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January 31, 2024

News | Research

Research highlights from 2023

At Ipas, research is a critical part of our work and contribution to the field of sexual and reproductive health and rights (SRHR). In 2023, Ipas staff and partners carried out important research and analyses, leading to more than 20 publications on topics including self-managed abortion, abortion and postabortion care service delivery, policy and advocacy, digital health and telemedicine, and adolescents and youth. We also contributed to the development of new measurement tools on abortion quality and abortion self-efficacy, and to research on abortion-related morbidity and mortality in humanitarian settings. In addition, we explored the impacts of the COVID-19 pandemic on reproductive health service delivery. Here are some highlights from the research we published in 2023.

Self-managed abortion

Ipas’s research on self-managed abortion investigates multiple aspects of the experience for women and for people who provide access to abortion pill information and care. In 2023, Ipas researchers explored the acceptability of an abortion self-management intervention in Bolivia, the clinical outcomes of self-managed abortion in Cambodia, the pathways to self-managed abortion in Kenya and Uganda, and the quality of facility versus pharmacy self-managed abortion care in Bangladesh. Collectively, this group of publications speaks to the safety and effectiveness of self-managed abortion, the positive way women engage with community-level support, and the comparable way women experience self-managed abortion in and outside of health-care facilities.

Abortion-related measurement

Last year, Ipas contributed two important measurement tools to the SRHR field. The first, the Abortion Care Quality (ACQ) tool, provides abortion-care sites, providers, program implementers and ministries of health with valid and reliable metrics for monitoring the quality of abortion care and informing quality improvement efforts. The ACQ project was a collaborative effort with Metrics for Management and Ibis Reproductive Health, and all ACQ tools and resources are available at https://www.acqtool.org.

The second tool, the Perceived Abortion Self-Efficacy Scale (PASES), is the first multi-item tool to measure perceived abortion self-efficacy and covers the concepts of enlisting social resources, accessing abortion information and care, and resilience in the face of abortion stigma. PASES can be used to understand the degree of perceived abortion self-efficacy among a population of interest, and to inform the design and evaluation of interventions intended to increase a person’s abortion self-efficacy.

Abortion and postabortion care service delivery

Ipas has decades of experience training and supporting clinicians around the globe in the provision of person-centered safe abortion and postabortion care and our service delivery-focused publications contribute to an ever-changing and growing body of evidence on best practices in abortion care. In 2023, our service delivery research documented the positive impact of Ipas-supported interventions on postabortion care in Pakistan and explored how over 300 clinicians in nine countries navigate the reuse and replacement of manual vacuum aspirators and cannulae to overcome supply chain barriers and provide safe abortion care for their patients.

Policy and advocacy for abortion and reproductive rights

In 2023, Ipas researchers published several papers that explored lessons learned and analyses from abortion policy and advocacy wins and challenges around the world. Ipas President and CEO Anu Kumar highlighted key lessons and approaches for US-based abortion advocates based on experiences liberalizing abortion laws in other countries and the use of a human rights-based reproductive justice framework. In the Democratic Republic of the Congo, Ipas researchers and partners presented an analysis on the country’s pathway from decriminalization of abortion to the provision of safe, accessible abortion care. Finally, Ipas staff contributed to a book chapter on the impact of the anti-rights movement in Latin American, specifically on multilateral human rights institutions like the Organization of American States. 

Provider attitudes

Despite progressive shifts in abortion attitudes in South Africa, “conscientious objection” among medical providers continues to threaten abortion access. Ipas researchers explored attitudes and behaviors relating to conscientious objection among health facility staff, finding that persistent abortion stigma, operational barriers, and lack of clarity on conscientious objection procedures can lead to ambiguity and inappropriate use of conscientious objection, with consequences for abortion access.

COVID-19 and reproductive health

In Ethiopia, Ipas researchers explored how the COVID-19 pandemic impacted reproductive health service delivery and utilization, highlighting how pandemic mitigation measures, fear of infection, commodity stockouts, and increased transportation costs all reduced access to and use of SRH services, leading some women to face reduced contraceptive access and consequent unintended pregnancies. 

Digital health and telemedicine

The articles below explore the process of providing reliable information and care on SRHR for those not able or interested in having a face-to-face visit. In Brazil, Ipas authors highlighted human rights violations stemming from a lawsuit to ban telemedicine in abortion care. From the Democratic Republic of the Congo, our article described lessons and insights from a three-year process of developing, prototyping, and scaling up the Nurse Nisa chatbot, which provides free, confidential SRH information on the stigmatized topics of abortion, contraception, emergency contraception, and gender-based violence.

Abortion in humanitarian settings

Today the world has more displaced people than ever in history. Our research published in 2023 explores abortion-related morbidity in humanitarian settings in Nigeria and the Central African Republic, highlighting the extent of the consequences of unsafe abortion and complicated miscarriages in two hospitals serving people affected by war, migration, and recurrent natural disasters. Further evidence of the challenges of accessing care in fragile settings is detailed in our paper on the causes of delay in reaching adequate care to treat severe abortion-related complications in Nigeria.

Adolescent and youth reproductive health

These three publications from Africa present the challenges faced by young people seeking SRH information and care, covering a range of topics, ages, geographies, and legal settings for abortion, and resulting in similar conclusions. All the studies—one in Ethiopia, one in Mozambique, and a multi-country study—propose recommendations for improving SRH care for adolescents on the continent. Survey data from four public universities in Ethiopia found high levels of unwanted pregnancy and abortion and low levels of hormonal or long-acting contraceptive use. A participatory research study conducted in six communities in Mozambique described how gender values, norms, and practices affect girls’ risk of unintended pregnancy and their experiences of pregnancy and abortion. A paper exploring the pregnancy recognition experiences among 313 young people ages 10-19 who sought abortion care in Ethiopia, Malawi, and Zambia documented the processes of recognizing they were pregnant, resulting in limited options and affordability for safe abortions.