Africa: ‘Let’s Treat Sexual and Reproductive Health Services as a Regular Part of Health Care to Remove Stigma’

Johannesburg — Too many girls and women continue to die and face both the short and long-term repercussions of unsafe abortions, yet potentially life-saving information on receiving quality care for abortion-related complications, remains in short supply.

To address this gap, the UN system for Human Reproduction Research (HRP), the World Health Organization (WHO) and partners, published new data on the issue, in the latest edition of the International Journal of Gynecology and Obstetrics. The newly published papers also explore the experiences of adolescents and women in accessing support in insecure environments, reports UN News.

This comes against the backdrop of some developed countries drastically reducing their support for family planning services in resource challenged settings. According to SciDev.Net, donor funding for family planning in 59 low-and-middle-income countries declined by more than US$100 million in 2020, putting women there at risk of unsafe abortions and death.

Despite the loss of support, contraceptive use in low- and middle-income countries prevented 135 million unintended pregnancies, 28 million unsafe abortions, and 140,000 deaths of women of reproductive age in 2022, according to the report.

One project looking to address the demand for services is She Soars, which advocates for the adolescent sexual and reproductive health and rights of young women who leave school prematurely due to pregnancy in Kenya, Uganda, and Zambia, and hopes to bring about accountable and equitable adolescent sexual health policies, legal frameworks, and services in the respective countries.

The project will address the lack of comprehensive sexual and reproductive health care and information in these areas by increasing the use of sexual and reproductive health services, improving the delivery of sexual and reproductive health services that respond to the needs and desires of adolescents, particularly girls and advocating for evidence-based, accountable and equitable adolescent sexual and reproductive health and rights policies, legal frameworks, and services, according a report by This is Africa.

“Countries that fail to provide comprehensive sexual education and access to effective contraception are also likely to outlaw the abortions that mitigate unplanned pregnancies. The victims of the lack of preventative measures and their inevitable consequences are adolescent girls. Unlike their male peers, adolescent girls experience major involuntary socioeconomic, educational, physical, and environmental life shifts from unplanned pregnancies. Very little of the rhetoric acknowledge the rape and reproductive coercion involved in these unplanned pregnancies, leaving the responsibility and stigma solely on the shoulders of female children”.

In a bid to protect the health of women and girls and help prevent over 25 million unsafe abortions that currently occur each year, the World Health Organization (WHO) has released new guidelines on abortion care.

Based on the latest scientific evidence, the consolidated guidelines bring together over 50 recommendations spanning clinical practice, health service delivery and legal and policy interventions to support quality abortion care. The guidelines demonstrate how many simple primary care level interventions can improve the quality of abortion care and save lives, from telemedicine to greater task-sharing among providers. They recommend removing all unnecessary barriers to safe abortion to help assure access.

Countries around the world have varying legal and policy situations that can range from allowing abortion as requested for women, to about 20 countries that don’t allow it under any circumstances whatsoever. What’s important to know is what evidence says, that when women and girls are not able to access safe services in their individual circumstances and when they need them then it just drives them (women and girls) to unsafe procedures, where they risk their health, and they risk their lives. It doesn’t actually do anything to reduce the numbers of abortion, it just moves them to more dangerous methods.

allAfrica’s Sethi Ncube spoke to Dr Bela Ganatra who leads the World Health Organzation’s work on preventing unsafe abortion.

What is being done or needs to be done to address stigma by health care workers especially in public health spaces?

You raise a really important point that health workers themselves need to be supported to provide safe and quality care. They need accurate information about laws and policies. They need accurate information about how to provide services and most importantly, they too mustn’t be judged, stigmatized or punished for providing what is basic health care. And I think there’s there’s much we can do to provide the sort of support to help workers so that they in turn, can be empathetic, compassionate providers to the woman who seek services from them.

One factor influencing girls and women to opt for unsafe abortions is the lack of discretion in public health spaces, what do you think needs to be done to promote discretion and privacy in these places?

I think that that’s important that when women and girls find that facilities, don’t treat them with the respect, dignity and privacy that they need, many of them may turn to very unsafe procedures. I think part of this answer lies in what we just talked about earlier, in that helping and facilitating health workers themselves to understand the needs of the women and girls they serve so that they are better attuned to respecting the needs of privacy and dignity. I think none of these interventions are such that they would be very expensive or could not be done even in the simplest of settings. It’s more about respecting the client and the woman that we’re serving. So these changes are possible with a change in values.

Do you think there’s enough sex education or education around safe abortion in schools?

Much more needs to be done to ensure that all girls, boys, everyone gets a comprehensive sexuality education, education about all aspects of Sexual and Reproductive Health and Rights (SRHR). Indeed, much much more needs to be done to ensure that.

What do you think needs to be done to de-stigmatize the use of family planning information and services?

The more you treat SRHR services as a regular part of health care, as a regular part of health systems, as a part of primary health care, and as your universal health coverage, the more we treat it as normal as any other health service that women and girls might need. That’s a very important way to be able to de-stigmatize, that is integrate it with other services and treat it as normal health care.

How difficult is it to get all countries especially in Africa and Asia interested in implementing the new WHO guidelines on abortion?

There are so many countries in Africa, in Asia and other parts of the world that over the last several years have made so many important gains in implementing recommendations around the clinical care, the service delivery aspects, all of which have improved the health of women and girls. So I would in fact say that there are many countries that within that context, what is appropriate, have already been working towards implementing existing guidance from WHO and I’m sure that that interest will continue.

Abortion and family planning services are very expensive is private institutions, is there something that can be done about this?

The interventions that we need both for basic family planning and basic safe abortion services are not actually expensive interventions, that’s an important thing to remember. But it’s also important that like with any other package of health services, there should be means and ways to support women and girls who may not be able to afford these at the point of care. So there could be systems within programs to support those who might not be able to afford out-of-pocket costs. But really, it’s important to note that first say, the interventions that are needed to provide safe care are not expensive interventions for the health system to implement.

From the list of the new recommendations, which one stands out the most for you?

I don’t think there’s any one recommendation that can stand out because this is about taking a holistic approach to what women and girls need. And you need to have an interaction of all of these different recommendations happening to ensure that women and girls get the care they need. So it’s not about one It’s about ensuring the right mix of recommendations.

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