Abortion Care in Stressed Settings

By Carrie Watters | 31 Jan, 2012

Hello Everyone,

I'm an American social worker with a Dutch NGO called Women on Waves (www.womenonwaves.org). We strive to provide access to safe abortion care (primarily via misoprostol) for women in countries where reproductive healthcare is severely restricted due to factors such as politics or resources.

While we've made some great progress in reaching women in a variety of settings via hotlines and email support (you can also see our sister NGO, www.womenonweb.org), we're hoping to find better ways to support women in conflict and other stressed settings (and those working with them) who don't traditionally have the resources needed to access our help.
We've been exploring remote trainings via Skype as well as creating a variety of training materials for high and low literacy populations (happy to share!). I would love to hear from anyone with similar goals (would be great to swap perspectives/resources) as well as to hear from any professionals or groups working on the ground with this population that might be interested in our support. This can be medical professionals, women's groups or laypersons.

I look forward to hearing from you and learning more!

Carrie Watters



Maggie Sullivan Moderator Replied at 12:47 PM, 6 Apr 2012

Hi Carrie, I apologize for the delayed response. I have asked several colleagues about this topic, but have encountered a dearth of helpful information. Instead, I have come across a few articles that might be of interest to you. Please don't hesitate to let us know if there's any other way for us to assist you in the important work that you do!
-Maggie Sullivan

WHO. The prevention and management of unsafe abortion. Report of a Technical Working Group. Geneva; 2002.

WHO. Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. 6. Geneva; 2011.

Sood M, Juneyja Y, Goyal U. Maternal mortality and morbidity associated with clandestine abortions. J Indian Med Assoc. 1995;93:77–79.

United Nations Population Division. Abortion Policies: a global review. http://www.un.org/esa/population/publications/abortion

Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, Shah IH. Unsafe abortion: the preventable pandemic. Lancet. 2006;368:1908–1919. doi: 10.1016/S0140-6736(06)69481-6.

Liskin L. Complications of abortion in developing countries. In Population reports. 1980;7:105–155.

Ahman E, Shah I. Unsafe abortion: worldwide estimates for 2000. Reprod Heatlh Matters. 2002;10:13–17. doi: 10.1016/S0968-8080(02)00012-5.

Carrie Watters Replied at 8:42 AM, 10 Apr 2012

Hi Maggie,

Thank you so much for getting back to me. These are great resources!
I've been encountering similar responses, but am pressing on nonetheless. I've been talking to lots of folks, and it appears that in general, larger scale NGOs simply cannot easily address this need despite being the most regular presence in conflict areas due to political, legal and funding issues, leaving it to smaller community groups to try to manage this themselves.
Everyone seems to agree that this is a massive gap in service, especially when the pregnancy is the result of war time rape, but few are able to address this need. My hope is that we can work somewhat as a go-between for local NGOs and community groups, lending training, support and resources to groups on the ground that cannot do this themselves. We are not bound by any of the legal/political/aid restrictions that others are when it comes to safe abortion, and would like to see if we can use this status to assist others in reaching this population.
Thus far, we've conducted one remote pilot training (via Skype) with a group in the MENA region and are actively creating more materials (covering a variety of reproductive health topics) to supplement and improve future trainings. I've attached some here, that are geared to a wider range of literacy levels. Please feel free to circulate/use however you like!
Also, if you know of any groups that would like us to create more of these resources in additional languages, I'm always happy to reformat and resend with new translations.
Great (virtually) meeting you!


Attached resources:

Jason Villarreal Replied at 2:39 PM, 19 Apr 2012

I would be curious to know how your organization and others works in stressed situations where abortion access is blocked due to widespread practice of women choosing abortion when they find out they are carrying a girl. I realize that many women are directly or indirectly coerced into abortion due to oppressive patriarchal mores which MUST change. However, such change will likely take generations, at best. The bottom line is that women are still choosing to end pregnancies until they are carrying a boy. While we work to change the patriarchy, what do organizations such as women on waves do when a woman presents for an abortion who desires it solely because she does not want to have a girl? Unfortunately, the effects of this widespread practice, which women choose, are already becoming dire in many parts of India and China, with the further effect of trafficking of women among many other horrendous results...


Maggie Sullivan Moderator Replied at 3:31 PM, 24 Apr 2012

Jason, thank you for this important observation. I don't know how (or if) Women on Waves addresses the situation of sex selection and abortion, but I can appreciate the delicacy and difficulty this presents. My feeling is that regardless, access to safe abortion should exist in all settings. This is not to say that it wouldn't be difficult for me to be in a situation where I was helping provide access to safe abortion, especially in a stressed setting, and learned that the person accessing the service was utilizing it primarily for sex selection. In fact, when I worked at Planned Parenthood here in the US, not a stressed or conflict-ridden setting, I treated many women whose reasons for having abortions were not always reasons I agreed with. As I'm sure many others would not agree with my own personal reasons behind the decisions I choose for myself. However, I continue to feel strongly about continuing to have protected access to safe abortion. I would hope that effective and high quality options counseling, supporting projects that work toward economic security and insuring the education of girls/women all go a long way toward shifting overtly patriarchal environments. I would love to hear others' suggestions for what organizations could do toward this end.

IYABO OBASANJO Replied at 9:06 PM, 24 Apr 2012

Maggie, I agree completely with your comments on what to do in such environment and also your hope for a solution. In many stressed situations the lives of girls are so miserable you cant even blame mothers so much for trying to avoid such misery for their progeny. I wish the international community would specifically fund prosecution for rape and violence aganist women in such environments to emphasize the importance of girls/women and the grievousness of the crimes which usually go unpunished and make girls perpetual victims.

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