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Table 1 Examples of SA activities by country

From: Evaluating implementation of the World Health Organization’s Strategic Approach to strengthening sexual and reproductive health policies and programs to address unintended pregnancy and unsafe abortion

Country Stage 1 Examples of Stage 2 and 3 activities
Bangladesh Year initiated 2002 • Developed menstrual regulation guidelines.
• Used information, education, and communication materials to disseminate information through fieldworkers.
• Focused on policy reform and securing funding for menstrual regulation kits and commodities.
Assessment team 11 members.
Stakeholders involved Physicians and social scientists.
Technical support WHO
Assessment sites Fieldwork was conducted in 5 districts and at the central level.
Ghana Year initiated 2005 • Developed and disseminated standards and guidelines and trained mid-level HCPs to increase quality and availability of services.
• Registered Medabon®, a co-packaged mifepristone-and-misoprostol product for medical abortion, which is approved for use by physicians in both public and private facilities.
• Created a fixed price for abortion services in public facilities with a fee-sharing provision for abortion providers to discourage clandestine provision of services.
• Conducted sensitization training for HCPs, members of the media, lawyers, police officers, and community leaders on legal indications for abortion, the incidence and impact of unsafe abortion, and ways to prevent it.
• Conducted a nationwide maternal health study with emphasis on abortion.
• Updated national monitoring system to improve the monitoring and evaluation on CAC.
• Initiated scale up of CAC and family planning services, mainly through international partners, although some districts and regions raised their own funds.
Assessment team 17 members
Stakeholders involved Policymakers, program managers, HCPs, and reproductive rights and women’s health advocates.
Technical support Ipas and WHO
Assessment sites Fieldwork was conducted in 6 administrative regions.
Guinea Year initiated 2009 • Country stakeholders were unable to secure funding or technical support to move beyond Stage 1.
Assessment team 18 members
Stakeholders involved Health professionals and representatives from NGOs, government agencies, research centres, and community organizations.
Technical support WHO
Assessment sites Fieldwork was conducted in 4 regions and the country’s capital.
Kyrgyzstan Year initiated 2011 • Developed new health strategy and provided training on new health strategy.
• Increased access to family planning services and contraception.
• Improved sexuality education.
• Conducted medical abortion operations research study and trained midwives to improve access to medical abortion in rural areas.
Assessment team 14 members
Stakeholders involved Clinical and research experts.
Technical support UNFPA, UNICEF, and WHO
Assessment sites Fieldwork was conducted in 3 regions.
Macedonia Year initiated 2007 • Developed national strategy for sexual and reproductive health, which was adopted by the MOH in 2011.
• Allocated funding in the national program budget for the operation of a youth counselling centre that provides free contraceptives and education materials.
Assessment team 13 members
Stakeholders involved MOH and government agencies, community and clinical organizations, and NGOs.
Technical support UNDP, UNFPA, and WHO
Assessment sites Fieldwork was conducted in 6 regions.
Malawi Year initiated 2009 • Conducted study to understand complications of unsafe abortion and cost to the health system.
• Focused on increasing provider-level capacity and facility-level equipment to improve PAC.
• Formed a local civil society coalition to advocate for legal reform.
Assessment team 24 members
Stakeholders involved Government agencies, human rights groups, and NGOs.
Technical support Ipas and WHO
Assessment sites Fieldwork was conducted in 10 districts.
Moldova Year initiated 2005 • Developed standards and guidelines for safe abortion services and trained HCPs.
• Increased access to contraceptives for youth and socially vulnerable groups through insurance system coverage.
• Piloted CAC at 4 model centres and subsequently included 2 more model centres.
Assessment team 23 members
Stakeholders involved MOH, clinical organizations, legal organization, researchers, NGOs, HCPs, and mass media.
Technical support East European Institute of Reproductive Health in Romania, Ipas, and WHO.
Assessment sites Fieldwork was conducted in 9 administrative units and 2 municipalities.
Mongolia Year initiated 2003 • Developed national standards and guidelines for abortion and the national pre-service training curriculum was harmonized with the new guidelines.
• Registered Mifepristone and Misoprostol for first and second trimester abortion and included these drugs in the National Drugs Registry in 2006.
• Established 3 model CAC units to provide high quality services and used these units as training centres for HCPs.
• Focused on improving national facility infrastructure and upgrading diagnostic and treatment centres.
Assessment team 19 members
Stakeholders involved Public health institute, research centres, youth organizations, and HCPs.
Technical support WHO, Population Council (Bangkok), Ipas
Assessment sites Fieldwork was conducted in 6 provinces and the nation’s capital.
Romania Year initiated 2001 • Developed standards and guidelines and improved infrastructure in several hospitals to provide high-quality abortion services.
• Improved access to contraceptive services by making them available from family physicians (not just gynecologists as was previously done).
• Pilot-tested free contraceptives intervention in 3 rural districts and scaled up to 42 districts to make contraceptives available to vulnerable groups of the population.
Assessment team 19 members
Stakeholders involved MOH, clinical organizations, government agencies, NGOs, and HCPs.
Technical support WHO and Ipas
Assessment sites Fieldwork was conducted in 8 administrative units and the county’s capital.
Russian Federation Year initiated 2009 • Revised regulatory documents and developed national guidelines, standards, and protocols according to WHO recommendations.
• Trained obstetricians and gynecologists on revised guidelines through post-graduate education.
• Conducted local operations research on safe practices of induced abortion in the first trimester.
• Increased accessibility to abortion services.
Assessment team 25 members
Stakeholders involved Researchers, community organizations, and health care professionals.
Technical support WHO
Assessment sites Fieldwork was conducted in 3 regions
Senegal Year initiated 2010 • Formed an advocacy task force, which conducted awareness-raising workshops with parliamentarians, religious leaders, journalists, and civil-society groups.
• Discussed a draft bill that includes all indications for abortion stipulated by the Maputo Plan of Action during a workshop in June 2011.
• Developed a national dialogue about unsafe abortion and the need for legislative changes and country stakeholders have been advocating for these changes.
• Initiated plans to improve sexual and reproductive health education, family planning, and PAC services.
Assessment team 28 members
Stakeholders involved MOH, civil society, government agencies, and NGOs.
Technical support Ipas
Assessment sites Fieldwork was conducted in 10 regions.
Sierra Leone Year initiated 2011 • Ongoing efforts to revise the abortion law resulted in the country’s members of parliament voting unanimously in favour of legislation that would legalize abortion at up to 12 weeks of pregnancy in December 2015. However, amidst religious protests, the country’s president declined to sign the bill. In February 2016, rights groups urged the president to give the bill assent. The bill has been referred to the constitutional review committee, which is currently reviewing the country’s constitution.
Assessment team 27 members
Stakeholders involved MOH, health professionals, NGO, and legal professionals.
Technical support Ipas and WHO
Assessment sites Fieldwork was conducted in 12 health districts.
Ukraine Year initiated 2007 • Implemented Comprehensive Care for Unwanted Pregnancies project (CCUP), which resulted in 5 new model clinics supported with capacity building activities on CCUP provision.
• Implemented new training curriculum on CCUP for obstetricians and gynecologists.
• Monitored and evaluated CCUP services in pilot regions.
• Developed scaling-up strategy for CCUP, which has been distributed to all the regions of Ukraine for implementation.
Assessment team 32 members
Stakeholders involved MOH, government agencies, higher educational establishment, and professional associations.
Technical support WHO and Ipas
Assessment sites Fieldwork was conducted in 2 regions.
Vietnam Year initiated 1997 • Formed National Technical Working Group on Abortion to finalize national technical guidelines for abortion services and included abortion-related policy recommendations in a national reproductive health strategy.
• Conducted the Comprehensive Abortion Care project from 2001 to 2009 and set up national abortion care guidelines for all health care levels to use modern abortion techniques.
Assessment team 12 members
Stakeholders involved MOH, clinical and community organizations, and physicians.
Technical support WHO
Assessment sites Fieldwork was conducted in 6 provinces.
Zambia Year initiated 2008 • Developed and disseminated CAC standards and guidelines to increase quality and availability of services.
• Conducted action research to introduce medical abortion drugs in 20 health facilities.
• Registered Medabon® and the government has begun to allocate funds for purchasing medicines/equipment for abortion services.
• Conducted a pilot program for distributing contraceptive injections through community-based workers.
Assessment team 17 members
Stakeholders involved Academics, program managers, HCPs, researchers, and women’s health advocates.
Technical support Ipas and WHO
Assessment sites Fieldwork was conducted in 5 provinces.