Resources for researchers and program implementors

Ipas conducts policy- and program-relevant research to generate knowledge for the larger reproductive health and rights community. Our goal is to understand more about women’s needs and wants, test new approaches and build evidence for turning policy into practices. Here is a collection of some of our key research on selected topics:

Medical abortion and abortion self-care

Developing a forward-looking agenda and methodologies for research of self-use of medical abortion

In December 2016, a group of 20 global abortion researchers convened following the Africa Regional Conference on Abortion to discuss current and future research on medical abortion self-use. This article lays out their list of identified research gaps and methodologic considerations in addressing them—challenges that are intended to inform both ongoing and future research.

A research agenda for moving early medical pregnancy termination over the counter

We sought to determine if female community health volunteers (FCHVs) and literate women in Nepal can accurately determine success of medical abortion (MA) using an 8-question symptom checklist. Women’s and FCHVs’ assessments were compared to experienced abortion providers using standard of care. Women’s self-assessment of MA success agreed with abortion providers’ determinations 85% of the time. Agreement between FCHVs and providers was 82%. We concluded that use of a checklist to determine MA success is a promising strategy. However, further refinement of such a tool, particularly for low-literacy settings, is needed before widespread use.

Determination of medical abortion success by women and community health volunteers in Nepal using a symptom checklist

Given the overall safety profile and increasing availability of medical pregnancy termination drugs, we asked: would the mifepristone–misoprostol regimen for medical termination at ≤10 weeks of gestation meet US Food and Drug Administration regulatory criteria for over-the-counter (OTC) approval, and if not, what are the present research gaps? We conducted a literature review of consumer behaviours necessary for a successful OTC application for medical termination at ≤10 weeks of gestation and identified crucial research gaps. If we were to embark on a development programme for OTC or more generally, self-use of medical termination, the critical elements missing are the label comprehension, self-selection and actual use studies.

Determination of medical abortion eligibility by women and community health volunteers in Nepal: A toolkit evaluation

The objective of this study was to determine if pregnant, literate women and female community health volunteers (FCHVs) in Nepal can accurately determine a woman’s eligibility for medical abortion using a toolkit, compared to comprehensive-abortion-care-trained providers. Women presenting for first-trimester abortion, and FCHVs, independently assessed each woman’s eligibility for medical abortion using a modified gestational dating wheel to determine gestational age and a nine-point checklist of medical abortion contraindications or cautions. Ability to determine eligibility was then compared to experienced CAC-providers using Nepali standard of care. Both women and FCHVs accurately interpreted the wheel 96% of the time, and the eligibility checklist 72% and 95% of the time, respectively. Further refinement of the eligibility tools, particularly the checklist, is needed before their widespread use. 

Quality of abortion and contraceptive care

Governments, advocates, providers, policymakers and other stakeholders who want to fully support women’s rights to access abortion across the globe must address quality of care, in addition to efforts to change abortion laws, train providers and expand service provision. Documenting and working to improve the quality of abortion care is necessary in order to improve service delivery and health outcomes, expand access to safe abortion especially in legally restricted settings, and to ensure the human right to the highest attainable standard of health, as outlined by the WHO. 

Service delivery correlates of choosing short-acting contraceptives at the time of uterine evacuation in Bangladesh

Training and monitoring providers can help ensure that all uterine evacuation clients have access to the full range of contraceptive information and services and that women’s choices, rather than service delivery factors, drive postabortion contraceptive use. 

Abortion and human rights/women’s rights

Zika virus infection in Brazil and human rights obligations

The February 2016 WHO declaration that congenital Zika virus syndrome constitutes a Public Health Emergency of International Concern reacted to the outbreak of the syndrome in Brazil. But the government’s urging to contain the syndrome, which is associated with microcephaly among newborns, is confounded by lack of reproductive health services. Women with low incomes in particular have little access to such health services. The emergency also illuminates the harm of restrictive abortion legislation, and the potential violation of human rights regarding women’s health. Proposed suggestions for remedying the widespread health-care inequities in Brazil are instructive for other countries where congenital Zika virus syndrome is prevalent.

Intimate partner violence and constraints to reproductive autonomy and reproductive health among women seeking abortion services in Bangladesh

The objective of this study was to understand intersections between intimate partner violence (IPV) and other constraints to women’s reproductive autonomy, and the influence of IPV on reproductive health. There were 457 participants included in the analysis and 118 (25.8%) had experienced IPV in the preceding year. IPV was associated with discordance in fertility intentions with husbands/partners and in-laws, with in-law opposition to contraception, with perceived religious prohibition of contraception, and with presenting unaccompanied. Ensuring women’s reproductive freedom requires addressing IPV and related constraints. 

Abortion stigma

The objective of this research was to explore the context of abortion stigma in Ghana and Zambia through qualitative research, and develop a quantitative instrument to measure stigmatizing attitudes and beliefs about abortion. Focus group discussions were conducted in both countries, and a Stigmatizing Attitudes, Beliefs, and Actions scale was created. It captures three important dimensions of abortion stigma: negative stereotypes about men and women who are associated with abortion, discrimination/exclusion of women who have abortions, and fear of contagion as a result of coming into contact with a woman who has had an abortion. It provides a validated tool for measuring stigmatizing attitudes and beliefs about abortion in Ghana and Zambia and has the potential to be applicable in other country settings.

Understanding abortion-related stigma and incidence of unsafe abortion: Experiences from community members in Machakos and Trans Nzoia counties Kenya

This study sought to explore abortion-related stigma at the community level as a barrier to women realizing their right to a safe, legal abortion. It found that abortion-related stigma plays a major role in a woman’s decision on whether to have a safe or unsafe abortion. Young unmarried women, in particular, bore the brunt of being stigmatized. 

Cost-effectiveness of abortion provision

The objective of this study was to estimate the costs of public-sector abortion provision in South Africa and to explore the potential for expanding access at reduced cost by changing the mix of technologies used. It concludes that South Africa can provide more safe abortions for less money in the public sector through shifting the methods provided–and says that more research is needed to understand whether the cost of expanding access could be offset by savings from averting costs of managing unsafe abortions. 

Costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa

This analysis aimed to estimate the costs and cost- effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings. It found that the cost per complete medication abortion was lower than the cost per complete MVA. This analysis supports the scale-up of medication abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication abortion with MVA as a back-up, without increasing costs.