Increasing safe abortion access through universal health care: promising signs from Nepal and Pakistan

Can universal health coverage eliminate unsafe abortion?

“…12 There have been promising shifts towards the inclusion of abortion and post-abortion care in essential service and health benefits packages in a few countries in recent years, achieved with support from evidence-based and diligent advocacy by civil society organisations. 13 For example, Nepal's Basic Health Service Package includes safe abortion care at public health facilities, and Nepal's government has committed to making abortion free of charge at the point of use, a process that has begun to enable access through public services and through private sector contracting. Although a causal link cannot be proved, Nepal has seen increases in the safety of abortion and use of government facilities over the years that these reforms have taken place.…”

“…Although a causal link cannot be proved, Nepal has seen increases in the safety of abortion and use of government facilities over the years that these reforms have taken place. 13 The second critical challenge is to ensure health services are accessible. Quick et al argued gender-equitable UHC could be achieved through the promotion of integrated, localised services, support for pharmacy provision and task-sharing.…”

“…This is particularly true in the early stages of transition from more to less restrictive abortion laws, when partnerships with non-governmental organisations have often played an important role in supporting development of clinical guidelines, clinical training, supportive supervision and provider behaviour change in the public sector. 13 The historical legacy of legal restrictions on abortion and the exclusion of abortion from the public health system in many countries, however, means that the private sector (for-profit, non-profit, formal and informal), often provides an important source of abortion care. Governments can build on this existing capacity for safe abortion care: in some countries, such as South Africa and Colombia, the demand for abortion services continues to be partially met by contracting non-governmental organisations, while others, such as Mexico, have relied more heavily on the public sector.…”

“…Abortion is commonly excluded from such indicators, for example contraceptive access is tracked as one of sixteen signal functions of UHC provision at the country-level by the WHO, but abortion access is not included in this list. 13 In addition to tracking the availability of abortion care, efforts to monitor resource flows for SRH, key equity indicators and quality of SRH services 18 should specifically include abortion. Evidence about abortion is often lacking at the national level due to its exclusion from vital statistics, health records and health surveys, but for unsafe abortion to be eliminated, we must end the exclusion of abortion from data sources and indicators.…”

“…This is a long-term goal, and one that requires fierce advocacy from civil society using evidence on the impacts of unsafe abortion and the safety and feasibility of providing abortion care at the community level. 13 In the absence of laws and policies that support safe abortion, ensuring access to high quality post-abortion care is critical. Post-abortion care reduces mortality and morbidity from unsafe abortion, and its availability has been shown to support the scaling up of safe abortion care following legal reform: in Nepal, Ghana and Ethiopia, providers were familiar with clinical abortion techniques and were ready to deliver scaled services due to their experience offering post-abortion care.…”