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November 15, 2005
Doctor takes patient's blood pressure
If safe abortion care is too far away, too expensive, or performed by insensitive providers, women will continue to turn to unsafe abortion.

To address the gap in reproductive health program evaluation, Ipas Vice President for Research and Evaluation Janie Benson developed a framework to examine the essential components of safe abortion care in order to evaluate program success. The framework was published in an article, "Evaluating abortion-care programs: Old challenges, new directions" in the September 2005 issue of Studies in Family Planning.

“The framework and related indicators offer a practical and feasible approach for evaluation of abortion programs. Evaluation of such important programs has been largely neglected. The article calls on the reproductive-health community to prioritize evaluation as an essential part of all abortion care programs,” said Benson.

National abortion care programs aim to reduce pregnancy-related deaths and injuries; increase women’s reproductive choices; and reduce repeat unintended pregnancy and unsafe abortion. These long-term outcomes are challenging to measure. At a broad population level, pregnancy-related deaths are relatively rare occurrences, and changes in the rate of these deaths occur slowly over a period of years. Deaths from unsafe abortion are not only even more rare; they are often clandestine occurrences, making them difficult to track. In addition, directly linking safe abortion programs to long-term results is difficult.

To address this information gap, Benson proposes that evaluation efforts focus on four feasible measures. These include abortion laws and policies; women’s ability to obtain safe abortion care; quality of and access to services; and use of such services. The article proposes a set of practical indicators that permit health systems to judge whether their abortion programs are hitting their mark.

For example, restrictive abortion laws are linked with high rates of unsafe abortion and accompanying deaths. Countries that have liberalized their laws have eventually seen their maternal mortality rates drop.  But changing the law alone will not reduce the death rate. Policies that doctors and midwives are trained to provide this care must be in place. Health-care facilities in both rural and urban areas must be equipped with up-to-date abortion technologies as well as family planning supplies to prevent future unintended pregnancies.

Finally, women must know where safe care is available, and it must be accessible to them: If safe abortion care is too far away, too expensive, or performed by insensitive providers, women will continue to turn to unsafe abortion.

Countries with safe abortion and postabortion care programs have not historically monitored these programs. While international donors have strongly supported the evaluation of contraceptive programs for more than 30 years, resources for safe abortion programs have been anemic at best. As a result, routine health information systems that track family planning programs often do not include abortion caseloads or essential commodities. Along with incorporation of abortion measures into health system monitoring, standard reproductive-health surveys should include questions about abortion. Special studies on the use of abortion services, women’s perspectives on abortion and barriers to care also are urgently needed.

“All of these indicators together paint a picture of whether a health system is serving women who seek abortions well or if they’re just getting by,” Benson said.

“International donors, national governments and nongovernmental organizations must increase their political support and resources for evaluation. Only then can we ensure that abortion care is effective, efficient and meets women’s needs.”

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258