Reaching women who need contraception: A ‘real strength’ of Ipas programs
Ipas evaluation expert Sally Dijkerman talks about our impact in 2019
Ipas’s 2019 Impact Report is now available, with stories and voices that highlight the vital importance of safe abortion and contraception. Sally Dijkerman, Ipas senior research and evaluation advisor, has helped collect and analyze Ipas’s annual results for 6 years, watching our impact grow and evolve. Here she shares her insights on this year’s results.
Question:What 2019 results do you find most interesting and why?
Sally: I’m most interested in what women and girls are telling us after having an abortion service at an Ipas-supported health facility. Most women leave having received woman-centered counseling on contraceptive options and the contraceptive method of their choice. Last year we surveyed almost 2,000 abortion clients at a sampling of Ipas-supported health facilities across eight countries, and over half of the women (59% on average) adopted a contraceptive method and had not been using any modern method before their visit. Of those women, 40% had never used contraception before in their lifetime. This is evidence that comprehensive abortion care is a critical service stream for increasing access to and use of contraception, particularly for women who may otherwise never have been able to access contraception. This is a real strength of Ipas’s comprehensive abortion care program model.
I’m also excited to see that our programs in Latin America are reaching a large percentage of women living below the national poverty line. Over half of women (55%) served at Ipas-supported health facilities in Mexico and a third (32%) of women accessing comprehensive abortion care in Bolivia are living below the national poverty line. By supporting the public health system to provide abortion services, Ipas is helping the poorest women and girls in those countries access safe abortion care.
Question: What results were most surprising or unexpected to you?
Sally: I was pleasantly surprised to see that our Nigeria program is reaching a high proportion of women and girls who have no formal education, with 42% of women served at Ipas-supported facilities having never attended school. Additionally, 25% are living below Nigeria’s national poverty line, and 83% of women who received contraception after an abortion became first-time users of a modern method. These data show that the Ipas Nigeria program is supporting the local health system to make safe, high-quality abortion services accessible to some of the most underserved populations.
For the first time, we heard from women about the social support they received from their communities as they sought abortion care. While the results varied by country, I was surprised to see how many women reported high levels of social support from their families, partners, and communities. In Mexico, for example, three-quarters (74%) of women said that someone supported their decision to seek abortion, and 84% said that someone made them feel cared for and valued during their decision and care-seeking journey. These results give us a baseline for social support in local communities, which we can benchmark future changes against to provide evidence on how Ipas programs impact social norms and supportive behaviors around abortion.
Question: The COVID-19 pandemic is already impacting access to abortion and contraception. Do Ipas’s 2019 results reveal any lessons or insights for our current situation?
Sally: This pandemic highlights the importance of providing alternatives to facility-based abortion care, since going to a health facility may increase a woman’s risk of exposure to COVID-19. In 2019, we added 250 Ipas-supported access points for abortion with pills—places like pharmacies and community-based organizations where people can obtain high-quality medications. Expanding women’s access to abortion self-care with pills has become essential, and Ipas is working with more urgency than ever—building on the access-point model we’ve already begun, plus integrating new approaches like telemedicine.