Journal Article > ResearchFull Text
Obstetric fistula in Burundi: a comprehensive approach to managing women with this neglected disease
BMC Pregnancy Childbirth. 2013 August 21; Volume 13 (Issue 1); 164.
Tayler-Smith K, Zachariah R, Manzi M, van den Boogaard W, Vandeborne A, et al.
BMC Pregnancy Childbirth. 2013 August 21; Volume 13 (Issue 1); 164.
BACKGROUND
In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000-2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges.
METHODS
Descriptive study using routine programme data.
RESULTS
Between July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31-51 days).
CONCLUSION
In a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed.
In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000-2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges.
METHODS
Descriptive study using routine programme data.
RESULTS
Between July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31-51 days).
CONCLUSION
In a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed.
Journal Article > ResearchFull Text
PLOS One. 2017 February 7; Volume 12 (Issue 2); e0170882.; DOI:10.1371/journal.pone.0170882
de Plecker E, Zachariah R, Kumar AMV, Trelles M, Caluwaerts C, et al.
PLOS One. 2017 February 7; Volume 12 (Issue 2); e0170882.; DOI:10.1371/journal.pone.0170882
OBJECTIVES
In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.
METHODS
A retrospective analysis of EmOC data (2011 and 2012).
RESULTS
A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%).
A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by ‘general practitioners with surgical skills’ and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died.
CONCLUSION
Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.
In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.
METHODS
A retrospective analysis of EmOC data (2011 and 2012).
RESULTS
A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%).
A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by ‘general practitioners with surgical skills’ and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died.
CONCLUSION
Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.
Journal Article > ResearchFull Text
Int Health. 2016 March 1; Volume 8 (Issue 2); 89-95.; DOI:10.1093/inthealth/ihv051
Shah SK, Van der Bergh R, Prinsloo JR, Rehman G, Bibi A, et al.
Int Health. 2016 March 1; Volume 8 (Issue 2); 89-95.; DOI:10.1093/inthealth/ihv051
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 who were 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
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 who were 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
Journal Article > ResearchAbstract
Trop Med Int Health. 2013 February 18; Volume 18 (Issue 2); DOI:10.1111/tmi.12022
Tayler-Smith K, Zachariah R, Manzi M, van den Boogaard W, Nyandwi G, et al.
Trop Med Int Health. 2013 February 18; Volume 18 (Issue 2); DOI:10.1111/tmi.12022
OBJECTIVES: To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières (MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality. METHODS: The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this estimate, the resulting theoretical maternal mortality ratio in Kabezi was calculated and compared to the Millennium Development Goal for Burundi. RESULTS: In 2011, 1385 women from Kabezi were transferred to the MSF facility, of whom 55% had a severe acute maternal morbidity. We estimated that the MSF intervention averted 74% (range 55-99%) of maternal deaths in Kabezi district, equating to a district maternal mortality rate of 208 (range 8-360) deaths/100 000 live births. This lies very near to the 2015 MDG 5 target for Burundi (285 deaths/100 000 live births). CONCLUSION: Provision of quality emergency obstetric care combined with a functional patient transfer system can be associated with a rapid and substantial reduction in maternal mortality, and may thus be a possible way to achieve Millennium Development Goal 5 in rural Africa.
Journal Article > ResearchFull Text
Confl Health. 2018 January 22; Volume 12 (Issue 1); DOI:10.1186/s13031-018-0137-1
Lagrou D, Zachariah R, Bissel K, Van Overloop C, Nasim M, et al.
Confl Health. 2018 January 22; Volume 12 (Issue 1); DOI:10.1186/s13031-018-0137-1
Provision of Emergency Obstetric and Neonatal Care (EmONC) reduces maternal mortality and should include three components: Basic Emergency Obstetric and Neonatal Care (BEmONC) offered at primary care level, Comprehensive EmONC (CEmONC) at secondary level and a good referral system in-between. In a conflict-affected province of Afghanistan (Khost), we assessed the performance of an Médecins Sans Frontières (MSF) run CEmONC hospital without a primary care and referral system. Performance was assessed in terms of hospital utilisation for obstetric emergencies and quality of obstetric care.
Journal Article > CommentaryFull Text
BMJ Glob Health. 2020 July 20; Volume 5 (Issue 7); e003175.; DOI:10.1136/bmjgh-2020-003175
Kumar M, Daly M, de Plecker E, Jamet C, McRae M, et al.
BMJ Glob Health. 2020 July 20; Volume 5 (Issue 7); e003175.; DOI:10.1136/bmjgh-2020-003175
SUMMARY BOX
• The COVID-19 pandemic has begun to severely limit access to sexual and reproductive healthcare, including contraception and safe abortion care (SAC), which have historically not been regarded as essential health services.
• Shutdown or delays of contraception and SAC during COVID-19 will disproportionately impact the most vulnerable populations, including women and girls in low-income and middle-income countries, and lead to considerable and preventable death and lifelong disability.
• Médecins Sans Frontières calls on the global health community to strengthen access to contraception and SAC for populations everywhere, and especially in poor and crisis settings, by engaging with women and their communities to develop self-managed models of care.
• The COVID-19 pandemic has begun to severely limit access to sexual and reproductive healthcare, including contraception and safe abortion care (SAC), which have historically not been regarded as essential health services.
• Shutdown or delays of contraception and SAC during COVID-19 will disproportionately impact the most vulnerable populations, including women and girls in low-income and middle-income countries, and lead to considerable and preventable death and lifelong disability.
• Médecins Sans Frontières calls on the global health community to strengthen access to contraception and SAC for populations everywhere, and especially in poor and crisis settings, by engaging with women and their communities to develop self-managed models of care.
Journal Article > ResearchFull Text
PLOS One. 2014 October 20; Volume 9 (Issue 10); e111096.; DOI:10.1371/journal.pone.0111096
Loko Roka J, Van der Bergh R, Au S, de Plecker E, Zachariah R, et al.
PLOS One. 2014 October 20; Volume 9 (Issue 10); e111096.; DOI:10.1371/journal.pone.0111096
BACKGROUND
Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).
METHODS
A retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012.
RESULTS
In Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13–17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20–35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion.
CONCLUSION
This study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.
Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).
METHODS
A retrospective descriptive cohort study, using routine programmatic data from the MSF sexual violence programmes in Masisi and Niangara, DRC, for 2012.
RESULTS
In Masisi, 491 survivors of sexual violence presented for care, compared to 180 in Niangara. Niangara saw predominantly sexual violence perpetrated by civilians who were known to the victim (48%) and directed against children and adolescents (median age 15 (IQR 13–17)), while sexual violence in Masisi was more directed towards adults (median age 26 (IQR 20–35)), and was characterised by marked brutality, with higher levels of gang rape, weapon use, and associated violence; perpetrated by the military (51%). Only 60% of the patients in Masisi and 32% of those in Niangara arrived for a consultation within the critical timeframe of 72 hours, when prophylaxis for HIV and sexually transmitted infections is most effective. Survivors were predominantly referred through community programmes. Treatment at first contact was typically efficient, with high (>95%) coverage rates of prophylaxes. However, follow-up was poor, with only 49% of all patients in Masisi and 61% in Niangara returning for follow-up, and consequently low rates of treatment and/or vaccination completion.
CONCLUSION
This study has identified a number of weak and strong points in the sexual violence programmes of differing contexts, indicating gaps which need to be addressed, and strengths of both programmes that may contribute to future models of context-specific sexual violence programmes.
Journal Article > ResearchFull Text
Public Health Action. 2016 June 21; Volume 6 (Issue 2); 72-6.; DOI:10.5588/pha.15.0075
van den Boogaard W, Manzi M, de Plecker E, Caluwaerts C, Caluwaerts S, et al.
Public Health Action. 2016 June 21; Volume 6 (Issue 2); 72-6.; DOI:10.5588/pha.15.0075
SETTING
A caesarean section (C-section) is a life-saving emergency intervention. Avoiding pregnancies for at least 24 months after a C-section is important to prevent uterine rupture and maternal death.
OBJECTIVES
Two years following an emergency C-section, in rural Burundi, we assessed complications and maternal death during the post-natal period, uptake and compliance with family planning, subsequent pregnancies and their maternal and neonatal outcomes.
METHODS
A household survey among women who underwent C-sections.
RESULTS
Of 156 women who underwent a C-section, 116 (74%) were traced; 1 had died of cholera, 8 had migrated and 31 were untraceable. Of the 116 traced, there were no post-operative complications and no deaths. At hospital discharge, 83 (72%) women accepted family planning. At 24 months after hospital discharge (n = 116), 23 (20%) had delivered and 17 (15%) were pregnant. Of the remaining 76 women, 48 (63%) were not on family planning. The main reasons for this were religion or husband's non-agreement. Of the 23 women who delivered, there was one uterine rupture, no maternal deaths and three stillbirths.
CONCLUSION
Despite encouraging maternal outcomes, this study raises concerns around the effectiveness of current approaches to promote and sustain family planning for a minimum of 24 months following a C-section. Innovative ways of promoting family planning in this vulnerable group are urgently needed.
A caesarean section (C-section) is a life-saving emergency intervention. Avoiding pregnancies for at least 24 months after a C-section is important to prevent uterine rupture and maternal death.
OBJECTIVES
Two years following an emergency C-section, in rural Burundi, we assessed complications and maternal death during the post-natal period, uptake and compliance with family planning, subsequent pregnancies and their maternal and neonatal outcomes.
METHODS
A household survey among women who underwent C-sections.
RESULTS
Of 156 women who underwent a C-section, 116 (74%) were traced; 1 had died of cholera, 8 had migrated and 31 were untraceable. Of the 116 traced, there were no post-operative complications and no deaths. At hospital discharge, 83 (72%) women accepted family planning. At 24 months after hospital discharge (n = 116), 23 (20%) had delivered and 17 (15%) were pregnant. Of the remaining 76 women, 48 (63%) were not on family planning. The main reasons for this were religion or husband's non-agreement. Of the 23 women who delivered, there was one uterine rupture, no maternal deaths and three stillbirths.
CONCLUSION
Despite encouraging maternal outcomes, this study raises concerns around the effectiveness of current approaches to promote and sustain family planning for a minimum of 24 months following a C-section. Innovative ways of promoting family planning in this vulnerable group are urgently needed.
Journal Article > ResearchAbstract
Trop Med Int Health. 2012 August 12; Volume 17 (Issue 11); DOI:10.1111/j.1365-3156.2012.03066.x
Tayler-Smith K, Zachariah R, Hinderaker SG, Manzi M, de Plecker E, et al.
Trop Med Int Health. 2012 August 12; Volume 17 (Issue 11); DOI:10.1111/j.1365-3156.2012.03066.x
Using routine data from three clinics offering care to survivors of sexual violence (SV) in Monrovia, Liberia, we describe the characteristics of SV survivors and the pattern of SV and discuss how the current approach could be better adapted to meet survivors' needs. There were 1500 survivors seeking SV care between January 2008 and December 2009. Most survivors were women (98%) and median age was 13 years (Interquartile range: 9-17 years). Sexual aggression occurred during day-to-day activities in 822 (55%) cases and in the survivor's home in 552 (37%) cases. The perpetrator was a known civilian in 1037 (69%) SV events. Only 619 (41%) survivors sought care within 72 h. The current approach could be improved by: effectively addressing the psychosocial needs of child survivors, reaching male survivors, targeting the perpetrators in awareness and advocacy campaigns and reducing delays in seeking care.
Conference Material > Abstract
Kumar M, Schulte-Hillen C, de Plecker E, Jamet C, de Vigne B, et al.
MSF Scientific Days UK 2019: Innovation. 2019 May 10
INTRODUCTION
Unsafe abortion is one of the main causes of maternal death and suffering worldwide. Since 2004, MSF policy has stated that safe abortion care (SAC) be provided as part of reproductive health care. Over the following decade, field teams have struggled to provide termination of pregnancy (TOP). MSF’s Working Group (WG) for reproductive health and sexual violence considered that internal barriers constituted a major obstacle to SAC provision. In 2015, to address the gap between ambition and action, the WG proposed an intersectional, multi-departmental, field-based initiative overseen by medical and operational directors, termed the “Task Force for Support to the Implementation of SAC.”
METHODS
Between Mar 2017 and May 2018, the Task Force conducted field support visits to 10 MSF projects in sub-Saharan Africa. The Task Force utilized a systematic and comprehensive approach, including: 1) Exploring Values and Attitudes (EVA) workshops; 2) clinical training; 3) discussions with local interlocutors; 4) threat and risk assessment; 5) implementation strategy; 6) data collection and monitoring.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
RESULTS
In Feb 2018, before the Task Force started, no projects reported providing TOP. Following the Task Force visits, all 10 projects reported a steady increase in TOP provision, with a total of 768 TOP provided by Jul 2018. 662 (86.5%) patients were 18 years or older, and 103 (13.5%) were less than 18 years. 632 (83%) had pregnancies at or under 13 weeks gestation, and 134 (17%) were beyond 13 weeks. 762 (99.2%) TOP were provided via the medication method (“abortion pills”). There were no severe medical complications and no major security incidents reported. The Task Force facilitated 40 EVA workshops for 746 MSF field staff. Pre- and post-survey results demonstrate increased understanding and support for MSF action regarding SAC after EVA workshops.
CONCLUSION
Today, more women in MSF projects have access to safe abortion care than ever before – including women of all ages and in the first and second trimester. The Task Force developed specific tools and integrated them into a comprehensive implementation strategy for field teams. The multi-level, field-based approach of the Task Force has contributed to the successful provision of safe abortion care in targeted MSF projects, thus creating movement on an issue where there had been roadblocks for many years. EVA workshops in particular are thought to be one of the keys in overcoming organizational inertia by opening up space for dialogue and understanding on a sensitive issue.
CONFLICTS OF INTEREST
None declared.
Unsafe abortion is one of the main causes of maternal death and suffering worldwide. Since 2004, MSF policy has stated that safe abortion care (SAC) be provided as part of reproductive health care. Over the following decade, field teams have struggled to provide termination of pregnancy (TOP). MSF’s Working Group (WG) for reproductive health and sexual violence considered that internal barriers constituted a major obstacle to SAC provision. In 2015, to address the gap between ambition and action, the WG proposed an intersectional, multi-departmental, field-based initiative overseen by medical and operational directors, termed the “Task Force for Support to the Implementation of SAC.”
METHODS
Between Mar 2017 and May 2018, the Task Force conducted field support visits to 10 MSF projects in sub-Saharan Africa. The Task Force utilized a systematic and comprehensive approach, including: 1) Exploring Values and Attitudes (EVA) workshops; 2) clinical training; 3) discussions with local interlocutors; 4) threat and risk assessment; 5) implementation strategy; 6) data collection and monitoring.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
RESULTS
In Feb 2018, before the Task Force started, no projects reported providing TOP. Following the Task Force visits, all 10 projects reported a steady increase in TOP provision, with a total of 768 TOP provided by Jul 2018. 662 (86.5%) patients were 18 years or older, and 103 (13.5%) were less than 18 years. 632 (83%) had pregnancies at or under 13 weeks gestation, and 134 (17%) were beyond 13 weeks. 762 (99.2%) TOP were provided via the medication method (“abortion pills”). There were no severe medical complications and no major security incidents reported. The Task Force facilitated 40 EVA workshops for 746 MSF field staff. Pre- and post-survey results demonstrate increased understanding and support for MSF action regarding SAC after EVA workshops.
CONCLUSION
Today, more women in MSF projects have access to safe abortion care than ever before – including women of all ages and in the first and second trimester. The Task Force developed specific tools and integrated them into a comprehensive implementation strategy for field teams. The multi-level, field-based approach of the Task Force has contributed to the successful provision of safe abortion care in targeted MSF projects, thus creating movement on an issue where there had been roadblocks for many years. EVA workshops in particular are thought to be one of the keys in overcoming organizational inertia by opening up space for dialogue and understanding on a sensitive issue.
CONFLICTS OF INTEREST
None declared.