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Workgroup recommendations

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

B. Thematic Workgroups

A. Workgroup recommendations for the following disciplines:
research, policy, training/education and service delivery.

Wednesday 5 December 2001

Research Workgroup

Group Recommendations

  1. What support do MLPs need to perform high-quality MR/abortion?
    1. What minimum conditions must be in place?
    2. How do these differ at various levels of the health care system?
  2. Assess the capacity of MLPs to provide abortion services. For advocacy reasons, may need country-specific research. Investigate clinical decision-making, clinical competency.
  3. What are the effects of values clarification workshops? To what extent do these yield enabling environments for MLPs providing MR or elective abortion services?
  4. What are the perceptions of women of quality abortion care? What are women’s demands? What are the barriers and enabling factors?

Individual Recommendations raised in the group:

  1. Identify barriers and facilitating factors to women accessing high-quality care.
  2. What values are attached to MLPs providing abortion services?
  3. What are the means of decentralizing services?
    1. mobile clinics?
    2. private providers?
  4. What support do MLPs’ need – psychological? Technological? Logistical?
  5. Understand client demands.
  6. What is the cost impact for the health care system of transitioning from physicians to MLPs providing abortion services?
  7. What are the mechanisms of regulating decentralized abortion services?
    1. incentives?
    2. supervision/regulation?
    3. accountability to community?

Policy Workgroup

  • It is the consensus of the group that the needs to be increased access to safe abortion services (including elective where legal) at all levels of the health system including (public and private).
  • Preferably such services should be available as part of integrated reproductive health care.
  • Define providers according to minimum standards of competence rather than according to their particular professional speciality or title.
  • The necessary competencies should be based on best available evidence.
  • To ensure safety and quality - services must be offered within an enabling environment.

Education/Training Workgroup

  1. Establish an enabling environment by mobilising community support:

    • Sexuality education in school
    • Gender perspective in a social context
    • Male involvement and responsibility in reproductive life

  2. Normalise reproductive health into medical education by:
    • integrating reproductive health and rights into basic education for all health care providers
  3. Education about abortion and PAC including values clarification should be included in basic education for health providers who care for women during their reproductive life
  4. Integrate clinical/technical competency training in TOP including counselling for MLP, who will provide reproductive health care for women through:
    • Pre-service training
    • Theoretical/clinical training for those who work in the field
    • Continuing education for those who are providing TOP and PAC services
  5. Implement and sustain best clinical practices for TOP and PAC through
    • Guidelines for trainers of trainers (TOT)
    • Standards for supervision and monitoring
    • Reliable referral systems
  6. Opportunities for continued education

Service Delivery Workgroup

  1. Access
    • Integrate abortion services into existing RH services
    • Strengthen existing sites and increase number of sites
    • Affordability
    • Establish provider network
  2. Quality services:
    • Provide skilled and competent teams at all service delivery sites
    • Make available clinical guidelines to all centers - and update regularly
    • Ensure enabling environment
    • Adequate supply and equipment
    • Referral system
    • Continuous monitoring and evaluations of services
    • Community participation
  3. IEC and awareness campaigns
    • Build community networks with CBO/CBD, NGOs and churches



Action steps


Eliminating stigmatization

Discuss with stake holders

Holistic approach

Review current policy guidelines

Strengthen and increase sites

Improve access

Evaluate current sites and identify new sites


Increase access for poor women

Evaluate fees (current)

Train MLPs for rural and peri-urban areas

B. Thematic Workgroups