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February 11, 2025

News | Research

Ipas 2024 research publications: Evidence in action for abortion access

Ipas research in published in 2024 provides crucial evidence to drive real change in legal abortion access, care quality and stigma reduction. With 26 publications in 15 peer-reviewed journals across nine countries, our findings can inform policies, improve health services, and help ensure sexual and reproductive health and rights (SRHR) are a reality for all. These studies not only deepen our understanding of barriers to care but also provide strategies to overcome challenges so that more people can get the quality sexual and reproductive health services they need.

Key findings from research focus areas

Client perspectives, service provision & care inequities

  • Facility-based abortion care has gaps in communication and environment, despite positive client experiences.
  • Midlevel providers can safely provide medication abortion after 12 weeks.
  • Pharmacy access to abortion pills in Ghana is safe and effective.
  • Persistent inequities in Nepal and Mexico limit abortion access, worsened by COVID-19.

Climate justice & humanitarian settings

  • Climate change disrupts SRHR access, requiring community-driven solutions.
  • Postabortion care in crisis zones (Nigeria & Central African Republic) needs urgent improvements.

Gender-based violence & abortion stigma

  • Bangladesh ARCHES intervention increased contraceptive use, reduced unintended pregnancy, and improved awareness of support services for survivors of gender-based violence.
  • Abortion stigma in Nepal remains high despite progressive laws, guiding community-based interventions.

Laws, policies, medical education & telemedicine

  • Democratic Republic of Congo case study highlights strategies for abortion law reform.
  • Ghana and Côte d’Ivoire research finds low awareness of abortion laws among providers and clients.
  • Global study (85 countries) shows high demand for abortion education among medical students but limited institutional support.
  • Midwifery-led abortion care in Democratic Republic of Congo faces policy and training barriers.
  • Telemedicine abortion in Colombia is as safe and effective as in-person care.
  • Systematic review confirms telemedicine is globally proven safe and effective up to 12 weeks.

Publications

Peer-reviewed journals

Countries

Listening to clients: What they experience and need

Research documenting the abortion care experience from the client’s perspective is essential to improving both access and quality. Such research ensures Ipas’s programs prioritize user experience—addressing facility-based barriers to care alongside clinical quality. In Ethiopia, research shows that facility-based abortion clients report positive care experiences, but improvements are needed in facility environment and patient communications.

In Nepal, facility-based treatment remains a barrier to a positive user experience for approximately 15% of abortion clients, highlighting a need for better service delivery in facilities.

In Bangladesh, researchers used the Abortion Care Quality tool and qualitative methods to compare client-reported quality of facility-based and pharmacy-based medication abortion care, revealing that Bangladeshi women report minimal differences between the two.

Expanding access: What’s working, and what’s not?

Expanding the pool of trained providers and sources of quality care is key to increasing abortion access. In 2024, Ipas continued publishing peer-reviewed research on the safety of abortion across diverse providers and settings.

In Ghana, research confirms that abortion pills accessed directly from pharmacies can be used safely and effectively.

In Ethiopia, research shows that midlevel providers can safely and effectively manage medical abortion (abortion with pills) after 12 weeks’ gestation, thus expanding available providers trained in safe abortion care.

In Nepal, an assessment of 767 health facilities revealed widespread gaps in abortion care readiness. This indicates an urgent need to align service delivery capacity with the country’s favorable legal framework, which permits abortion on request up to 12 weeks’ gestation and up to 28 weeks for certain indications.

Who gets left behind? Measuring inequities in care

Ipas research in Nepal and Mexico examined abortion service availability, exposing persistent inequities that hinder access—crucial insights for closing gaps and improving care for everyone. In Mexico, research revealed that COVID-19 worsened disparities in accessing abortion at public health centers in the Mexico City metropolitan area, particularly among adolescents and women with less education.

Research in Nepal demonstrated that despite progress made from two decades of legalized abortion, inequities persist in access—particularly for women from lower socioeconomic backgrounds.

Rising temperatures, rising barriers: Climate change and SRHR

Ipas is adding to the growing evidence on links between climate change and sexual and reproductive health and rights (SRHR). As a convenor of the SRHR and Climate Justice Coalition, Ipas staff are working with civil society organizations across more than 50 countries to advance climate justice.

In partnership with the SRHR and Climate Justice Coalition, Ipas contributed to a commentary in The Lancet Planetary Health outlining key research considerations on climate change and SRHR—including robust methods, intersectional analysis, and community-driven approaches. Ipas is also leading original research on this critical issue.

In Nepal, Ipas led mixed-methods research showing how climate change disrupts health care access and poses unique risks to women, especially to their sexual and reproductive health.

Humanitarian response must include comprehensive abortion care

The world’s displaced population is at an all-time high and continues to grow due to conflict, climate crises and limited opportunities.

This Bangladesh study evaluates Ipas’s comprehensive sexual and reproductive health humanitarian response program, which includes abortion, assessing its efficiency and quality, and providing recommendations for sustainability and scale-up.

One of the few studies on postabortion care in humanitarian settings, this research examines care quality in hospitals in Bangui, Central African Republic, a city shaped by decades of conflict-driven migration, and Jigawa, Nigeria, a fragile rural state facing floods, disease outbreaks, kidnappings, and an influx of displaced people.

The link between abortion and gender-based violence

Published in the Lancet, research from the ARCHES (Addressing Reproductive Coercion in Health Settings) study provides strong evidence that an intervention implemented in Bangladesh increased contraceptive use, decreased unintended pregnancy and intimate partner violence, and increased knowledge of intimate partner support services.

Breaking stigma: Shifting attitudes about abortion

Abortion stigma remains a major barrier to care, even in countries with progressive abortion laws. Our research shows that tackling stigma is essential to ensuring people can fully exercise their reproductive rights.

Despite 20+ years of legal abortion in Nepal, negative attitudes and stereotypes about women who have an abortion remain high, with some groups holding more stigmatizing views than others. Ipas is using research findings to shape community engagement efforts that challenge harmful attitudes.

Changing laws, expanding rights

Our research informs advocacy for legal and policy reforms worldwide, resulting in several notable Ipas publications in 2024.

In the Democratic Republic of Congo, Ipas staff shared strategies and lessons learned from the country’s experience domesticating the  Maputo Protocol, specifically applying the commitments on abortion decriminalization and access.

In Nepal, research explored how contemporary abortion policies affect safe abortion access, as well as knowledge, attitudes and practices regarding abortion among federal and provincial policymakers.

Other research by Ipas staff explored knowledge of abortion legality among health facility staff in Ghana, and among women in Cote d’Ivoire and Ghana, finding overall levels of knowledge were low among providers and clients alike.

Training the next generation of abortion providers

Ipas research highlights gaps in abortion education for medical students, but an expansion of access through midwifery.

In one of the largest studies about abortion care education in medical curricula to date, a global study of medical students in 85 countries found high demand for comprehensive abortion education but limited institutional support.

Research from the Democratic Republic of the Congo highlights the overlooked role of midwives in comprehensive abortion care. In this article, authors identify key factors for strengthening midwifery-supported care, including legislation, expanded scope of practice, administrative support, fair pay, and better access to continuing education.

Telemedicine works: Safe, effective and reaching more people in need

Published research from Colombia provides strong evidence for the effectiveness of telemedicine abortion services and their capacity for expanding access to quality abortion care.

Authors from Ipas and the organization Profamilia found that medication abortion provided by telemedicine was as effective and satisfactory as medication abortion procedures provided in-person. Findings support telehealth as a powerful tool to expand access, especially for underserved, rural and marginalized populations. A systematic review further confirms evidence that abortions provided with medication abortion are safe up to 12 weeks of pregnancy.