When “Youth+Tech+Health Live 2015” convened in San Francisco last month, bringing together youth advocates and technology and health experts from around the world, Ipas and partners were on hand to put sexual and reproductive health and rights into the conversation—more specifically, to share the innovative ways Ipas and our partners are using mobile technology to expand women’s access to safe, comprehensive abortion care.
“More than 47,000 women die from unsafe abortions each year,” says Dr. Rebecca Braun, Ipas mHealth consultant. “The vast majority of these deaths are in the global south, where the use of cell phones and other mobile devices is growing rapidly, including in rural communities. This opens up exciting new possibilities for reaching women with life-saving, abortion-related information, support and care.”
As the use of mobile technology to deliver health information and services grows at a lightening pace, Ipas has implemented mobile health (or “mHealth”) projects in four countries—South Africa, Bangladesh, Kenya and Nigeria—and is supporting researchers and community-based organizations with the development of new mHealth projects in several others. Many abortion-related mHealth projects focus on improving young women’s access to abortion care; one of those projects, in Indonesia, was highlighted at the Youth+Tech+Health Live conference.
mHealth for medical abortion
“One unique opportunity for mobile technology,” says Dr. Braun, “centers on expanding women’s access to medical abortion—abortion with the use of pills—at the community level. For example, a crucial question about medical abortion outside the formal health system is whether women can accurately assess their own eligibility for medical abortion.”
In South Africa, Ipas-funded research is exploring the feasibility of an online gestational calculator women could use to accurately determine their eligibility. If it proves successful, Ipas will expand on this project by building mobile tools that further support community-level access to abortion care.
Inna Hudaya is the founder of Samsara, an Indonesian organization that promotes sexual and reproductive health and rights information, including on safe abortion.
Using mobile technologies to increase access to safe abortion in Indonesia
Highlighted at the youth conference in San Francisco were the efforts of Samsara, a rights-based organization founded in Indonesia in 2008 that promotes sexual and reproductive health and rights education and information, including safe abortion. One of Samsara’s major programs is a national safe abortion hotline, which provides medical abortion information.
Abortion is highly restricted in Indonesia, but, according to a 2008 report by the Guttmacher Institute, there are an estimated two million abortions in Indonesia each year, many of them unsafe. Abortion in Indonesia is legally permitted only to save the life of the woman and in cases of fetal impairment and rape. Spousal authorization is required, and unmarried women often are restricted from accessing abortion services.
Samsara is developing and evaluating two complementary mHealth projects—a mobile application and a text-messaging platform—so that women can receive information about safe abortion in the format that best matches the mobile technology they currently use. Both projects will draw from content used for the hotline and other technical sources to provide step-by-step help with the medical abortion process, as well as information on identifying side effects and when to seek follow-up care.
Inna Hudaya, the founder of Samsara, says medical abortion has had a “revolutionary impact” on women because it gives them the opportunity to have control over the abortion process while in the privacy of their home or whatever setting they choose. However, she says, there is a great need for reliable information and counseling to ensure that women know how to correctly use medical abortion pills—and mobile technology offers an affordable and efficient way to get that information to women.
While the mobile application will be designed for Internet-enabled phones (smartphones), the text-messaging platform will be for feature phones, which are much more widely used in the rural areas of Indonesia. “Right now, most women find Samsara from searches on the Internet or through a smartphone, and most of these women are from big cities,” says Hudaya. “We need to reach more women—those who don’t have access to the Internet or smartphones, and who live in rural areas. And they are likely to be using feature phones.”
With respect to young women, in particular, Hudaya says, “We have to use the tools and the language they use. Indonesians love to chat. Text messaging is important to them. That’s why it’s important to have these text-messaging applications.”
“When it comes to safe abortion,” she adds, “it’s not just a matter of medical or clinical options. It’s also about comprehensive information on safe abortion. Mobile technology can help us get the right information to women. And that will mean they have the tools and information to make their own decisions about their future.”
mHealth across the continuum of reproductive health care
Ipas-supported projects focus on many aspects of abortion-related care, from data collection and management, to clinical care and social support. As Dr. Braun notes, “At Ipas, we’re using mobile technology to support women across the continuum of needs they experience in seeking and receiving safe, comprehensive abortion services, including postabortion care and contraception. There are ways to support health-care providers and community-based organizations as well.”
Among the key findings from Ipas projects implemented to date:
- Women in South Africa who had medical abortions and signed up for a free text message service providing support and follow-up information had a highly favorable response. Ninety-eight percent of the women who participated in client exit interviews said they had read every text, and 100 percent said the text messages had been helpful.
- Ipas-trained abortion providers in Nigeria who received a series of 77 post-training text messages providing clinical information, encouragement and reminders said the messages were useful and that they wanted to continue receiving them.
- In Kenya, the collection, reporting and utilization of reliable data on the numbers of women receiving abortion services at public health facilities improved significantly when data collection and reporting was shifted from a paper system to an electronic system using Android phones. Health-care providers and community members participating in the new system said they were comfortable with it and liked its quick and confidential nature.
- In a study in Bangladesh, three-quarters of women served by Ipas-trained providers had personal mobile phones, and almost all of those women expressed interest in calling a hotline to receive information about abortion care. These findings prompted a partnership with MSI to create a text message system to support postabortion contraception.
The ‘mHealth’ revolutionpromises to expand access to abortion care in the world’s poorest countries
Samsara’s Inna Hudayaon abortion access in Indonesia
Abortion in Indonesia research brief
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