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Table of contents

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This thematic meeting on Contraception and Abortion was the first of 4 thematic meetings to be

organised by Share-Net in 2015. Share-Net members Women on Waves, AIGHD, ICCO Alliance,

KIT, PSI-Europe, Simavi, Radio Netherlands Worldwide and the Ministry of Foreign Affairs co-

organised the meeting. SRHR professionals from abroad and from the Netherlands and an

audience of individual experts, people from Dutch non-profit organizations, universities, research

institutes and the Ministry of Foreign Affairs gathered in the IDA zaal in The Hague. About 50

people were present.

Dr. Caron Kim, Medical Officer, WHO, (Department of Reproductive Health and Research) and

Marge Berer, founding editor of Reproductive Health Matters and Coordinator of the International

Campaign for Women’s Rights to Safe abortion, provided an update on developments in

contraceptives and abortion: methods, perceptions, acceptability and use. After listening to their

presentations, participants explored their personal norms, values and perspectives on

contraception and abortion. Then, Women on Web, Ipas and Simavi shared experiences and

promising strategies on how to increase access to contraception and safe abortion services at

community level by showing 3 cases from the field. The thematic meeting ended with two

interactive sessions during which participants identified implications for policy, programmes and

research based on what had been discussed in the meeting.

Please find the slides of Dr. Caron Kim in the attachment and the full text of her presentation in

annex 1.

In her presentation, Dr. Kim aims to review the global and

regional trends on contraceptive access, to provide an update

on contraception with a focus on the new contraceptive

technologies and to highlight WHO’s normative work in

contraception and abortion.

Dr. Kim highlights the high unmet need for modern

contraceptives stating that about 140 million women

worldwide, or one in five women who are married or in union

say they would like to delay or avoid pregnancy, but do not

have access to voluntary family planning. If traditional method

users are included, this number rises to 215 million married or women living in union with an

unmet need for modern methods.

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As emerging contraceptive methods, Dr. Kim reflects upon progesterone receptor modulators,

multi-purpose technologies, male contraception immunocontraception (for more information see

the full text). Furthermore, Dr. Kim presents efforts employed by the WHO to address the unmet

need for family planning. She mentions, amongst others, research accomplishments, technical

consultations, the umbrella fund, agenda setting activities, etc.

Dr. Kim closes her presentation by elaborating on guidelines and normative work in family

planning/contraception carried out by the WHO.

Q: Why has anti-hcg1 research stopped? According to Dr. Kim, the WHO family planning team said

it was because it was a good idea in theory but that it did not show enough promises to move

forward at the onset of the research and when looking at the pharmaceutical studies performed.

Another reason was that, at the same time, multi-purpose methods seemed more promising. So,

because multi-purpose methods were more feasible, anti-hcg research shifted down on the

priority list.

1 hCG (human chorionic gonadotrophin) is a hormone secreted in pregnancy that is made by the developing embryo soon

after conception and later by the syncytiotrophoblast (part of the placenta) to maintain the fetal viability preventing the disintegration of the corpus luteum of the ovary and thereby maintaining progesterone production that is critical for a pregnancy in humans; it also affects the immune tolerance of the pregnancy.

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Q: How is WHO/HRP? addressing the issue of conscientious -objection?

Dr. Kim: Conscientious objection is when the provider does not want to provide the care that

women ask for. The provider refuses because they do not believe in it. It is the same with

pharmacists: they don’t provide it because they do not believe in it. To address this, WHO has

responded in various documents that we need to increase access/provision; this is what needs to

be acknowledged and there have been various meetings with providers and value clarification

exercises. Conscientious -objection needs attention and further to this focus should be on

reproductive choice for women: they need to be provided with what they want.

Q: How much priority is given to contraceptive development for men?

Dr. Kim: It is a priority, preliminary research had to be stopped because of the adverse effects,

but there is interest so there will not be a complete stop to it.

Q: I wanted to mention the environmental factors you mentioned at the beginning of the

presentation. How are we looking at this issue? Implants that are biodegradable?

Dr. Kim: This is indirectly being addressed, but it is basically looking at how they can

provide/decrease the repercussions on the economy when the need is not being met or not being

used properly. So the various systems that are not being disposed correctly can basically hurt the

environment. Therefore, they are putting implants that the provider can take out and in that way

can protect the environment.

Resources that are in the pipeline:

Guidelines on mid-level provision of safe abortion care: Estimating the magnitude and

impact of unsafe abortion

Multi-country survey on abortion

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Please find the complete presentation of Marge Berer in the attachment.

The second presenter during this thematic meeting is Marge Berer, Founder Editor of

Reproductive Health Matters and coordinator for the International Campaign for Women's Right

to Safe Abortion.

After her introduction, Marge Berer, summarizes women's main reasons for non-use of

contraception. She mentions that the level of unmet need for contraception (estimated 222

million women in developing world, 2012) declined only slightly in recent decades. Marge Berer

notes that a lack of access to family planning education and information exists as well as

unwillingness to risk the social disapproval associated with seeking services are barriers to using

contraceptives for young unmarried women.

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Policy, legal and political reasons for non-use, are other reasons for not using contraceptives. For

example, there is a failure of health systems to make all methods available, there are campaigns

against methods due to abuse of informed consent, refusal exists by providers to provide ‒

conscientious objection to provide contraceptives to single women or in absence of husband

consent, etc.

So, what is it that women actually need? Most of the time, sexually active women want to avoid

getting pregnant, and when necessary, terminate unwanted pregnancies. This includes mostly

adolescents and young people, those who don’t want any children, and those who have already

had the children they want. Having babies is occupying only a few of women's fertile years (if at

all). A substantial group of women and men are remaining childless. People need good

information, access to a range of affordable methods, good quality services and help with

problems to avoid method failure and discontinuation.

Adolescents and young people, experience the most unwanted pregnancies, STIs and HIV. They

are sexually active but have least access to services. Among the 21.6 million women each year

with unsafe abortions, adolescents suffer the most from complications and have the highest

unmet need for contraception, but they are still not perceived as eligible for “family planning” in

many countries. They suffer from a lack of access to knowledge about sex, bodies and fertility,

how to negotiate safe, wanted sex and refuse unwanted sex, how to talk to partners about sex

and using protection. Adolescent girls in particular experience widespread pressure and coercion

to have sex. Too little effort is made to ensure young people have someone to talk to or know

where to get help.

Finally, Marge Berer argues that abortion is not a problem, it's a solution. She mentions that one

should stop using stigmatising language about abortion. Instead we should use language

supportive of women’s right to decide for themselves. For example:

Contraception, abortion and sterilisation are all safe and legitimate methods of controlling

fertility.

Abortion is as much a part of women’s experience as pregnancy.

Preventing unwanted pregnancy and providing safe abortions are equally important ways

of meeting women’s reproductive health needs.

Abortion is the keystone of women’s liberation.

Q: You mentioned alternative abortion providers, e.g. nurses, midwives. In many countries, even

where abortion is legal, many doctors don’t know how to perform a surgical abortion. How do you

see this integrated into the medical curricula?

M. Berer: If you look at a list of competencies of midwives, a whole section can be found about

competency related to abortion, but almost no one gets this training. Medical training includes a

couple of hours, there is very little on it, unless someone asks about it. This problem needs to be

addressed. We should propose a basic training on provision of abortion to be put into the

curriculum of medical schools and of nurses and GP’s as well. Doctors are reluctant: they hand

you a prescription or pills, that is all they have to do. It is only where abortions are unsafe that

women need to get to hospital for incomplete abortions. This is a major area that is not getting

enough attention.

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All participants were asked to fill out a questionnaire at the beginning of the meeting, which

formed the basis of the statements used in this session. Please find the outcomes of the

questionnaire attached to this report.

During the session, participants were asked whether they ‘agree’ or ‘disagree’ with each

statement, thereby forming two “camps” standing opposite each other.

Statement 1: One pill that can be used for both contraception and medical abortion would be a

good thing.

About 8 people disagree, 30 people agree.

Reasons to agree:

It can be really pragmatic and having a medical abortion will become more accessible.

Having an abortion can be done earlier (right after conception), which makes it less

invasive for the woman.

Bringing contraception and abortion into one category challenges the idea that they are

separate.

Reasons to disagree:

It is preferred to separate the pill from abortion. If we put them together, then we are

asking for problems: my daughter will never get an IUD if contraception can be used for

abortion as well. People who don’t like abortion have a valid point that should be

respected. You’re asking for more resistance, including resistance to contraception, if you

combine both.

It can be used but we need to be clear about it being in the same package.

From my experience in Africa, I have seen many churches and people who agree with

contraception but don’t agree with abortion, so it is better to keep the two separate.

If a person is illiterate, and the service provider doesn’t give you the proper information,

then this determines whether it’s a good thing or not.

Statement 2: Abortion should always be allowed.

About 10 people disagree, about 28 people agree.

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Reasons to agree:

Women should have the right to decide for themselves. They should be supported in their

decisions.

When it is seen that something of the foetus is not viable, women should be able to have

an abortion.

The child should be wanted; otherwise the child can also be hurt when it is born.

Reasons to disagree:

The right of unborn child is important, although not often discussed. Life is precious, also

unborn life.

I am comfortable that it is the right thing as an activist, but if I really look at my own beliefs

I think the only person who can decide ever is the woman. So I’m at the wrong side.

It’s context-related. The situation and the quality of the health system in many countries

is not that good. If a baby is 8 months and needs to be aborted, it causes a lot of problems.

The baby’s age matters.

Sanderijn: question: abortion should always be allowed. Would you still agree if a woman is

pregnant for 39 weeks and says she wants to abort her baby?

How many women do that? The answer is none.

I am in the position that abortion should always be a decision of the woman herself. If she

makes this decision, she has a good reason for that.

Statement 3: Making the abortion pill available for everyone via telemedicine is a good thing.

About 6 people disagree, 32 people agree.

Reasons to agree:

In many health care settings there is rarely proper counselling and almost never post-

abortion counselling. It is therefore maybe even better to do it at home because it’s in a

safe environment without judgemental providers. There’s always the assumption that we

need 7 days to think, why are we always psychological unstable? Why are we not able to

handle an abortion? Only because our emotions fluctuate a bit around our menstrual

cycle?

Counselling is overrated and patronizing and makes woman look like they are not able to

make a decision about such an important issue in their life. Counselling is available if they

want, but not as a mechanism that should be there (compulsory).

Issue is access: counselling is a huge thing but if a country forbids abortion, and it’s the

only option a woman has, than it’s important abortion is there, even without counselling.

Reasons to disagree:

If a woman is psychological stable it can be an option: but many women are not stable in

that period

If a woman orders pills by internet, no one can give proper counselling/information

Women should decide themselves but it should be an informed decision

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Please find the slides for each presentation attached to this report.

1. Women on Web: Rebecca Gomperts

‘ Task shifting in the provision of medical abortion’

Hypothesis: Task shifting in the provision of medical abortion may result in increased access to

and availability of medical abortion services while maintaining the same quality of care. Task

shifting can be done from physicians to other healthcare professionals or provided directly to

women with the use of telemedicine.

Assumptions:

1. Restricting access to safe abortion care causes higher morbidity and mortality.

2. Women around the world still face many obstacles when trying to access safe abortion

services. These can be:

- legal

- financial

- administrative and procedural

- logistical

3. Medical abortion is one of the safest medical procedures, with minimal morbidity and a

negligible risk of death.

4. Increased access to medical abortion can lead to a decline in maternal morbidity and

mortality.

5. Telemedicine can reach women with access to modern communication.

Note: that the taking of tablets sublingual is not recommended by WHO. However, Women on

Waves found that some women prefer the taking of tablets despite the side effects. A reference

for WHO guidelines for medical abortion can be found in the literature list provided in annex 3

2. Ipas – Alyson Hyman ‘Tanzania: access to medical abortion through rural pharmacies’

Abortion is legally restricted in Tanzania: it is only permitted to save a woman’s life. Local

women’s groups have set up pharmacies to stock and distribute misoprostol. Various medicines

are sold there (e.g. cold medicines, contraceptives, etc.). The Pharmacies have an alliance with

like-minded doctors to provide support for problems or complications. Misoprostol is used for

preventing post-partum hemorrhage, treating incomplete abortion, and inducing safe abortion.

The outcomes of this set up are:

• Easy access to supplies

• Increased availability of misoprostol and contraceptives

• Access to counseling

• Increased awareness and demand

• Created competition among private drug sellers, reducing prices

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This model works well based in this rural setting because there’s enough time to talk to a

woman; there are no long queues. There is a song that community facilitators have taught to

women about how to take the pills: songs are effective in this community and also good for

women who are illiterate. As far as Ipas can tell, this has been a very successful model[1] for a

rural area like this.

3. Simavi – Lara van Kouterik

‘India: using community scoring cards’

This case is about the use of a social accountability mechanism for contraceptives. A women’s

group in India used community scoring cards: a list of questions they go through regularly and

by filling it out they make their needs visible. Simavi did this in a number of villages. The results

are presented in the village health committee: a platform where decision-makers address the

gaps they identified through their scoring cards. What impact did this have on uptake? It started

in 2011 with contraceptive options in 16 clinics. After two years, 11 out of 16 clinics increased

contraceptive choice: more methods were available and family planning counselling was

offered, which was not happening at the beginning of the project. The number of women who

didn’t know any form of contraception decreased. By having different groups of women

represented, Simavi saw an increased demand of Muslim women for contraceptives. But at the

same time there was a challenge to increase uptake in this group, having to do with cultural

taboos, etc. We had to include men and increase their access to contraceptives. This case

showed that social accountability mechanisms have a positive effect on family planning uptake

and choice and has been successful because various stakeholders are included in the

development committee: a platform is created where women have a voice and are being heard.

In this session, initially 6 groups started to

discuss the implications for their work. In

the next round, groups were combined into

3 groups and each of these groups had to

finalize 3 main implications in the field of

programme, research and policy.

The outcomes of the discussions are:

[1] More information: http://www.ipas.org/en/Get-Involved/Because/Because-Summer-2013/Harm-Reduction.aspx

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1. Contextualisation of policies/programmes/approaches to get maximum effect for

women (+ men) (+well-functioning health system)

2. Training of providers (incl. at primary care level) (+strengthening health systems)

3. Communication, sharing knowledge + collaboration. Working towards SRHR for all,

including safe abortion. Make full use of available (informed/trained) media.

1. Programmes should be needs-driven,

evidence-based, community-based &

youth-friendly, including males, and

empower women

2. Task shifting is important to improve

access and acceptability (including

the use of modern technology)

3. Promote integrated services to

increase access for services that are

not easily accessible/acceptable on

their own

4. Reduce regional disparities between

groups in-country, e.g. migrants or

refugees

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1. What are the best ways to

communicate and enforce people’s

right to contraception & abortion?

2. Conduct a political and economic

analysis of how individual

contraceptive choice is affected by

global dynamics (e.g. pharmaceutical

companies)

3. Promote research on contraception

& abortion beyond hormonal

commodities (based on what women

want; look at combining methods,

e.g. condom & early abortion)

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As we all know, contraception is a primary prevention strategy that can save many lives by averting

unintended pregnancy. The lifetime risk of maternal death, or the probability of dying from a

pregnancy or childbirth related cause during a woman’s reproductive life span is quite high in a

number of regions across these continents. It is influenced by both the risks associated with an

average pregnancy as well as the number of times a woman gives birth. Access to safe abortion

is also important. Each minute every day, a woman dies from pregnancy or childbirth-related

causes. Most recent estimates suggest that annual maternal deaths total nearly 300, 000

worldwide, and nearly 50,000 women die each year due to the complications of unsafe abortion.

Most deaths occur in developing countries in Africa and Asia. Approximately 20% of maternal

deaths occur in India. Approximately 94,000 maternal deaths could be avoided each year if all

women who said they want to avoid pregnancy were able to stop childbearing either temporarily

or permanently. Unfortunately, the benefits from family planning are not realized in many

locations around the world where the unmet need for family planning remains substantial.

While measures to support family planning access and uptake are formally included within the

targets for Millennium Development Goal 5 (to improve maternal health by reducing maternal

deaths by three quarters and achieving universal access to reproductive health services),

contraception is a key cost-effective intervention that can substantially improve health and

development more broadly. Facilitating family planning, birth spacing and limiting in line with

women’s and families’ fertility goals, has important implications for achieving all the other MDGs.

For example, in the eradication of poverty and hunger (MDG 1), use of contraception to limit family

size can help improve the economic status of families, communities and countries by reducing

demand for scarce food resources. Moreover, contraception can help girls stay in school,

important for achieving MDG 2 (universal primary education); girls often leave school because of

unintended pregnancies or to take care of younger siblings.

Avoiding unintended pregnancy and birth spacing and limiting also empowers women and

changes gender norms, improves child health and well-being, reduces HIV transmission, and

decreases demands on ecological resources. Indicators being used to track progress include

contraceptive prevalence rates, unmet need for family planning, and adolescent birth rates.

Globally, maternal mortality has declined by 47% over the last two decades. While progress falls

short of achieving MDG 5 by the 2015 deadline, all regions have made important gains. Maternal

mortality has declined by about two-thirds in Eastern Asia, Northern Africa and Southern Asia.

African countries show wide disparities in maternal and reproductive health. Maternal mortality

tends to be lower in countries where levels of contraceptive use and skilled attendance at birth

are relatively high. With a contraceptive prevalence of only 25 percent and low levels of skilled

attendance at birth, sub-Saharan Africa has the world’s highest maternal mortality ratio. Some

140 million women worldwide, or one in five women who are married or in union say they would

like to delay or avoid pregnancy, but do not have access to voluntary family planning. If traditional

method users are included, this number rises to 215 million married or in-union women with an

unmet need for modern methods.

According to the most recent data available from the UN Department of Economic and Social

Affairs, Population Division, contraceptive prevalence among women of reproductive age who are

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married or in a union varies between 4 per cent in South Sudan and 88 per cent in Norway.

Contraceptive prevalence is lowest in Africa (31 per cent), and less than 25 per cent in Middle

Africa and Western Africa, and 70 per cent or higher in Europe, Latin America and the Caribbean

and Northern America.

Nine out of every 10 contraceptive users in the world rely on modern methods of contraception.

For the world as a whole, female permanent contraception (formerly known as sterilization) is the

most common method of contraception, used by 19 per cent of women aged 15 to 49 who are

married or in a union. Female sterilization is most prevalent in Latin America and the Caribbean

at 26%. The IUD is the second most widely used contraceptive method worldwide. It is most

commonly used in Asia (18%) and its prevalence is highest, greater than 40% in China, the People’s

Republic of Korea and Uzbekistan.

Recognizing the uneven progress towards achievement of the MDGs with targets for maternal

health lagging behind, further global initiatives have emerged to help mobilize resources to

increase access to contraception. Launched by UN Secretary-General Ban Ki-moon during the

United Nations Millennium Development Goals Summit in September 2010, Every Woman Every

Child is a global movement to mobilize and intensify international and national action by

governments, multilaterals, the private sector and civil society to address the major health

challenges facing women and children around the world. The movement puts into action the

Global Strategy for Women’s and Children’s Health, which presents a roadmap on how to enhance

financing, strengthen policy and improve service on the ground for the most vulnerable women

and children. It includes work to strengthen measurement of 11 indicators and includes one on

family planning. Further, the London Summit of 2012 reinvigorated family planning (FP) as a

health and development issue of global importance, particularly in low resource settings. Family

Planning 2020 (FP2020), the initiative launched out of the summit, pledges to increase access to

voluntary family planning information, contraceptives, and services to 120 million more women

and girls in the world's poorest countries.

FP2020 complements and contributes to the UN Secretary General's Strategy for Women's and

Children's Health, 'Every Woman, Every Child', and its efforts to improve accountability. By 2020,

the goal is to deliver contraceptives, information, and services to a total of 380 million women and

girls in developing countries so they can plan their families. Currently in the field of contraceptive

research, a number of efforts are underway to enhance or alter existing methods in ways to

improve acceptability while also exploring innovative technologies for new methods and delivery

systems. I will talk briefly about some such developments.

Oral contraception

In recent years, a number of alternative pill-taking regimens to the traditional 21/7 active/placebo

administration (24/4, 84/7 and 365) have demonstrated reduced risks for ovulation and

acceptable bleeding patterns with no adverse effects on safety. In addition, there is ongoing

research exploring pills for pericoital administration among women with infrequent intercourse.

RHR is engaged in a study evaluating the safety and effectiveness of use of LNG emergency

contraceptive pills as a primary contraceptive in this setting. New combined pills containing

natural estrogens are being used with the objective of overcoming metabolic effects and

decreasing the thrombotic effects associated with ethinyl estradiol, the traditional estrogen

commonly found in combined pills. Large safety studies are ongoing to evaluate for these

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potential benefits. (Estradiol valerate and estradiol). New molecules such as selective

progesterone receptor modulators are also being explored and show promise as future oral

contraceptive products, both for daily use and as emergency contraception.

Vaginal ring

The combined hormonal contraceptive vaginal ring is a relatively new hormonal contraceptive

method, considered a semi-long acting method with high acceptability and effectiveness. This

delivery system is favorable because it is user-controlled with easy insertion and removal

independent of a health provider. One CVR in development uses low doses of nestorone in

combination with ethinyl estradiol and is designed for one year of use. Nesterone, developed by

the population council is a progesterone derivative with no androgenic or estrogenic effects that

is highly effective in blocking ovulation when delivered via non-oral routes. Another ring releasing

the selective progesterone receptor modulator, ulipristal, is in development.

Transdermal systems

Of note, there is a new combined hormonal patch being tested using the highly potent

progesterone, gestodene, with a low dose of estrogen (9 mcg/d) that shows promise. Additional

developments include combination hormonal gels and skin spray.

Injectables

You are probably aware of the development of a self-injectable system for administering DMPA

which could considerably improve the method if it becomes a user-controlled self-injectable with

a requirement for less trained providers.

LARC

New IUD that are associated with smaller frames and various progestin doses are being studied.

The addition of other molecules such as SPRMs or indomethacin are meant to reduce side effects,

offer additional health benefits and improve efficacy.

Emerging contraceptive technologies

Selective progesterone receptor modulators are a key class of molecules being investigated for

contraception as I was mentioning. To clarify, selective progesterone receptor modulators (SPRM)

are agents that act on the progesterone receptor. A characteristic that distinguishes such

substances from receptor full agonists (like progesterone) or full agonists (like mifepristone) is

that their action differs in different tissues– it is an agonist in some and antagonist in others. The

mixed profile leads to selective stimulation or inhibition progesterone-like action in different

tissues and furthermore raises the possibility of dissociation of desirable therapeutic effects from

undesirable side effects in synthetic progesterone receptor drug candidates. These molecules

are being studied for use across a number of delivery systems- pills, rings, gels, and intrauterine

contraception.

Research into multi-purpose technologies desires to combine multiple health benefits into a

single delivery system, commonly linking both pregnancy and STI prevention. This is a very

important area of investigation as there is an urgent need to help women protect themselves

against sexually transmitted infections, particularly HIV/AIDS and to prevent unintended

pregnancy. Several CVRs are under investigation that release both the progesterone

levonorgestrel with one of several anti-retroviral medications. Additionally, a combination of

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similar agents for vaginal application as a gel are also showing some promise. As far as methods

for men are concerned, simplicity, reversibility and effectiveness are desirable characteristics.

Current efforts to develop male hormonal contraception include treatment with androgen alone

or androgen in combination with a progestin or feedback suppression of the hypothalamic-

pituitary-gonadal axis. Various delivery systems including pills, injections, implants and gels are

under investigation. The notion of immunocontraception or the development of a contraceptive

vaccine is also a compelling area of research. Leading targets for investigation include anti-sperm,

anti-LH and anti-HCG vaccines.

Now having these methods does not translate to meeting the FP needs. To address the unmet

need for family planning, there have been several different efforts employed by WHO. In

November 2012, WHO and partners convened a meeting dedicated to sharing information about

new contraceptive technologies and to determining HRP/RHR’s role in contraceptive research. A

number of scientific experts, clinical and community providers, programme managers, academic

institutions NGOs and partner agencies with global representation were gathered with the

following objectives: To share the state of the art of contraceptive methods (current and pipeline)

and their potential to expand the family planning method mix, and to identify research gaps and

needs in global efforts to widen the range of family planning commodities. The meeting resulted

in determining the four main areas for HRP/RHR to advance the family planning research agenda.

These include basic science research, product development, clinical trials for effectiveness and

safety as well as implementation science. Task forces were formed among participants at the

meeting to advise the department on project development.

As mentioned in the Umbrella grant, existing WHO guidelines will be utilized and ensured their

implementation to in the countries. In addition to the diverse resources currently available from

WHO to support evidence-based family planning policies and practices, a number of documents

have recently been produced by WHO to facilitate improved contraceptive access that I would like

to share with you. (Review of WHO guidelines: 4 Cornerstones which includes the updated MEC

guidelines 5th edition; Safe Abortion Guidance and Clinical Handbook. In the pipeline: Guidelines

on mid-level provision of safe abortion care, Estimating the magnitude and impact of unsafe

abortion, Multi-country Survey on Abortion and Policies on Abortion).

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Marge Berer

Coordinator of International Campaign for Women’s Rights to Safe abortion (info@safeabortionwomensright.org)

Lucia Berro University of Groningen

Moniek van den Bogaard MinBuza

Rosalijn Both UvA

Jennifer Bushee GNP+

Marina Manger Cats Individual

Kristen Cheney ISS

Lotte Dijkstra Youth ambassador

Colin Dixon Share-Net

Sanderijn van der Doef Rutgers WPF

Veronica Fernandez Women on Waves

Rebecca Gomperts Women on Waves

Billie de Haas Individual

Amalia Puri Handayani

Odette Hekster PSI Europe

Kate Hencher PSI Europe

Stefan Hennis Choice for youth and sexuality

Patricia Hernandez UNFPA/NIDI

Karen t Hooft Share-Net

Susan Huider KIT / Share-Net

Alyson Hyman Ipas

Emma de Jong Women on Waves

Dick Jungst Concept Foundation

Julia Kahana Women on Waves

Caron Rahn Kim WHO

Korrie de Koning KIT

Winny Koster AIGHD

Lara van Kouterik Simavi

Aika Van der Kleij Simavi

Lincie Kusters KIT

Elly Leemhuis MinBuza

Corie Leifer AFEW

Lisa Ligterink Cordaid

Agnieshka Olszewka Women on Waves

Charlotte Petty PSI Europe

Catherine Garcia Porras Lecturer & consultant

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Jan Reynders Individual

Jeanette Slootbeek Individual

Meike Stieglis Share-Net

Karin van der Velde MinBuza

Douwe Verkuyl

Karin Vrijburg UNFPA/NIDI

Remco Van der Veen Cordaid

Anke Plange-Well Prisma

Anneke Wensing Rutgers WPF

Nienke Westerhof STOP AIDS NOW

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1. Guidelines & factsheets

ARHP (2014). Choosing a birth control method. A quick reference guide for clinicians.

https://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for-

Clinicians/choosing/Injectable

Guttmacher Institute (2012). Facts on Induced Abortion Worldwide.

http://www.who.int/reproductivehealth/publications/unsafe_abortion/induced_abortion_2012.p

df

Ipas. Medical Abortion: Frequently Asked Questions

http://www.ipas.org/en/What-We-Do/Comprehensive-Abortion-Care/Elements-of-

Comprehensive-Abortion-Care/Medical-Abortion--MA-/Medical-Abortion-FAQ.aspx

WHO (2014). Clinical handbook on safe abortion.

http://apps.who.int/iris/bitstream/10665/97415/1/9789241548717_eng.pdf?ua=1

WHO (2014). Ensuring human rights in the provision of contraceptive information and services

Guidance and recommendations.

http://apps.who.int/iris/bitstream/10665/102539/1/9789241506748_eng.pdf?ua=1

WHO (2012). Safe abortion: technical and policy guidance for health systems. Second edition.

http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241548434/en/

WHO (2012). WHO recommendations. Optimizing health worker roles to improve access to key

maternal and newborn health interventions through task shifting.

http://apps.who.int/iris/bitstream/10665/77764/1/9789241504843_eng.pdf?ua=1

WHO (2010). Medical eligibility criteria for contraceptive use: Fourth edition.

http://www.who.int/reproductivehealth/publications/family_planning/9789241563888/en/

2. Abortion

Cheng L, Che Y, Gülmezoglu A (2015). Methods of emergency contraception. Cochrane.

http://www.cochrane.org/CD001324/FERTILREG_methods-of-emergency-contraception

Bela Ganatra, Philip Guest, Marge Berer (2015). Expanding access to medical abortion:

challenges and opportunities. Reproductive Health Matters, Volume 22, Issue 44, Supplement 1,

Pages 1–3.

http://www.rhm-elsevier.com/article/S0968-8080(14)43793-5/abstract

Carol Levin, Daniel Grossman, Karla Berdichevsky, Claudia Diaz, Belkis Aracena, Sandra G Garcia,

Lorelei Goodyear (2009). Exploring the costs and economic consequences of unsafe abortion in

Mexico City before legalization. Reproductive Health Matters, Volume 17, Issue 33, Pages 120–

132.

http://www.rhm-elsevier.com/article/S0968-8080(09)33432-1/pdf

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Loi, Ulrika Rehnström ; Gemzell-Danielsson, Kristina ; Faxelid, Elisabeth; Klingberg-Allvin, Marie

(2015). Health care providers’ perceptions of and attitudes towards induced abortions in sub-

Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative

data. BMC Public Health Volume 15, page 139. http://www.biomedcentral.com/1471-

2458/15/139

Juliana Melo, Marissa Peters, Stephanie Teal, Maryam Guiahi (2009). Adolescent and young

women’s contraceptive decision-making processes: Choosing “the best method for her”.

Contraception, Volume 88, Issue 3, Page 459.

Kevin Sunde Oppegaard, Erik Qvigstad, Christian Fiala, Oskari Heikinheimo, Lina Benson, Kristina

Gemzell-Danielsson (2015). Clinical follow-up compared with self-assessment of outcome after

medical abortion: a multicentre, non-inferiority, randomised, controlled trial. The Lancet,

Volume 385, No. 9969, page 698–704.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61054-0/abstract

Beverly Winikoff (2014). Is one of these things not just like the other? Why abortion can’t be

separated from contraception. Conscience, vol. xxxv – no. 3, pages 27-29.

http://digital.graphcompubs.com/publication/?i=226388

3. Contraception

Lesley Hoggart, Victoria Louise Newton (2013). Young women’s experiences of side-effects from

contraceptive implants: a challenge to bodily control. Reproductive health matters, 21 (41),

pages 196-204.

http://www.sciencedirect.com/science/article/pii/S0968808013416889

Jennefer A. Russo, Elizabeth Miller, and Melanie A. Gold (2013). Myths and Misconceptions About

Long-Acting Reversible Contraception (LARC). Journal of Adolescent Health, 52(4 Suppl), pages

14-21.

http://www.jahonline.org/article/S1054-139X(13)00063-3/abstract

Lisa Mwaikambo, Ilene S. Speizer, Anna Schurmann, Gwen Morgan, and Fariyal Fikree (2011).

What works in family planning interventions: A systematic review of the evidence. Stud. Fam.

Plann., 42 (2), page 67-82.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761067/

4. Websites

WHO: http://www.who.int/en/

Guttmacher: https://www.guttmacher.org/

Ipas: http://www.ipas.org/

Population Council: http://www.popcouncil.org/

UNFPA: www.unfpa.org

USAID: http://www.usaid.gov/

International Consortium for Emergency Contraception: http://www.cecinfo.org/

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International Consortium for Medical Abortion: www.medicalabortionconsortium.org/

Condoms4all: http://www.condoms4all.org/