Ipas evidence in action 2025: Research insights on abortion access, quality, and equity

Expanding access

Self-managed abortion with pills: Access, experience, and quality information

Self-managed abortion with pills is expanding access, but people still face misinformation, inconsistent counseling, and uneven availability. These studies give advocates evidence to strengthen pharmacy and community access while pushing for safeguards like accurate counseling, pharmacist training, and clear referral pathways.

In India, a trend analysis shows a substantial increase in self-managed abortion (SMA) with pills between 2014 and 2021 and demonstrates the transformative power of SMA in increasing access to safe and effective abortion: The transformative terrain: An in-depth analysis of trends in self-managed abortion in India using NFHS-5 national data

In the Democratic Republic of Congo, research shows that misoprostol was available in less than 50% of pharmacies and mifepristone and misoprostol in less than 2% of surveyed sites. Mystery client interactions reveal that most pharmacists need training on medication abortion counseling and regimens: Quality of information on medication abortion in private pharmacies: Results from a mystery client study in Kinshasa, Democratic Republic of Congo

In Ethiopia, a pilot study on SMA through private pharmacies demonstrates high demand from women and interest from pharmacies in providing women with medication abortion, but Ethiopia’s legal framework presents challenges to a pharmacy-based model: Increasing access to self-managed abortion through pharmacies: programmatic results and lessons from a pilot program in Oromia, Ethiopia

In Cambodia, an exploration of women’s SMA experiences reveals that young women’s success rates were comparable to those of adult women, and they generally had better experiences than their older counterparts. Young women were more likely to seek support from family and friends, highlighting the important role of social support and the need for accurate information on abortion to be disseminated at the community level: Comparing medical abortion outcomes and experiences between young and adult women: Evidence from urban Cambodia

Using data from Cambodia and Ghana, Ipas authors compare the SMA information and counselling provided by pharmacists to women with that provided by a health provider at a clinic. While pharmacists and clinic-based providers focused on different aspects of SMA counseling, results indicate that both cadres would benefit from training to ensure their clients receive the best information and counseling possible: Assessing information and counselling provision for medical abortion care in pharmacies versus clinics: Secondary analysis of two non-inferiority cohort studies

Telemedicine: Quality care beyond major cities

Telemedicine can expand abortion access by reaching people who face barriers to in-person care, including those who live outside major cities. In 2025, Ipas and partners at Profamilia in Colombia compared clients who received medication abortion care via telemedicine with those who received in-person care.

The study found that clients in both groups were highly satisfied with their care. It also found that telemedicine was as effective as in-person care when clients received clear, comprehensive guidance, reinforcing telemedicine as a strong option for expanding access, quality, and equity: Adherence to first-trimester medication abortion in telemedicine versus in-person care: a prospective cohort study in Colombia, 2024

Improving quality and equity

Quality of abortion care: Safety, experience, and equity

Abortion quality can mean many things, from clinical safety and effectiveness to how well a person is supported, respected, and understood throughout their care experience. Ipas research explores multiple aspects of abortion quality and provides the opportunity to support the development of policies and programs that improve the quality of abortion across numerous dimensions.

In Argentina, a 2020 law change provided the opportunity to explore how legal reform impacts access to quality care. This study found that while the safety of abortion care in the study sites remained consistent, legal reform expanded access to safe abortion services up to 15 weeks, especially for disadvantaged women: Expanding access to safe ambulatory manual vacuum aspiration abortion up to 15 weeks following Argentina’s legal reform: an observational study in the public health sector.

In Mexico, most patients who have a facility-based abortion have no complications, but those that do experience a complication are more likely to come from a marginalized area and be seeking care later in pregnancy.  This research uncovers the challenges associated with abortion care-seeking in Mexico, highlighting how location and timing contribute to the safety of abortion care received.: Public hospital-based care for abortive events in Mexico: complication rates and socio-demographic factors, 2018-2022.

For women in Uganda, the experience of seeking and receiving quality abortion care within the public health system can be a challenge due to a restrictive law and abortion stigma. Research shows that high-quality abortion care is  client-centered and provided by clinicians that are trained in compassionate communication to improve a client’s experience: Mapping the journey: enhancing abortion care in Uganda’s health systems.

Contraception decisions: Access, information, and choice

Research on contraception, whether after an abortion or during another phase in a person’s reproductive lifetime, provides critical information on why people use (or do not use) contraception and can inform programs and policies that support contraceptive decision-making. These publications help pinpoint where counseling and method options fall short in pharmacies, and how immigration policies impact barriers to access.

Ipas’s SMA research in Cambodia and Ghana provides insights into women’s uptake of post-abortion contraception from pharmacists versus clinics. Results showed that although the rates of contraceptive use were the same between women who got abortion pills from a pharmacy versus a clinic, pharmacy clients were more likely to use a less effective method, and contraceptive information and options were more readily offered by clinics, indicating a need for supporting pharmacies in providing more information and effective methods at the time of SMA purchase: Post-abortion contraceptive use among women purchasing medication abortion from pharmacies vs. clinics: Evidence from Cambodia and Ghana

Using data from the National Survey of Family Growth in the United States, researchers examined how state-level immigration policies are associated with effective contraceptive method use among US-born and foreign-born Mexican-origin women. Results reveal how exclusionary immigration policies are associated with lower contraceptive use among US- and foreign-born Mexican women: Immigration policy climate and contraceptive use among Mexican-origin women in the United States

Reaching people facing complex barriers

Humanitarian settings: Essential care and better evidence in crises

In humanitarian crises, abortion and postabortion care are often left out even when they are urgently needed. These studies offer practical methods that can be used in other crisis settings, including ways to study self-managed abortion and estimate deaths linked to unsafe abortion when routine data is limited. Together, they make the case for including maternal health care, postabortion care, and safe abortion care in humanitarian response and provide tools for research and to document needs that are often overlooked.

In forcibly displaced populations, a new study protocol outlines a community-facility capture-recapture approach to better estimate maternal deaths due to abortion complications, helping strengthen measurement where official data is incomplete: Maternal mortality due to abortion complications in forcibly displaced populations: A study protocol for a community-facility capture-recapture (CFCR) study

In two humanitarian settings in Uganda and Kenya, a respondent-driven sampling study examines abortion incidence and safety, providing evidence on access and outcomes where care is often constrained: Incidence and safety of abortion in two humanitarian settings in Uganda and Kenya: a respondent-driven sampling study

A mixed-methods study assesses whether respondent-driven sampling can be used to feasibly recruit participants with recent abortion experiences in humanitarian contexts, offering practical guidance for researchers working in hard-to-reach settings: Feasibility of respondent-driven sampling to recruit participants with recent abortion experiences in humanitarian contexts: a mixed-methods community-engaged research study

Youth and abortion care: What helps, what hurts

Young people face added barriers and stigma when seeking abortion care, which can push them toward unsafe options.

This study centers African adolescents’ own voices and shows that when policies are less restrictive and services are easier to reach, adolescents are more likely to obtain safe care and less likely to resort to unsafe abortion methods. These findings support the push for youth-responsive services, clearer pathways to care, and reforms that reduce fear, delay, and stigma: Adolescent abortion care trajectories and safety in Ethiopia, Malawi, and Zambia: a comparative mixed methods study

Climate justice: How climate shocks shape sexual and reproductive health and rights

Climate change and related disasters disrupt access to care, increase risk, and worsen existing inequities. Ipas’s research adds to the growing evidence on how climate vulnerability affects sexual and reproductive health and rights, especially for people already facing access barriers. The findings below make a strong case for climate adaptation that includes sexual and reproductive health services and for locally led solutions that protect autonomy and rights.

In cyclone-affected communities in Bangladesh, researchers found that extreme weather can make it harder for people to get the sexual and reproductive health care and information they need, and that marginalized groups, such as low-income and displaced people, experience the most severe disruptions: Applying an intersectional climate justice lens to understand climate crisis impacts on sexual and reproductive health and rights and identify local solutions: Qualitative findings from Khulna, Bangladesh

In Nepal, research explored how repeated climate disasters are linked to changes in women’s safety and daily lives, including increased risk of gender-based violence, but also greater autonomy in decision-making as men migrate for work: Climate change and its differential impact on sexual and reproductive health and rights among women in Nepal

A third publication documents the journey of the Sexual and Reproductive Health and Rights and Climate Justice Coalition, co-founded by Ipas. The coalition connects more than 100 organizations working to build evidence, challenge harmful narratives, and champion locally led solutions rooted in autonomy and rights: No climate justice without sexual and reproductive health, rights and justice: past, present, and future challenges faced by the Sexual and Reproductive Health and Rights and Climate Justice Coalition.

Strengthening systems, challenging norms

Innovations in measurement: What we count shapes what we improve

Even when measurement is challenging, investing in the right tools and methods can drive equity and progress. In 2025, Ipas and partners published two papers that push the field to measure sexual and reproductive health in ways that better reflect people’s real lives and experiences. These studies offer improved ways to capture pregnancy recognition and to measure sexual and reproductive wellbeing, expanding what programs can track beyond clinical endpoints.

In one study, authors propose improved survey questions about when and how people realize they are pregnant, including response options that capture physical signs, practical constraints, and emotional factors. Better measurement of pregnancy recognition can help explain why people seek care when they do, including abortion care: Capturing pregnancy recognition trajectories: a critical reflection of new quantitative measures tested in Ethiopia, Malawi, Nigeria and Zambia.

A second publication offers a new definition of sexual and reproductive wellbeing and a short measure to assess it, shifting attention toward whether people are able to live the sexual and reproductive lives they want, not just whether services were delivered: What about well-being? Measuring what we really care about in sexual and reproductive health.

Midwives: Key figures for expanding access and building local research leadership

In the Democratic Republic of the Congo (DRC), midwives are playing a growing role in comprehensive abortion care as access to legal services has expanded. Ipas DRC has supported training midwives to provide care and to lead research that reflects what clients and communities need.

In 2025, Ipas DRC and partners published three papers that show how midwife-led models can strengthen access and quality. The studies explore how communities view midwife-provided care, what it takes to build midwives’ research capacity through collaboration, and what clients themselves say they experience when seeking person-centered abortion care.

• “With an unwanted pregnancy, we are looking for midwives in the neighbourhood to show us what to do.” Stakeholder perceptions of midwife-led woman-centred comprehensive abortion care in the province of Kinshasa, Democratic Republic of Congo: a qualitative descriptive study.
• Research capacity-building of midwives expanding access to safe abortion in the Democratic Republic of Congo: transnational research collaborations with civil society organizations.
• Experiences of person-centred comprehensive abortion care: A qualitative study among women in Kinshasa, Democratic Republic of Congo.

Values clarification: Reducing stigma in clinical settings

Abortion law reform matters, but so do the beliefs and attitudes of the people providing care.

This chapter documents a regionwide effort across Latin America and the Caribbean in which 18 obstetrician-gynecologist associations, connected through the Latin American Federation of Obstetrics and Gynecology Societies  (FLASOG), used values clarification workshops to spark reflection and shift perspectives on abortion and sexual and reproductive rights. With 36 trained facilitators delivering 44 workshops to 1,182 health workers, it provides a real-world model advocates can use to work with health professionals to reduce stigma and support respectful, rights-based care: Clarificación de valores: alianzas con sociedades médicas para promover una salud reproductiva basada en derechos humanos en América Latina y el Caribe.

Gender-based violence: When sexual violence affects abortion access

Gender-based violence can directly shape people’s risk of unintended pregnancy and their ability to get care.

In 2025, Ipas-supported research in Brazil examined “stealthing,” removing a condom during sex without consent, and how it may fit within Brazilian law as a form of sexual violence with implications for legal abortion eligibility. This paper argues that pregnancies resulting from “stealthing” should qualify for legal abortion under existing exceptions for pregnancies resulting from rape: Direito ao aborto em casos de stealthing: reflexões, desafios e possibilidades legais no Brasil.

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