The long-lasting impact of the Self-Management of Abortion Project

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Following the inclusion of self-managed abortion in the updated 2022 WHO abortion guidelines, FIGO has been proud to partner with the Zambia Association of Gynaecologists & Obstetricians (ZAGO) over the past year to identify and remove barriers to the provision of self-management abortion in the country. As the Self-Management of Abortion project draws to a close, we take a moment to celebrate key achievements and reflect on its legacy.  

Widening access to safe quality abortion care  

Self-management of abortion (SMA) is a safe and affordable addition to existing abortion services provided within health facilities. It helps to provide care in a way that meets the needs of many women and girls who prefer to use medication abortion outside of a facility, increasing their privacy and autonomy. 
 
FIGO’s Self-Management of Abortion project worked closely with 30 healthcare facilities across 10 districts in Zambia to increase availability of self-managed medical abortion services in the country, thus improving access to safe, timely, affordable and person-centred abortion care for women and girls. A key part of the project focused on promoting evidence-based practices and training healthcare professionals to ensure women and girls receive the best possible care and treatment. As a result of the project, the final evaluation showed that 83.6% of providers surveyed had been trained to support women and girls access to self-manage medical abortion care (up from 63.4% at the start of the project) and 98.5% always reference existing guidelines, protocols, and job aids on SMA (up from 87.5%).    

The project also engaged and trained community health volunteers and youth associations in knowledge-sharing and capacity building activities. This important work enabled them to disseminate accurate information and sensitisation messages within their communities, helping to create demand for SMA and empowering women to make informed decisions about their own bodies and reproductive health. Our final evaluation showed a massive increase of availability of trained community health volunteers that provide health education on self-managed abortion care services from 25.3% to 93.1% through the course of the project.  

Changing minds, shifting attitudes 

The Self-Management of Abortion project developed and implemented a comprehensive communications and advocacy strategy to help reduce stigma and discrimination associated with abortion. Its aim was to promote a culture of openness and acceptance to create an enabling environment for women and girls to seek safe abortion care without fear. 

 Some of the key tactics used in the project included: 

  • Disseminating accurate and evidence-based information on sexual and reproductive health, including SMA, through various channels including workshops, conferences, newsletters, websites, social media and mainstream media. The final evaluation from the project showed that 96.7% of health care workers now provide details to women on how to get more information on SMA and/or dealing with complications (up from 84% before project activities). Data showed that over the course of the project 91.5% of medical abortions were self-managed.  
  • Raising awareness about the legal framework on abortion in Zambia to open the minds of the people who did not know that abortion is legal in the country, and that self-managed abortion is an option. This was targeted not only at the community, but also health workers themselves, who showed an increase in awareness of the Zambian guidelines on SMA from 70.7% to 93.8% during the project.  
  • Delivering training to pharmacists and supply chain managers to improve availability of medical abortion drugs in all facilities that provide the service. The initial training did help to improve availability of SMA combipacks from 10.7% to 22% during the project, but more work is needed in this area to improve the availability further.     
  • Engaging with local community leaders, including religious leaders and traditional healers, to promote understanding of and support for safe abortion services, including through self-management. 
  • Providing onsite mentorship on SMA to comprehensive abortion care providers, community health volunteers and youth organisations, resulting in a motivated and more competent personnel to roll out self-managed abortion as an option to women and girls. 

Towards a safer future for women and girls 

The future for increasing access to safe abortion services in Zambia looks promising. Although the project has ended, ZAGO will ensure that their sensitisation and community engagement efforts go beyond the project lifespan, facilitating scalability and sustainability of positive outcomes. 

ZAGO will continue to:   

  • Seize every opportunity to provide training and build skills of healthcare providers, particularly in rural areas, to ensure that they are better equipped to provide safe and comprehensive abortion services, including self-managed abortion. 
  • Sensitise the public about the importance of safe and legal abortion and address common misconceptions and myths using any available channel including mainstream media, websites, newsletters, social media and public events. 
  • Strengthen collaborations with their growing pool of partners - such as women’s rights organisations, reproductive health organisations and government agencies - leveraging efforts and resources to advocate with one strong voice for increased access to sexual reproductive healthcare and safe abortion services.  
  • Champion access to and use of contraceptives, including long-acting reversible contraception, to reduce the need for abortion. 
  • Collaborate with the Ministry of Health to integrate self-managed medical abortion care with existing reproductive health services, such as maternal health services, and ensure that women and girls have access to comprehensive care.  
  • Gather evidence on the effectiveness of self-management of abortion services in the country and strengthen monitoring and evaluation mechanisms to inform policy and program development.  

As we celebrate the far-reaching impact of FIGO’s Self-Management of Abortion project, we are delighted to share some excellent news. ZAGO has recently succeeded in securing funding for a new two-year project to improve access to and use of sexual reproductive health and rights services by adolescents and young people in Zambia. This is another important step in the journey to build a better, safer future for women and girls worldwide. 

If you would like any more information on the Self-Management of Abortion project, or would like to discuss working with FIGO on delivering a similar project, please contact [email protected]