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Table 3 Stage 2 activities and SEM factors influencing Stage 2 implementation

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

Stage 2 activities SEM level factors influencing Stage 2 implementation
Countries with restrictive abortion laws
• Advocated for legal reform to make abortion services legal and accessible.
• Conducted quantitative research to better understand the magnitude of unsafe abortion and possible implications of liberalizing the law.
• Policy: Alignment of Stage 2 activities with country’s existing policy reform initiatives.
In Malawi and Sierra Leone, using the SA in conjunction with ongoing national discussions on liberalizing the law allowed the SA team to build on the groundwork initiated by advocates on these issues and garner their support for SA activities.
• Community: Alignment of Stage 2 activities with community advocacy groups’ objectives.
In Malawi, the establishment and mobilization of community advocacy groups, such as the Coalition for Prevention of Unsafe Abortion, helped maintain pressure to influence policy reform.
Countries with less restrictive abortion laws
• Piloted innovations to improve access to and quality of family planning, comprehensive abortion care (CAC), and post-abortion care (PAC) services.
Ghana, Macedonia, Moldova, Romania, Russia, Ukraine, and Zambia developed national standards and introduced technical guidelines.
Ghana, Kyrgyzstan, Moldova, Russia, and Sierra Leone trained HCPs to implement new or existing guidelines.
In Mongolia, Moldova, and Ukraine, a model of CAC was established and tested at specific intervention sites called “model clinics” to demonstrate high-quality CAC services and train HCPs.
Romania, Kyrgyzstan, and Zambia pilot tested services for different geographical and socioeconomic groups.
• Raised awareness of the provisions of the law.
Ghana, Zambia, and Bangladesh conducted community-level sensitization workshops to reduce stigma around abortion and disseminated information on reproductive rights.
• Policy: Alignment of Stage 2 activities with country’s existing initiatives.
In Ukraine, dissemination of Stage 1 outputs aligned with the country’s concurrent efforts to update national abortion standards, which helped inform the development of these standards and obtain buy-in for their adoption.
• Organizational: Alignment of Stage 2 activities with the mandate and areas of expertise of external organizations providing financial support.
In Zambia, an NGO’s interest in operations research led to the introduction of manual vacuum aspiration at pilot sites while WHO provided support for clinical research and guideline development.
• Individual: HCPs’ personal views on providing contraceptive and abortion services.
• Individual: HCPs’ knowledge and uptake of safe abortion laws, standards, and guidelines.
• Organizational: Facility-level adoption of national safe abortion protocols and guidelines.
• Policy: Availability of commodities (e.g., medical abortion drugs and equipment).
• Individual/Community/Policy: Stigma and cost associated with accessing services.