Clarifying values and transforming attitudes to improve abortion access: Results of a global assessment

Globally, unsafe abortion accounts for an estimated 66,500 deaths and innumerable disabilities annually. Values clarification is a WHO-recommended strategy to address barriers to provision of and access to safe abortion resulting from misinformation, stigmatization, negative attitudes and obstructionist behaviors. Ipas has implemented values clarification and attitude transformation (VCAT) workshops with a variety of audiences including health care providers, trainers, administrators, policymakers, journalists and other key stakeholders in more than 24 countries since 2002. Ipas conducted a global assessment of VCAT workshops that included entries from an organizational training database, staff interviews, workshop agendas and reports and pre, post and follow-up workshop surveys on participants' abortion-related knowledge, comfort levels, values and behavioral intentions. Staff and workshop participants considered VCAT an effective and important strategy that delivered results. Matched pre- and post- survey data (N=154) from select workshops indicated that VCAT was associated with a statistically significant (p<.001) increase in participants' knowledge about abortion and supportive attitudes toward abortion provision; positive shifts were also reported in behavioral intentions to support comprehensive abortion care. Knowledge scores at a pilot follow-up (N=16) were lower than those directly following VCAT workshops but were substantially higher than those recorded before exposure to VCAT. Attitudes supportive of abortion were even higher at follow-up (N=16) than on post-surveys. The majority (81-100% per item) of the participants in the follow-up surveys fulfilled their behavioral intentions with only one exception. Recommendations for improved and broader implementation, further evaluation and applications to other stigmatized health services are discussed.