International Safe Abortion Day 2022: Persevering Amid Uncertain Times

By Amy Agarwal, Principal Writer and Editor, and Preethika Sundararaj, Consultant, Sexual and Reproductive Health and Rights

The June 2022 US Supreme Court decision to deny women and gender minorities the constitutional right to access safe and legal abortion—nearly 50 years after the landmark Roe v Wade decision in 1973—heralds uncertainty for people in the US and beyond. While we know that the US is not alone in facing new and dangerous abortion restrictions, we also recognize that more than 35 countries have adopted more liberal abortion laws in the past decade—and that gives us hope. The dedication, determination, and diligence of our colleagues and partners—and the achievements they have contributed to in several countries—also give us hope.

EngenderHealth works to expand access to comprehensive abortion care, with programs that support national advocacy and the development of standards and guidelines, offer training and capacity strengthening models, integrate service delivery, and promote community engagement. EngenderHealth also supports high-quality abortion care in humanitarian settings and is a proud steering committee member for the Inter-Agency Working Group on Reproductive Health in Crises. In our last program year (July 2021 to June 2022), our projects supported more than 33,000 individuals in receiving high-quality, comprehensive abortion care.

EngenderHealth has been part of the safe abortion discourse and action for almost 30 years. In 1994, at the groundbreaking International Conference on Population and Development, member countries of the United Nations agreed that no woman should die from complications from unsafe abortion. That same year, EngenderHealth joined other organizations in creating a postabortion care consortium and partnered on a project that introduced safe abortion care in Vietnam. In the decades since, we have designed and implemented programs in Ethiopia and Tanzania to ensure the availability, accessibility, and quality of safe abortion care. We have also supported comprehensive abortion care programs in several countries in West and Central Africa; this includes activities in Benin since 2019 and in Burkina Faso and Côte d’Ivoire since 2014. These programs have and continue to support capacity strengthening of local partners, increase awareness at the community level, improve services at the facility level, and strengthen laws and policies at the national level.

As stated by our President and CEO Traci L. Baird, “Our commitment to quality abortion care, to comprehensive abortion care, is unchanged. This is an important part of EngenderHealth’s portfolio—it has been for almost 30 years. We should be very proud of the work that we do. It is truly lifesaving work to ensure people can control their bodies and have their rights fulfilled.” Uncertain times call for diverse, collective action that targets the numerous compounding barriers to quality abortion care. At EngenderHealth, we engage and collaborate with stakeholders using a variety of approaches to increase access to safe abortion care and support communities in demanding the right to safe, legal, and accessible abortion.

Countering Misinformation

Recognizing that a key barrier to demand and uptake is a lack of information and/or pervasive misinformation, many of our programs seek to raise awareness. In Ethiopia, for example, we have supported community volunteers to facilitate community dialogues and home visits to raise awareness about sexual and reproductive health and rights (SRHR) and to share information about the availability of healthcare services, including abortion care. In Benin, we are collaborating with local youth-led organizations to disseminate key abortion-related messages, including through the #TraversonLaLigne (Let’s Cross the Line) social media campaign, which shared information about the abortion in the region, as well as the “My Choice” campaign, which promoted access to safe abortion care and shared information about a hotline setup to refer young people to available services. We are similarly working with youth-led organizations in Côte d’Ivoire. Together, we have organized radio shows on a range of SRHR topics, including abortion; supported the #TraversonLaLigne campaign; trained young feminist bloggers and influencers as part of the #LesFemmesVeluent (#WomenWant) digital campaign, which sought to counter SRHR misinformation with facts related to contraception, abortion, and more; and partnered with a local journalist organization to reinvigorate a website hosting information about contraceptive and abortion care.

Enhancing Service Delivery

To ensure high-quality services are available to match demand, our programs focus on strengthening providers’ skills, transforming providers’ attitudes, and equipping facilities with critical abortion care commodities. In the 1990s, EngenderHealth launched and shared our COPE© model (COPE stands for Client-Oriented, Provider-Efficient), which we later adapted for comprehensive abortion care (COPE for CAC©) to support service quality improvements in low-resource settings. Today, we continue to emphasize client-centered services using customized, contextually relevant approaches designed to strengthen health systems. In Ethiopia, we have facilitated abortion orientation and training sessions for providers and facility staff; helped address commodity shortages; and advocated for integrating abortion care within family planning, maternal and child health, and HIV units to increase the availability of high-quality, comprehensive abortion care. We have also worked to reach internally displaced persons in the Somali region through community-led awareness raising, demand creation, and referral linkages for SRHR services, including safe abortion care. In Benin, we are building upon the 2021 amendment of the 2003 Sexual and Reproductive Health Law, by developing training materials and introducing abortion values clarification and attitude transformation sessions for healthcare providers to increase access to safe abortion care. In Burkina Faso, we have facilitated clinical trainings and provided essential medical equipment to increase the availability of safe abortion care, as part of the SRHR component of the Ministry of Health’s universal health coverage program. In Côte d’Ivoire, we are co-facilitating abortion values clarification and attitude transformation sessions for practicing midwives.

Advocating for a Supportive Enabling Environment

Strong health systems are critical for sustaining safe abortion care and health system strengthening is one of EngenderHealth’s core strategic approaches for supporting SRHR and ensuring people can realize their rights. Through regional programming, we have worked in Benin, Burkina Faso, and Côte d’Ivoire to improve the policy environment for comprehensive abortion care, building on countries’ commitment to the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (also known as the Maputo Protocol). In Burkina Faso, we have conducted abortion values clarification exercises with decision-makers as part of advocacy efforts.  

Our Next Frontier for Quality Abortion Care

On International Safe Abortion Day 2022, we can reflect upon our long history and global impact in the safe abortion space, but we also must look ahead. As the priorities, challenges, and potential opportunities around the world are ever-evolving, along with the policy and legal environments surrounding abortion, we must adjust our approaches as we chart our path forward.

In these uncertain times, we commit to expanding our support in our current program countries as well as new countries, working closely with local stakeholders and other partners. We envision reaching this goal by deepening and expanding our partnerships and investments, implementing evidence-based solutions and cutting-edge clinical services in line with the 2022 WHO Abortion Care Guideline, furthering our localization efforts, and working with partners to tackle the growing influence and effects of anti-choice ideologies and movements.

EngenderHealth stands in solidarity with and is eager to continue learning from and supporting other organizations and individuals as we persevere in our advocacy for SRHR, including the right to quality abortion care. We are disheartened but refuse to be discouraged by regressive laws around the world. Instead, we are even more committed and look forward to strengthening our partnerships, expanding our efforts, and raising our collective voices to ensure all people are able to exercise their SRHR—including through accessing quality abortion care.