244112 Applying the WHO Strategic Approach to unsafe abortion: Experience in five sub-Saharan African countries

Monday, October 31, 2011

Emily Jackson, MD MPH , Independent Consultant, Los Angeles, CA
Brooke Ronald Johnson, PhD , Department of Reproductive Health and Research, World Health Organization, Geneva 27, Switzerland
Peter Fajans, MD, MPH , Department of Reproductive Health and Research, World Health Organization, Geneva 27, Switzerland
Merrill Wolf, MA , Ipas, Chapel Hill, NC
The World Health Organization's Strategic Approach to Strengthening Reproductive Health Policies and Programmes is a country-owned, participatory, interdisciplinary methodology designed to assist countries identify and prioritize sexual and reproductive health service needs, test appropriate interventions and scale up successful programs. Five African countries (Ghana, Zambia, Malawi, Guinea and Senegal) have used the Approach to examine unsafe abortion-a significant cause of maternal morbidity and mortality worldwide and accounting for a third of maternal mortality in some sub-Saharan countries. In these five countries, this methodology has helped document the extent and impact of unintended pregnancy and unsafe abortion, shed light on underlying causes, and facilitated consensus among key stakeholders, including Ministries of Health, on strategies for addressing these significant public health problems. Factors contributing to high levels of abortion-related mortality have included: barriers in availability and accessibility of contraceptives and safe, legal abortion services; legal restrictions on abortion; incomplete implementation of post-abortion care services; and countries' religious, institutional and cultural contexts. In addition to describing countries' research, policy and programmatic responses to assessment findings, we discuss and evaluate facets of the Approach that facilitate countries' ability to address the sensitive issue of unsafe abortion, including use of a systems framework, multi-disciplinary team approach, qualitative field-oriented process, research capacity strengthening and flexibility to address both national priorities and local concerns. While addressing limitations of this methodology, and lessons learned during its application, we confirm the value of the Strategic Approach in stimulating improvements in health systems, programs and policies concerning abortion.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1) Discuss the application of the Strategic Approach methodology in various African contexts. 2) List common causes of abortion related maternal mortality in the African setting. 3) Give examples of successful interventions addressing the issue of abortion related maternal mortality in 5 African countries where the Strategic Approach has been used.

Keywords: Abortion, International Reproductive Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I can speak knowledgeably about Ipas's role and the broader collaborative process of implementing the WHO Strategic Approach to address unsafe abortion in Africa, and about the related policy and service delivery context. I have been affiliated with Ipas, and thus worked in international reproductive health, for more than 20 years.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Ipas Unsafe abortion Employment (includes retainer)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.