In 2012, Ipas undertook an assessment in Bangladesh, India, Nepal and Pakistan to determine the specific needs and gaps in the pre-service education systems for midlevel providers and to identify opportunities, strategies and recommendations for creating more equitable access to safe abortion care. Sources for the pre-service assessment include curricular review; government documents; key informant interviews; reports; assessments of provider performance and training; and site observation visits. The assessment results and recommendations in this report focus on Bangladesh.

This brief describes the advocacy efforts, led by Ipas Pakistan and local partners, to integrate WHO-approved approaches (UE methods and training of additional cadres of providers) into the healthcare system. In particular, it details the work done to establish the Punjab Reproductive Health Technology Assessment Committee (PRHTAC)—a provincial body formed to review existing evidence on UE technologies, address concerns about stigma, examine a legal basis for clinical expansion to MLPs, consider the financial implications of new technologies, and, ultimately, to make recommendations/changes for the adoption of misoprostol and MVA into the local healthcare system.

This brief examines the key results from expanding abortion service provision to midlevel providers in 10 Ipas country programs throughout Asia and Africa, including a global analysis of programmatic data from all 10 countries and two case studies (Ethiopia and Bangladesh).