Canadian programs around the world bring safe abortion rights and services into focus

Abortion can be a difficult topic to talk about in many countries, from raising taboos to risking criminal prosecution in some places. In the Democratic Republic of Congo (DRC), Nurse Nisa is at the ready with advice and answers to questions ranging from finding safe and legal abortion services to getting proper post-abortion care. This information is provided confidentially, minimizing the chance that it may put someone at risk if abortion is not easily accessible or accepted.

Not a real person but an app for mobile phones, Nurse Nisa offers clear and reliable information about abortion, as well as about contraception and gender-based violence.

“This is totally revolutionary,” says Jean-Claude Mulunda, DRC country director for Ipas Partners for Reproductive Justice, which implemented the phone app in both DRC and Kenya in collaboration with Dimagi, a social-impact technology company. “This is an opportunity to reach many people with the information they need in a way that is safe and user-friendly.”

He says that Nurse Nisa, accessible on the WhatsApp platform, explains options and offers medically approved instructions for before, during and after an abortion. Available in French and Swahili, the digital application addresses concerns about abortion-related procedures, covers abortion self-care, and links users to healthcare workers and organizations that provide abortion services and support.

Canada provided funding to Nurse Nisa under a recent Global Affairs Canada (GAC) grant to Ipas aimed at increasing access to safe and legal abortion and contraception in Central America and Africa.

A commitment to global health and rights for women and girls

In 2019, Canada made a 10-year commitment to the health and rights of women and children, with aims to raise our global health funding to $1.4 billion per year by 2023. Of this amount, $700 million is dedicated to sexual and reproductive health and rights (SRHR). Canada currently funds a number of international assistance projects that include comprehensive sexuality education, family planning (including contraception), advocacy, as well as advancing the rights of women to choose safe, legal abortions and to get post-abortion care.

“It's so important the work that Canada is supporting in developing countries to make sure that those rights are protected,” says Karin Nilsson, lead of the support unit for SheDecides. The international organization was formed 5 years ago to mobilize political support for safe abortion services, using a network of global champions and grassroots advocacy around the world.

She says the right to bodily autonomy “is not a given” for women anywhere in the world. Particularly for those in low-income countries, when that right is compromised “it worsens poverty, and it worsens the possibility to participate fully in society. It’s all connected,” Nilsson says. SheDecides has designated a diverse group of 50 champions, among them Harjit Sajjan, Canada’s Minister of International Development, to support and protect bodily autonomy “as a global society,” she says. “It’s really important to stand up, and to resist and persist.”

Indeed, while some countries are liberalizing their abortion laws (Benin, Argentina, Colombia and Mexico, for example,) in other places getting an abortion, or even helping someone get an abortion, can land you in jail. And misinformation and politicization about this safe and effective procedure threatens the ability of women around the world to get what is considered essential healthcare.

Efforts on the ground

Efforts on the ground in developing countries supported by Canada are helping women and girls exercise the right to a safe abortion. Meghan Doherty, director of global policy and advocacy at Action Canada for Sexual Health & Rights, notes that it’s critical to foster an environment where people can fully understand their choices, and can access needed services.

GAC supports a 4-year project by Action Canada—a progressive, pro-choice organization committed to advancing and upholding sexual and reproductive health and rights in Canada and globally—in targeted districts of Bolivia, Ecuador, Guyana and Peru. Doherty says the initiative, called Rights from the Start, is aimed at young people and especially adolescent girls. It has three pillars: the provision of SRHR services, including abortion care where permitted; the delivery of comprehensive sexuality education; as well as advocacy and movement building.

When the COVID-19 pandemic response caused many countries to re-direct resources away from SRH services, Action Canada’s local partners “stepped in to fill the gap,” Doherty says. “What is incredible is the ways in which these organizations have adapted to try and continue to meet the needs as best as they could.”

Now that pandemic restrictions have eased, “they’re keeping the best of the things that they put in place for COVID,” Doherty says. This includes sharing information on social media, setting up community computer stations and offering cell-phone credits so people can attend telemedicine appointments. This makes it possible to reach far more people and provide services to remote communities.

New ways of reaching young people

In Peru, for example, an organization called INPPARES, in partnership with Action Canada and with funding from Rights from the Start, created a youth-led interview podcast called “Sin Roche” (“Without Shame” in English), which covers a wide range of SRHR topics. This enables the organization to reach young people with comprehensive sexuality education that was typically not possible, INPPARES says. Youths host the podcast and choose content they consider relevant.

Themes of the podcast have included sexually transmitted infections, early/unintended pregnancy, violence against women and gender diversity. The most recent episode, entitled “Deciding is not a crime, it’s a right” deals with abortion. Interviewees in the episode include psychologist Guadalupe Torres, who points out that there were some 28,000 hospitalizations for unsafe abortions in the country in the last year. “The right to decide is a human right,” she comments.

Other innovative abortion-rights strategies like the Nurse Nisa phone app, which was introduced amidst the COVID-19 pandemic, offer new ways of reaching people, especially younger audiences, and at a greater scale than was previously possible.

Jean-Claude Mulunda, a medical doctor who previously provided SRH services, says that it was once impossible in the DRC to even discuss abortion. A regional treaty known as the Maputo Protocol, which was passed in 2005 and ratified by the DRC in 2008, allowed access to abortion services in situations such as rape and incest, for matters of mental health or when the life of a woman is in danger.

However, stigma around abortion and restrictions remain, he says. Unsafe abortion is the second-highest cause of maternal mortality in the DRC, Mulunda explains, because women and girls typically don’t have information about the complications that can arise if abortions are not performed according to medical guidelines. Ipas works with political leaders to promote the idea that abortion should be accepted by the community, and to make women and girls more aware that they have a choice to access it.

The Nurse Nisa phone app is part of this, he says, providing a menu of answers, facts and referrals to supportive services. Topics include the right abortion medications to use, he says, “so that women can negotiate that in the pharmacy.” This gives them greater confidence and the ability to manage such abortion methods in a safe and effective way.

Providing critical information

“It gives people a way to get critical information in a fast, easy and safe way,” says Jennifer Holloway, director of communications for Ipas. The organization works with partners across Africa, Asia and Latin America to make abortion and contraception widely available, to connect people with information so they can find services and to campaign for legal, accessible abortion.

“Having the ability to make decisions about your own body, and about your healthcare and reproduction, allows you as a person to contribute to your society, to your community, to your family,” she says. “Without that ability, your choices in life, your trajectory in life, becomes more limited.”

Ipas also focuses on making abortion care accessible in humanitarian settings, such as in refugee camps. It notes that an estimated 35 million women and girls of reproductive age are living in such settings around the world, often with little or no access to contraception and abortion services. The organization trains healthcare providers at all levels to provide safe, high-quality services and information, Holloway says. “Lack of information, stigma, climate change and conflict—as well as restrictions on abortion—create barriers that we’re working to break down.”

She feels the fact that more attention is currently being paid to abortion can be positive. “It is talked about in a way that can perhaps normalize it. We're talking about healthcare,” she says. “That's why we're working with GAC on these projects. We have this shared vision of what the world could be, rather than in many ways what it is now.”

A 5-year Ipas project in Mozambique supported by GAC is designed to increase access to SRH services, including safe abortions, in 3 provinces that have the country’s highest rates of gender-based violence. Jorge Matine, Mozambique country director for Ipas, says it’s critical to strengthen the healthcare system, reduce stigma surrounding abortion and limit the distances that women and girls have to travel for SRH services.

Countering stigma and gender inequality

A major element of the Ipas programming in the 3 provinces focuses on enhancing communication and countering damaging taboos, which are often based on gender inequality and discrimination. Ipas works with local journalists and community radio stations to present programs that inform people about the availability of services and to counter misinformation, he says. “All those myths that are there, they need to be removed.”

Improving access to abortion in developing countries “is an incremental process,” says Meghan Doherty. “The small steps, they all add up, but you have to take those small steps.” For example, she notes that Ecuador recently decriminalized abortion for rape victims. Many other countries are following suit, recognizing that prohibiting abortions doesn’t stop them, it just makes them less safe. While Action Canada is not a proponent of exceptions like allowing abortion only in rape cases, which can be politicized and thus subject to changing governments, the change in Ecuador’s law creates a precedent and it is an improvement over the severe restrictions that were in place previously, she says. “It provides an opportunity for the training of health-care providers, and it will eventually build onto broader advocacy for greater liberalization of the law.”

Canadians should be mindful of the fact that “the challenges to accessing sexual reproductive health and rights are pretty universal,” Doherty adds. “These issues are not something that happen over there, this is also something that happens here. We have a lot in common and we all need to work together.”

Karin Nilsson says it’s critical for countries “to rise up for abortion rights together.” SheDecides would like to see political leaders become more “vocal that it's a fundamental human right to be able to decide over your own body, life and future. Unfortunately, we're not there yet.”

Making a difference

She would like to see more investment in the issue. She notes that Canada is “making a difference” through its Feminist International Assistance Policy.

“The Canadian leadership is really helpful for us,” Nilsson adds. “We're really happy about working together with the Canadian government and Global Affairs Canada, because they have the same vision to connect and support and collaborate with other countries across the world.”

Jean-Claude Mulunda appreciates the fact that Canada supports women’s autonomy and that it funds programs such as the Nurse Nisa phone app “so women have the right information that allows them to choose.”

He wants to see abortion legalized for all women in his country. In the meantime, “we would like to be sure that women can benefit from the existing law,” by increasing awareness and access to safe abortion through the information available on Nurse Nisa.

He says the phone app will continue to be improved with interactive features and programmed with new content in response to user feedback. There are plans to bolster Nurse Nisa’s ability to connect users with trusted local hotlines, pharmacies and health centres when in-person services are needed.