Zero Unsafe Abortion Campaign in Terathum District

Delivering speech by the Deputy Chair of Atthrai Rural Municipality ward No. 3
After collecting commitment with signature at Atthrai Rural Municipality ward No. 3

With the support of locally elected government representatives, the District Coordination Committee and other stakeholders, the Terathum district is working to become a “Zero Unsafe Abortion District.” The campaign aims to create awareness in local communities—including among health practitioners in the district—on the dangers of unsafe abortion and to provide information on the legality and availability of safe abortion services.

Terathum district has prepared a strategic plan to guide the district toward achieving the goal of zero unsafe abortions. Ipas Nepal—along with local partner NGOs Mission for Prosperous Terathum and FECOFUN Terathum and district level government and non-governmental stakeholders—are working together for this mission. Several activities including, awareness activities and orientation/capacity building programs are conducted during the two-year campaign.

All local government bodies have allocated funds and prioritized their involvement in the zero unsafe abortion movement. Political parties, media and other civil society organizations are also taking part in the campaign. Ward- and Palika-level unsafe abortion declaration program were organized in each Palika during February and March 2020. A final district level declaration program was planned for March 8 during international women’s day events but was postponed due to COVID-19 pandemic situation. There are plans to hold this event at a later date.

Safe abortion: Preservice Education in Ob/ Gyn curriculum

Workshop with medical colleges on pre-service integration

Not all qualified obstetricians and gynecologists (OB/GYNs) are certified to provide safe abortion services in Nepal, which can create gaps in the availability of abortion care. Integrating on-the-job training (OJT) in safe abortion services into OB/GYN residency programs is one way to help expand the availability of services. On-the-job training allows pre-service providers to acquire new knowledge and skills within the comfort of their workspace and available time.

Ipas Nepal has already progressed in implementing the integration of first-trimester abortion service into the pre-service curriculum, in close collaboration with National Health Training Center and Family Welfare Division. This is mainly focused on developing the pool of trained safe abortion service providers.  The integration of this training in the pre-service curriculum will help OB/GYNs become confident and competent to provide comprehensive abortion services by the time they graduate. It will also reduce absenteeism of providers from their workplace in addition to being cost effective. At present Ipas is working with five facilities under four universities for approval of this pre-service curriculum.

Blended Learning Approach: Training providers in abortion care at or after 13 weeks gestation

Clinical Mentoring of Blended Learning Participant

Abortion was legalized in Nepal in 2002, and Ipas Nepal has been training providers at public sector health facilities in first-trimester abortion care since 2004. In 2007, Ipas Nepal began providing trainings using a traditional training model for at and above 13 weeks service (second-trimester training). The traditional training model requires all providers to attend an in-person training at the training facility. But the length of this training meant that providers were absent from their health facilities for an average of 16-17 days, which resulted in the cessation of several services during their absence.

To reduce the amount of time providers are absent from their sites and to cut training costs, Ipas Nepal has transitioned to a blended learning approach for at and above 13 weeks training. This new approach relies on close communication between the second-trimester trainers and trainees prior to training.

Ipas Nepal collaborated with National Health Training Center (NHTC) to create blended learning approach. Blended learning is an education/training approach that combines individual study using self-paced online digital media with traditional classroom and clinical skills practice requiring the physical presence of both facilitator and learners. The standard national norms for the training are implemented from assessing the knowledge and skill of the trainees.

Balanced Counselling Approach: Post-abortion Contraception

Balanced Counselling on PAFP

Post-abortion contraceptive care is an integral part of comprehensive safe abortion services and can prevent unintended pregnancies.

The balanced counselling approach used by Ipas Nepal is adapted from a counselling strategy for contraception developed by the Population Council.  It is a practical, interactive, client-friendly counseling strategy, and compared to traditional counselling methods, is less time-consuming. which could increase the uptake of post abortion contraceptive methods. Ipas Nepal has also developed guidance for providers to how use balanced counselling and has produced a short documentary video as well on the approaches for counselling different types of clients.

Injectable Contraceptives

Sayana Press injecting during country lockdown

Injectable contraceptives are an important option for preventing unintended pregnancy, chosen by many women worldwide for their safe and effective protection, convenience, and privacy. As part of a family planning project funded by the Department for International Development (DFID), Government of UK,  Ipas Nepal is supporting Family Welfare Division to pilot accessibility and feasibility of the injectable contraceptive  Sayana Press®  in 14 public health facilities in Sindhuli and Nawalpur districts of Nepal.

Easy-to-use injectable contraceptives can dramatically expand family planning access by increasing opportunities for lay health workers—and even women themselves—to administer injections.

Sayana Press (DMPA-SC) is similar in formulation to the intramuscular injectable contraceptive Depo-Provera but contains 30% lower dose (150 mg of DMPA-IM vs 104 mg of DMPA-SC) and is administered subcutaneously using a single-use syringe with a short needle causing less pain and discomfort. The product can be stored without refrigeration. Because of its unique method with alternative route of delivery requiring less trained providers and the product being compact, discreet, and easily transportable- Sayana Press has the potential of being provided at low-resource, non-clinic settings, and this could potentially transform the way in which women access and receive their preferred method of contraception. Sayana Press is approved by regulatory authorities in more than 40 countries across the world.