{
    "abstract": "Despite instituting a policy in 2004, M\u00e9decins Sans Fronti\u00e8res (MSF) continuously struggled to routinely provide safe abortion care (SAC). In 2016, the organization launched an initiative aimed at increasing availability of SAC in MSF projects and increasing understanding of abortion-related dynamics in humanitarian settings.\nFrom March 2017 to April 2018, MSF staff conducted support visits to 10 projects in a country in sub-Saharan Africa. Each visit followed a systematic approach with six key components and related tools that were later shared with teams worldwide. Data regarding women seeking abortion services and related outcomes were collected and analyzed retrospectively.\nFrom Q1 2017 through Q4 2019, SAC provision increased significantly in all 10 projects, rising from three to 759 safe abortions per quarter. Teams received 3831 patients seeking SAC and provided 3640 first and second trimester abortions, over 99% via medication methods. The overall complication rate was 4.29% and 0.3% for severe, life-threatening complications. No major security incidents were reported. MSF provision of SAC worldwide increased from 781 in 2016 (the year before this initiative began) to 21,546 in 2019.\nImplementation of SAC in humanitarian settings-even those with significant legal restrictions-is possible and necessary. Both first and second trimester medication abortion can be safely and effectively provided through both home- and facility-based models of care. Programmatic data provide valuable insights into abortion-related dynamics which must shape operational decision-making. Addressing internal barriers and providing direct field support were key to stimulating organizational cultural change.",
    "authors": [
        {
            "affiliation": "M\u00e9decins Sans Fronti\u00e8res, Operational Centre Amsterdam, Amsterdam, Netherlands.",
            "firstname": "Manisha",
            "initials": "M",
            "lastname": "Kumar"
        },
        {
            "affiliation": "M\u00e9decins Sans Fronti\u00e8res, International Office, Geneva, Switzerland.",
            "firstname": "Catrin",
            "initials": "C",
            "lastname": "Schulte-Hillen"
        },
        {
            "affiliation": "M\u00e9decins Sans Fronti\u00e8res, Operational Centre Brussels, Brussels, Belgium.",
            "firstname": "Eva",
            "initials": "E",
            "lastname": "De Plecker"
        },
        {
            "affiliation": "M\u00e9decins Sans Fronti\u00e8res, Operational Centre Brussels, Brussels, Belgium.",
            "firstname": "Ann",
            "initials": "A",
            "lastname": "Van Haver"
        },
        {
            "affiliation": "M\u00e9decins Sans Fronti\u00e8res, Operational Centre Barcelona, Barcelona, Spain.",
            "firstname": "Sonia Guinovart",
            "initials": "SG",
            "lastname": "Marques"
        },
        {
            "affiliation": "M\u00e9decins Sans Fronti\u00e8res, Operational Centre Amsterdam, Amsterdam, Netherlands.",
            "firstname": "Maura",
            "initials": "M",
            "lastname": "Daly"
        },
        {
            "affiliation": "M\u00e9decins Sans Fronti\u00e8res, Operational Centre Brussels, Brussels, Belgium.",
            "firstname": "Hilde",
            "initials": "H",
            "lastname": "Vochten"
        },
        {
            "affiliation": "M\u00e9decins Sans Fronti\u00e8res, Operational Centre Geneva, Geneva, Switzerland.",
            "firstname": "Lisa",
            "initials": "L",
            "lastname": "Merzaghi"
        },
        {
            "affiliation": "M\u00e9decins Sans Fronti\u00e8res, Operational Centre Brussels, Brussels, Belgium.",
            "firstname": "Brice",
            "initials": "B",
            "lastname": "de le Vingne"
        },
        {
            "affiliation": "M\u00e9decins Sans Fronti\u00e8res, Operational Centre Barcelona, Barcelona, Spain.",
            "firstname": "Jean Fran\u00e7ois",
            "initials": "JF",
            "lastname": "Saint-Sauveur"
        }
    ],
    "conclusions": "Implementation of SAC in humanitarian settings-even those with significant legal restrictions-is possible and necessary. Both first and second trimester medication abortion can be safely and effectively provided through both home- and facility-based models of care. Programmatic data provide valuable insights into abortion-related dynamics which must shape operational decision-making. Addressing internal barriers and providing direct field support were key to stimulating organizational cultural change.",
    "copyrights": "\u00a9 2022 The Authors. Perspectives on Sexual and Reproductive Health published by Wiley Periodicals LLC on behalf of University of Ottawa.",
    "doi": "10.1363/psrh.12209",
    "journal": "Perspectives on sexual and reproductive health",
    "keywords": [],
    "methods": null,
    "publication_date": "2022-10-24",
    "pubmed_id": "36273433",
    "results": "From Q1 2017 through Q4 2019, SAC provision increased significantly in all 10 projects, rising from three to 759 safe abortions per quarter. Teams received 3831 patients seeking SAC and provided 3640 first and second trimester abortions, over 99% via medication methods. The overall complication rate was 4.29% and 0.3% for severe, life-threatening complications. No major security incidents were reported. MSF provision of SAC worldwide increased from 781 in 2016 (the year before this initiative began) to 21,546 in 2019.",
    "title": "Catalyst for change: Lessons learned from overcoming barriers to providing safe abortion care in M\u00e9decins Sans Fronti\u00e8res projects.",
    "xml": "<Element 'PubmedArticle' at 0x7885049cb150>"
}