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3. Catalyst for change: Lessons learned from overcoming barriers to providing safe abortion care in Médecins Sans Frontières projects.

Author

Kumar, Manisha, Schulte‐Hillen, Catrin, De Plecker, Eva, Van Haver, Ann, Marques, Sonia Guinovart, Daly, Maura, Vochten, Hilde, Merzaghi, Lisa, de le Vingne, Brice, and Saint‐Sauveur, Jean François

Subjects
EVALUATION of human services programs, NONPROFIT organizations, MEDICAL care research, PATIENT safety, MEDICAL care, RETROSPECTIVE studies, TREATMENT effectiveness, MEDICAL records, ACQUISITION of data, QUALITY assurance, PREGNANCY complications, ADVERSE health care events, ABORTION
Abstract

Context: Despite instituting a policy in 2004, Médecins Sans Frontières (MSF) continuously struggled to routinely provide safe abortion care (SAC). In 2016, the organization launched an initiative aimed at increasing availability of SAC in MSF projects and increasing understanding of abortion‐related dynamics in humanitarian settings. Methodology: From March 2017 to April 2018, MSF staff conducted support visits to 10 projects in a country in sub‐Saharan Africa. Each visit followed a systematic approach with six key components and related tools that were later shared with teams worldwide. Data regarding women seeking abortion services and related outcomes were collected and analyzed retrospectively. Results: From Q1 2017 through Q4 2019, SAC provision increased significantly in all 10 projects, rising from three to 759 safe abortions per quarter. Teams received 3831 patients seeking SAC and provided 3640 first and second trimester abortions, over 99% via medication methods. The overall complication rate was 4.29% and 0.3% for severe, life‐threatening complications. No major security incidents were reported. MSF provision of SAC worldwide increased from 781 in 2016 (the year before this initiative began) to 21,546 in 2019. Conclusion: Implementation of SAC in humanitarian settings—even those with significant legal restrictions—is possible and necessary. Both first and second trimester medication abortion can be safely and effectively provided through both home‐ and facility‐based models of care. Programmatic data provide valuable insights into abortion‐related dynamics which must shape operational decision‐making. Addressing internal barriers and providing direct field support were key to stimulating organizational cultural change. [ABSTRACT FROM AUTHOR]

Published
2024
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4. Catalyst for change: Lessons learned from overcoming barriers to providing safe abortion care in Médecins Sans Frontières projects

Author

Kumar, Manisha, primary, Schulte‐Hillen, Catrin, additional, De Plecker, Eva, additional, Van Haver, Ann, additional, Marques, Sonia Guinovart, additional, Daly, Maura, additional, Vochten, Hilde, additional, Merzaghi, Lisa, additional, de le Vingne, Brice, additional, and Saint‐Sauveur, Jean François, additional

Published
2022
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8. Provision of emergency obstetric care at secondary level in a conflict setting in a rural area of Afghanistan – is the hospital fulfilling its role?

Author

Lagrou, Daphne, primary, Zachariah, Rony, additional, Bissell, Karen, additional, Van Overloop, Catherine, additional, Nasim, Masood, additional, Wagma, Hamsaya Nikyar, additional, Kakar, Shafiqa, additional, Caluwaerts, Séverine, additional, De Plecker, Eva, additional, Fricke, Renzo, additional, and Van den Bergh, Rafael, additional

Published
2018
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9. Care requirements for clients who present after rape and clients who presented after consensual sex as a minor at a clinic in Harare, Zimbabwe, from 2011 to 2014

Author

Harrison, Rebecca E., primary, Pearson, Linda, additional, Vere, Michael, additional, Chonzi, Prosper, additional, Hove, Brian Tafadzwa, additional, Mabaya, Sharon, additional, Chigwamba, Margaret, additional, Nhamburo, Juliana, additional, Gura, Juliet, additional, Vandeborne, An, additional, Simons, Sandra, additional, Lagrou, Daphne, additional, De Plecker, Eva, additional, and Van den Bergh, Rafael, additional

Published
2017
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10. Unregulated usage of labour-inducing medication in a region of Pakistan with poor drug regulatory control: characteristics and risk patterns

Author

Shah, Safieh, primary, Van den Bergh, Rafael, additional, Prinsloo, Jeanne Rene, additional, Rehman, Gulalai, additional, Bibi, Amna, additional, Shaeen, Neelam, additional, Auat, Rosa, additional, Daudi, Sabina Mutindi, additional, Njenga, Joyce Wanjiru, additional, Khilji, Tahir Bashir-ud-Din, additional, Maïkéré, Jacob, additional, De Plecker, Eva, additional, Caluwaerts, Séverine, additional, Zachariah, Rony, additional, and Van Overloop, Catherine, additional

Published
2015
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11. One Size Fits All? Standardised Provision of Care for Survivors of Sexual Violence in Conflict and Post-Conflict Areas in the Democratic Republic of Congo

Author

Loko Roka, Jerlie, primary, Van den Bergh, Rafael, additional, Au, Sokhieng, additional, De Plecker, Eva, additional, Zachariah, Rony, additional, Manzi, Marcel, additional, Lambert, Vincent, additional, Abi-Aad, Elias, additional, Nanan-N’Zeth, Kassi, additional, Nzuya, Serge, additional, Omba, Brigitte, additional, Shako, Charly, additional, MuishaBaroki, Derick, additional, Basimuoneye, Jean Paul, additional, Moke, Didier Amudiandroy, additional, Lampaert, Emmanuel, additional, Masangu, Lucien, additional, and De Weggheleire, Anja, additional

Published
2014
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12. Obstetric Fistula in Burundi: a comprehensive approach to managing women with this neglected disease

Author

Tayler-Smith, Katie, primary, Zachariah, Rony, additional, Manzi, Marcel, additional, van den Boogaard, Wilma, additional, Vandeborne, An, additional, Bishinga, Aristide, additional, De Plecker, Eva, additional, Lambert, Vincent, additional, Christiaens, Bavo, additional, Sinabajije, Gamaliel, additional, Trelles, Miguel, additional, Goetghebuer, Stephan, additional, Reid, Tony, additional, and Harries, Anthony, additional

Published
2013
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13. Unregulated usage of labour-inducing medication in a region of Pakistan with poor drug regulatory control: characteristics and risk patterns.

Author

Shah, Safieh, Van den Bergh, Rafael, Prinsloo, Jeanne Rene, Rehman, Gulalai, Bibi, Amna, Shaeen, Neelam, Auat, Rosa, Daudi, Sabina Mutindi, Njenga, Joyce Wanjiru, Khilji, Tahir Bashir-ud-Din, Maïkéré, Jacob, De Plecker, Eva, Caluwaerts, Séverine, Zachariah, Rony, and Van Overloop, Catherine

Subjects
DRUG laws, MOTHER-infant relationship, MATERNAL health, LABOR (Obstetrics), PATIENT compliance, OXYTOCIN -- Regulation, MEDICAL care, HEALTH
Abstract

Background: In developing countries such as Pakistan, poor training of mid-level cadres of health providers, combined with unregulated availability of labour-inducing medication can carry considerable risk for mother and child during labour. Here, we describe the exposure to labour-inducing medication and its possible risks in a vulnerable population in a conflict-affected region of Pakistan. Methods: A retrospective cohort study using programme data, compared the outcomes of obstetric risk groups of women treated with unregulated oxytocin, with those of women with regulated treatment. Results: Of the 6379 women included in the study, 607 (9.5%) received labour-inducing medication prior to reaching the hospital; of these, 528 (87.0%) received unregulated medication. Out of 528 labour-inducing medication administrators, 197 (37.3%) traditional birth attendants (also known as dai) and 157 (29.7%) lady health workers provided unregulated treatment most frequently. Women given unregulated medication whowere diagnosed with obstructed/prolonged labour were at risk for uterine rupture (RR 4.1, 95% CI 1.7-9.9) and severe birth asphyxia (RR 3.9, 95% CI 2.5-6.1), and those with antepartum haemorrhage were at risk for stillbirth (RR 1.8, 95% CI 1.0-3.1). Conclusions: In a conflict-affected region of Pakistan, exposure to unregulated treatment with labour-inducing medication is common, and carries great risk for mother and child. Tighter regulatory control of labour-inducing drugs is needed, and enhanced training of the mid-level cadres of healthcare workers is required. [ABSTRACT FROM AUTHOR]

Published
2016
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