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Helping Women Survive and Thrive with Family Planning and Safe Abortion Services

Working as a family planning nurse at a health center in Addis Ababa, Hamleseb was struck by the number of women and girls who came in search of abortion services. At first, she simply told them that the service was not available and sent them away. But gradually she began to reflect on their distress, and it became harder to turn her back.

“I realized that a good few of them were victims of sexual violence,” she says sadly. “They all had heartbreaking stories. For most of them, seeking an abortion was the toughest decision they had to make.”

While Hamleseb wanted to help these women, there was little she could do beyond pointing them to clinics offering abortion services. “Some of them would come back and tell me that they couldn’t afford the fee,” she recalls.

Hamleseb was also disturbed by the high incidence of repeat abortion. “I realized that repeated abortion was the result of lack of awareness, and I knew abortion could be an excellent entry point to introduce family planning.”

In March 2009, Hamleseb was among a group of health providers trained in comprehensive safe abortion care by EngenderHealth. “The training opportunity couldn’t have come to me at a better time,” she said recently. “It gave me the opportunity to assist people who needed help.”

Right from the outset, there was something extraordinary about Hamleseb’s performance: All of the clients she served left the health center with a contraceptive method, and about 80% of them opted for long-acting methods, such as the intrauterine device.

The secret to her success, Hamleseb says, “is listening, listening, and listening. If you listen to clients actively, they pour their heart out. That builds trust, setting the scene for an effective consultation. Asking the right questions is the other magic bullet.”

As Hamleseb builds rapport with her clients, she tries to gauge their knowledge and perceptions about family planning and childbearing. Based on the gaps she identifies, she provides information and advice about the family planning methods available at her health center, as well as each method’s effectiveness, advantages, and disadvantages.

She invests extra effort in counseling abortion clients on long-acting methods, given that women seeking abortion services have demonstrated a strong interest in avoiding pregnancy long term. In Hamleseb’s words, “No wonder most of my clients opt for a long-acting contraceptive. Most of them would like to delay or space birth[s] for a considerable period of time. Besides, I explain to them that any time they want, pregnancy can resume as soon as the contraceptive is discontinued.”

The main reason for Hamleseb’s success, however, is her commitment to helping people in crisis. She believes firmly that her clients deserve all the help she can give. “It is extremely hard work and sometimes frustrating, but I just keep my eyes on the mothers I save. I work and work and work. There is no shortcut. I just keep on working.”

Hamleseb is adamant about the need for more action to prevent unsafe abortion. “Unsafe abortion is still taking the lives of mothers, and we should do more to make sure that every child is wanted,” she says. “Health facilities need to allocate more resources to reduce deaths due to unsafe abortion. More needs to be done to change the attitudes of health professionals, too. Many of them do not understand the desperate situation abortion seekers are in.”

Hamleseb also reflects on the unflinching commitment demanded of people in her profession—and its unique rewards. “Our profession is a tough one, so we need to be tough to live up to our responsibilities,” she says firmly. “Let us show tenacity and courage in the face of adversity. We are saving lives and we are serving the poorest of the poor. This is a privilege. Let us be thankful and proud of the job satisfaction that our profession offers us.”

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