Women in all of Mexico's 31 states and the Federal District have a legal right to terminate pregnancy in the case of rape. Obstacles in the health and judicial systems - as well as both women's and health care providers' lack of knowledge of the law - usually impede their ability to obtain legal abortion in such cases, however.

In response to this critical gap in service accessibility, Ipas Mexico, based in Mexico City, has developed and begun to implement a strategy to introduce comprehensive care, including legal abortion, for survivors of sexual violence. The strategy includes several phases:

• developing a model for comprehensive care
• conducting awareness-raising and skills training for health care providers in the delivery of high-quality legal abortion and related services for survivors of sexual violence
• establishing multidisciplinary teams in participating health care facilities and implementing services
• monitoring and evaluating the services

A three-part model

The model of comprehensive care originally developed by Ipas Mexico included three components: legal advice, psychological support and medical care for survivors of sexual violence. The first component entails detailed explanation of the indications for which abortion is legal and medical professionals' obligations to provide abortion-related care, in interaction with the judicial system. The second component aims to promote sensitivity among clinical staff to women's need for humane, women-centered treatment, screening for sexual violence, psychological support, and links to professional psychological services support after experiencing sexual violence. The third element of the model includes clinical services for emergency contraception, STD prevention and uterine evacuation, including management of potential complications.

Collaborative training

With the support of the Ministry of Health of the Federal District, in early 2001 the project team began conducting awareness-raising workshops to introduce health care providers to the model. Through these workshops, the team collected important feedback and suggestions from the providers which were used to expand and fine-tune the model - a process that is ongoing.

Next, Ipas Mexico, the Ministries of Health of the Federal District and the State of Hidalgo, the Department of Justice of the State of Mexico and the Program for Women and Health organized an in-depth training course in the skills and knowledge required to provide comprehensive, high-quality care. The first course took place April 8-12, 2002, in Mexico City. These institutions' and facilities' active involvement in planning the course was essential to establishing a sense of ownership and to facilitating the ongoing participation of providers within those institutions.

The training - which was presented in two parallel courses, one in the morning and one in the afternoon -- addressed 15 main themes, many of which were considered within a broader framework of human rights (see sidebar). Formats used included panel presentations and workshops led by 25 experts from Brazil, Costa Rica, Guatemala, Mexico, the United States and Venezuela. In addition, organizers encouraged active participation and debate by breaking the larger group out into four smaller groups that were more conducive to the sharing of experiences - an important element of the learning process. These smaller groups, comprising providers from different disciplines, worked together during nine workshops during the course of the day.

Although organizers initially expected approximately 200 participants, interest in the course exceeded all expectations. All told, 330 participants representing 56 institutions and organizations took part. They included individuals who had participated in the previous year's awareness-raising and informational workshop; health care providers from 33 hospitals in the Federal District and the States of Mexico, Hidalgo and San Luis Potosi; and individuals from nongovernmental organizations (NGOs), academic and legal institutions, medical associations and the criminal justice system. All participants had a personal interest in and commitment to improving care for survivors of sexual violence, as well as strategic positions within their organizations or institutions that would increase the likelihood of comprehensive services being implemented in the participating hospitals. In addition, many institutions were represented by multidisciplinary teams, an approach encouraged by the training organizers as an indication of institutional commitment.

Sign of the times

The Minister of Health of the Federal District, Dr. Asa Cristina Laurell, noted that the training was "a sign of new times, where NGOs and the government work together to improve health services and where in a single event the physicians, nurses, social workers, psychologists and other members of the health team work together to improve women's lives."

Most participants left the training expressing commitment to implement comprehensive care for survivors of sexual violence upon their return to their health units or institutions. Many said they particularly appreciated the opportunity to interact with like-minded individuals on a topic in which they felt completely isolated.

Follow-up

The next steps in Ipas Mexico's initiative to improve comprehensive care for survivors of sexual violence include selecting two facilities among those represented at the April training in which to strengthen teams and implement services, which will serve as models for other hospitals and institutions. Criteria for selection include need and commitment to improving the full range of services in the model, including legal abortion. The project team also plans to identify two additional states in which to initiative related activities, including replicating the awareness-raising workshops and the training course held in Mexico City.

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For more information, contact media@ipas.org