A. Research, policy, training/education and service delivery

B. Thematic Workgroups

Workgroup I. Expanding Access to Abortion Services in Restrictive Settings

1. International (cross-border) initiatives
2. Train Providers in PAC
   • private providers in communities (e.g. midwives)
   • public providers
3. A. Awareness campaigns/education of providers and communities about all legal indications for abortion.
    B. Train providers to offer abortion for all legal indications.
4. A. Complement training strategies with policy review and analysis.
   • protecting MLPs in challenging legal contexts (sensitization)
   • identify appropriate and strategic entry points (e.g PAC)
   • educate administrators/policy makers
   • involve stakeholders with strategic skills/contributions, e.g. legal
   • interpreters/advisors, medical associations, key policy partners, authorities
   • governing curriculum/scope of practice.
   • involve private and NGO providers.
    B. Complement training with data collection and analysis:
   • collect evidence-based data showing that MLPs can provide safe abortionservices, e.g. pilot studies, clinical trials
   • Involve community-based workers.
     • Strengthen/build linkages from indigenous providers to safe services
     • review the literature and evidence re: community-based providers linking women to other safe services, such as safe pregnancy care, for key lessons/strategies.
   • Document and compile models of PAC efforts where there has been success in expanding access either to other indications or geographically, e.g. Kenya, Ghana.
   • Engage lawyers to help interpret the law re: involving MLPs in any abortion care and/or protecting MLPS as elective service providers.
   • Identify opportunities for sharing information via documentation, study tours, ToTs. Such information to include:
     • effect of unsafe abortion on maternal mortality and morbidity;
     • sharing successful program experiences (incl. integrated service delivery models);
     • advocacy strategies;
     • training models
   • Advocacy via women’s groups – local, national and/or international.
   • Advocacy via professional organizations, e.g.: ICM, FIGO, AMRN, ACNM, IMIA, WHA.

1. South to South exchanges
   • study tours
   • ToT
   • Conferences
   • Research
2. North to South efforts
   • links to professional organizations and donors
   • fellowships
   • sharing experiences
   • research collaboration
3. Sharing about ongoing programs
   • medical abortion
4. Use expanding Access website and email for exchange
   • establish "corners" for project development, curriculum review, research, policy.
5. Conduct research regarding women’s priority concerns on high quality abortion care.
6. Share information regarding MSI model.
7. Pursue funding for further communication.

Participants in the discussion came from following countries:

• Cambodia
• Kenya
• South Africa
• Sweden
• UK
• USA
• Vietnam

General Statements

• Medical abortion (MA) is a method worth including as an option for early termination of pregnancy (ToP), within MLP's scope of competence.
• MA is a matter of choice rather than access; where other methods are available MA will improve quality of care by offering choice of methods for safe abortion.
• With information, support and back up by MLPs, medical abortion is a method for fertility regulation that can be left in the hands of women.

Advantages/disadvantages

• The earlier - the better. More effective in very early stages (Medical menstrual regulation). Drawback – only up to 8th week of pregnancy.
• Many visits burdensome and expensive for the woman. On the other hand, repeat contacts improve counselling and post abortion services.
• The number of visits can be reduced by intake of second drug at home. To have the "miscarriage" at home is seen both as an advantage (being in control) and as a disadvantage in communities or homes where privacy can't be secured.
• High cost for the drugs - makes the method unnecessarily expensive both for health services and for clients.

Cambodia

According to the law midwives can provide ToP services, but there is no formal education or training for abortion care. In reality midwives provide quite a number of D&C and MVA - without theoretical education.

Wish for the future:

• Include MA as a method for ToP. Pilot project with technical and financial support for registration and provision of the drugs.
• Training of trainers in this method
• Include training on all abortion methods in basic education and training for RHC providers.

Kenya

• Include MA as an option in PAC, administered by MLPs.IEC and advocacy in the community to promote the method.

South Africa

According to the law MA is a legal method for ToP that can be provided by midwives. In reality there is no guidelines, no training.
To put it into practice:

• Advocacy to government, policy makers and providers – registration and approval of the drugs.
• Sensitise and train health workers about MA
• Decentralise the service delivery from hospital to clinics
• Acknowledge and overcome cultural barriers by IEC and advocacy to women, community, etc

Sweden

Midwives have gradually taken over care of medical abortion clients, always on a doctors delegation, though.
Wish for the future: Develop and expand midwives role in MA services, including revision of the law to give midwives authorisation to prescribe the drugs and provide MA independently.

USA

Develop the provision of MA services by midwives with advocacy for MEDICAL MENSTRUAL REGULATION to normalise abortion service delivery.

Vietnam

MA an option along with MVA. Today only provided at hospitals in urban areas, at a distance of 30 minutes.

Problem: High cost of the drugs. Need for ultra-sound to confirm gestation age and to avoid ectopic pregnancy.

Wish for the future: To make MA available at more decentralised level with physicians or MLPs as providers, and without ultra-sound as a routine.

Workgroup III. Value Clarification Education (VCE)

What must be done

• Review available training material
• Develop Standard Values Clarification guidelines that will be inclusive of (MR) menstrual regulation
• Use of VCE in advocating for Integrated RH Care Delivery Systems

How is this to be done?

• Coordinated and focused training workshops
• Establish a Reference Group to work on specific issues/develop guidelines and training programme

What is needed to achieve the project? Funding by conference: Ipas/IHCAR

ALL THE ABOVE LINK (CROSS-CUTTING) APPROPRIATELY WITH SUGGESTED FOCUS GROUPS, viz:

• Research
• Policy
• Service Delivery
• Education and Training

Workgroup IV. Developing the Network

• May develop into an association for dissemination, further organizing and funding
• Necessity for a core/steering group – Ipas, IHCAR, North-South representatives

Working groups with moderators:

• Research
• Policy and advocacy
• Service delivery
• Education and training

Website: Country reports, statement, proceedings available without names.
Names of network members on protected part of the website. Contacts through the webmaster (Bengt Estborn)

Unsubscription: anyone now on the participant list, who do not want to become a member of the network, can unsubscribe using the information on the bottom of the e-mail letters from the exp-acc Yahoo group

Suggested name of the network, strapline and goal:

FARR – Full Access to Reproductive Rights

An international network of health care professionals dedicated to expanding access to safe MR and abortion care.

In order to achieve this goal, a central tenet will be to foster an enabling environment which supports competency-based practice by a variety of reproductive health care providers

A. Research, policy, training/education and service delivery