped to clarify roles and responsibilities of the key players which are volunteers role as key advocates, management role to create enabling environment for service delivery, providers as sensitive and supportive CAC service providers and partners as collaborators in abortion advocacy and service delivery. VCAT created opportunity to bring people together. The platform facilitated open interaction on abortion between the young and the old and between service providers and management. It enhanced volunteers and management understanding of the complexity of abortion services and helped volunteers and management to understand provider concerns. Most importantly number of women accessing safe abortion services, postabortion counseling and family planning has significantly increased especially in Burkina Faso, Ghana, Ethiopia, Cameroun and Kenya where the VCAT was introduced first.

Program implications/lessons / Implications pour le programme/leçons:

VCAT is a key tool especially Civil Society Organizations such as IPPF member associations to bring everybody on board and assist people to make an informed decision regarding their commitment about sensitive issues such as abortion. Based on the lessons from CAC, IPPF is now using VCAT to improve access to services for gender based violence and LGBTI. IPPF will share the experience of using VCAT to expand access to abortion related services including postabortion family planning services in the Africa Region. The paper will discuss the different models of VCAT, the outcomes and lessons that can be replicated.


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