Access to safe abortion in Mozambique

OUTCOME 1: SUPPORTED THE CREATION OF ENABLING AND SUSTAINED POLICY ENVIRONMENT FOR ACCESS TO SAFE ABORTION FOR WOMEN AND GIRLS •Approval and promulgation of Mozambiques revised Penal Code that includes language that improves (Sexual and Reproductive Health and Rights) SRHR and Comprehensive Abortion Care (CAC) access; •Development and approval of Clinical Standards and Guidelines. •Inclusion of mifepristone in the Input Acquisition Plan of Maternal Health Program, although still waiting to be included on the National List of Essential Medicines. •Approval of monitoring guidelines (supervision and mentoring checklists) to optimize MCH services, including sexual and reproductive health and CAC services. •Develop a pilot instrument to monitor main CAC indicators at provincial level and has been used as evidence to improve the gynecological urgency Book now in revision. •Approval of a National Communications Campaign to inform and promote abortion services and Post Abortion Family Planning. •Preparation of national guidance for recommended SRH service flow in the context of COVID-19, and general guidelines for the prevention of COVID-19. •Strengthened the skills of the SRH group members in using the SIGLUS platform so health facilities could better monitor drug stocks and reduce the incidence of stock-outs. •Defined strategies to improve CAC indicators for postabortion contraception coverage and pain management, and established a multidisciplinary team to monitor the program at the facility and district level. OUTCOME 2: IMPROVED AVAILABILITY AND ACCESSIBILITY OF SERVICES FOR GIRLS AND YOUNG WOMEN THROUGH MULTIPLE POINTS OF CARE •Ipas partnered with the Ministry of Health to design activities to strengthen the public health systems capacity to offer high-quality comprehensive abortion and contraceptive services. Over 6 years, Ipas sensitized public-sector staff, trained providers, and equipped and renovated facilities in the two target provinces. Some of the interventions results are briefly listed below: •41 Health facilities supported in Nampula and Zambezia provinces. •Rehabilitated and/or equipped a total of 39 gynaecological emergency rooms with minimum quality standards, improving privacy and confidentiality. •Established a province-level training center at an existing public- sector health-care facility for subsequent Training of Trainer (TOT). •Built a network of 32 provincial Master Trainers that are equipped with the necessary competence and confidence to lead subsequent CAC trainings for health service providers in the provinces in partnership with the Institute of Psychology, DPS Nampula and DPS Zambézia provinces. •Supported MoH in developing guidance for healthcare providers and health facility managers to ensure access to SRH services including abortion services during the COVID-19 period. •Monitoring and mentoring tools for CAC services throughout the country designed and officially approved. •42 district health statistics technicians and Heads of the District Statistics Centers (NEDs), 36 district maternal and child health supervisors and one general medicine technician trained on Data Monitoring and Evaluating System. •Two Training centers rehabilitated and equipped to serve as public training centers for CAC. •744 public health providers (MCH nurses, general practitioners and specialists), 42 SAAJ providers and 30 MCH teachers trained in comprehensive abortion care services. •77 health workers (18 in Nampula and 59 in the Zambézia) who deal with emergency obstetric care in partnership with Mozambican Association of Obstetricians and Gynaecologists. •165 public sector pharmacists, 33 private pharmacist and 192 health managers trained to ensure provision of Medical Abortion information and supplies. •Developed and updated training materials and capacity-building frameworks including regular refresher and mentorship sessions. •A hotline on WhatsApp for anonymous SRHR questions and/or to locate/connect with 295 members and trusted providers and trainers created. •Virtual technical support and CAC service availability during COVID-19 pandemic in Nampula, Zambézia provinces ensured. •22 monitoring clinical visits at selected facilities to assess the quality and sustainability of CAC services conducted. •Provincial clinical mentoring networks for CAC in Nampula and Zambézia composed of 25 mentors established. •2,651 community intermediaries who take part in Ipas activities to ensure provision of Medical Abortion information, supplies, and referral linkages. •Alô Vida hotline care for patients seeking information about abortion and post-abortion care services in gynecological consultations for the self-use abortion strategy. OUTCOME 3: INCREASED YOUNG WOMENS AND GIRLS KNOWLEDGE AND AGENCY AND STRENGTHENED THEIR SOCIAL SUPPORT NETWORKS •Ipas supported 33 youth-friendly health service (SAAJ) corners, 16 in Zambezia and 17 in Nampula, providing technical assistance to health providers to strengthen the referral of adolescents for CAC services. The SAAJ corners are a key link between the community and CAC services at health facilities. • In an effort to engage teachers and community leaders who support youth corners, Ipas conducted VCAT workshops aimed at reducing stigma and discrimination around gender-based violence. In Nampula, 48 teachers and 37 community leaders from 8 districts participated in the workshops, including Nampula, Rapale, Ribaué, Murrupula, Mogovolas, Meconta, Eráti and Muecate. In Zambezia province, 38 teachers and 30 community leaders from Mocuba, Quelimane, Nicoadala and Namacurra districts were reached •In 2021, with support from Ipas and the Technical Working Group, MoH approved the First communications Strategy on abortion in Mozambique. Ipas Mozambique developed a training package for Community stakeholders on this strategy and trained trainers in each province to support dissemination. The research, titled Understanding barriers and facilitators to safe abortion options in Nampula and Zambézia provinces was conducted in 2018 in three communities in Nampula province (Nampula City, Nacala-Porto and Mogovolas) and three communities in Zambézia province (Quelimane, Mocuba and Mugeba locality in Mocuba district). The research helps fill a critical evidence gap vis-à-vis abortion in Mozambique. It was useful to inform the MoH National Plan with latest evidence on young women´s and girls´s abortion experience and preferences. KEY INSIGHTS OF ABORTION KAP STUDY •Unwanted pregnancy and abortion cause significant physical and emotional wide-ranging impact on womens and girls lives because of prevalent stigma and discrimination against women and girls; •Although abortion is perceived as risky and undesirable, it is often seen as the only option for a woman or girl wanting to avoid the consequences of an unwanted pregnancy; •Abortion is not seen by girls as a right, but rather the end of a shameful, unsustainable situation, or as a way of avoiding the far-reaching consequences of a pregnancy; •Gender roles have a strong influence on the outcomes of unwanted pregnancies and abortions; and •Lack of knowledge about safe options for abortion, fear of the familys reaction to the pregnancy, rejection by the partner, and fear of stigmatization often lead girls to procure an unsafe abortion in secret. OUTCOME 4: NEW KNOWLEDGE GENERATED AND DISSEMINATED •Community Radio is one of the main actors of Ipas Communication Strategy. After a mapping, Ipas established 21 community radio stations partnerships (9 of Nampula and 12 of Zambezia) to promote SRHR and community engagement activities around safe abortion. •Ipas trained 26 media professionals on SRHR including safe abortion and contraception, relevant laws, policies and regulations, and use of VCAT to bring out and address values conflicts and stigma surrounding SRHR and abortion and contraceptive services. The training was conducted in collaboration with the Institute of Social Communication and Health Promotion Office within the Department of Public Health and DPS in Nampula and Zambézia provinces. •All stations are under the supervision of Social and Communication Institute (ICS), Community Radio Forum (FORCOM) and the Ministry of Science and Technology/UNESCO, all produced radio programs that integrate SRHR content that include contraception, and all stations hold a commitment to using radio to promote public health more broadly (e.g. education on malaria and other diseases). In terms of reach, its estimated that the Community Radio stations reached an audience of about 2,520,000 listeners, with about 1,710,000 listeners in Zambézia and about 810,000 listeners in Nampula.

The goal of the project is to improve the knowledge, ability, opportunities, and choices of women and girls in Mozambique to access safe, high-quality abortion care and contraception. Ipas would achieve this goal through the following four outcome areas: •outcome 1: support the creation of an enabling and sustained policy environment for access to safe abortion for women and girls. •outcome 2: improved availability and accessibility of services for girls and young women through multiple points of care. •outcome 3: increased young womens and girls knowledge, agency and strengthened their social support networks; and •outcome 4: new knowledge generated and disseminated.