Doctors as Advocates for Self-Managed Abortion and Reproductive Justice

Photo credit: Martina Šalov

by Jessica Morris

The International Federation of Gynecology and Obstetrics (FIGO) is the world’s largest alliance of national professional societies of obstetricians and gynecologists. FIGO supports comprehensive, equitable, and accessible sexual and reproductive health (SRH) for everyone, recognizing that these are fundamental human rights and essential components needed to achieve global health goals.

FIGO works through its technical committee and its programmatic arm to improve access to abortion across the globe. Over the last two decades, FIGO has been a global advocate and played an important role in encouraging progressive, evidence-based thinking on abortion with its 130+ national professional societies and other stakeholder groups. FIGO has worked to strengthen and support these societies in becoming national leaders on SRH and driving important improvements, including  legal and policy developments, service provision, increasing supportive attitudes, and raising awareness and challenging bias.

What is the role of doctors in the de-medicalization of abortion?

Self-managed abortion (SMA) offers a unique opportunity to improve access, making it more equitable, safe, and person-centered, especially for marginalized people who are more often impacted by the multitude of barriers to care. While physicians and other health care providers will always be an essential part of the abortion ecosystem (especially for surgical abortions, complications, and complex cases) the essence of SMA is moving abortion care out of the facility, away from the provider and into the hands of women and pregnant people themselves. Doctors have an important role in supporting and advocating for this. Why?

Firstly, doctors, especially in lower resource settings, have seen first-hand what happens when women are forced to resort to unsafe abortion to end an unwanted pregnancy. Their powerful stories are significant for countries wanting to reduce these preventable maternal deaths and achieve global development goals.

Secondly, doctors and the professional societies that represent them are well placed to be technical advocates. Often privileged with advisory roles to decision makers, their clinical advice is viewed as neutral, evidence-based, and well respected.

Thirdly, with many countries far from having recommended ratios of healthcare providers, task-sharing across the continuum of providers, including self-care is essential to meet a country’s healthcare needs and will bring benefits to communities, as well as the health workforce, the economy, and beyond.

What has FIGO done to support SMA?

FIGO has been involved at all levels of SMA advocacy, which include education, capacity building, and research implementation for SMA. Here are some examples.

International advocacy of SMA

FIGO has published statements providing guidance to doctors and member societies on abortion topics, notably calling for decriminalization, providing evidence to UN bodies, and working with partner organizations to advocate for increased access to medical abortion and SMA.

FIGO raises its voice to defend rights when they are challenged in the legal system through involvement in strategic litigation, having recently provided evidence to support cases in Europe, the USA and Latin America. 

Regional Expertise Sharing and Support

FIGO established communities of practice in SRH with regional groups representing East, Central, and Southern Africa and Francophone West Africa. Totaling 30 national societies, these groups share expertise and motivational support. SMA has been a focus area, working with these groups to learn more about evidence-base, explore areas of resistance, and develop advocacy and communication skills. Some of these societies have expanded on this work, driving the agenda forward in their countries.

National level impact – Zambian example

FIGO’s flagship SRH project on Advocating for Safe Abortion covers many aspects of improving access to safe abortion, both on the supply and demand side. It provided evidence of impact and a proven model for FIGO’s engagement. It also laid important groundwork on SMA which has been further built on in countries such as Zambia. Here, the Zambia Association of Gynaecologists and Obstetricians (ZAGO) has been working over the past year, with FIGO support, to identify barriers to the implementation of SMA and to remove or reduce them. This is driven by society’s belief that this will lead to improved access, financial and social benefits to patients, and reduced stigma around abortion care.

While SMA can be completely independent from the medical establishment, in Zambia, women still need to come to facilities for initial consultation, but can take the medications at home and self-assess abortion success. The ZAGO team worked in key facilities to support the implementation of these aspects of SMA.

Success requires multiple strategies

ZAGO knows that to be effective, it needs to work through the parts of the abortion ecosystem that it is well-equipped to engage with, while working with other national partners to ensure a comprehensive approach. ZAGO implemented its work through the following pathways:

Pathway 1: Improving knowledge, attitudes, and practices around relevant guidelines (and in particular on SMA) with healthcare providers at regional hospitals that receive high volumes of unsafe abortion cases.

Pathway 2: Identifying and removing barriers to information and access to SMA.

Pathway 3: Creating a favorable environment for operationalization of the relevant guidelines, including work with networks and evidence-driven advocacy.

Early results are promising, providing another example of the important contribution doctors and professional societies can make in improving women’s access to SMA.

Challenges and Opportunities

Abortion remains, for now, a controversial topic. As such, FIGO will face internal and external challenges as it progresses in its work in this area. While the option of SMA is an important one for women, girls and pregnant people, there is resistance from some healthcare workers and national decision makers to this. FIGO feels a strong obligation to continue sharing evidence, challenging negative attitudes, and finding opportunities to promote solidarity and an ethic of conscientious provision. SMA will continue to be a priority in our work as we support national societies and continue to advocate on a global scale.

Jessica Morris is a women’s health and rights technical and programme management specialist with more than 17 years of experience. Jessica works as Head of Programmes Development at the International Federation of Gynecology and Obstetrics (FIGO) with responsibility for strengthening and developing the Programmes Department, ensuring alignment and amplification of project work throughout FIGO’s structures.