Supporting innovative solutions to tackle the world’s unsafe abortion crisis

Every year, millions of people around the world risk their lives having unsafe abortions.

While safe, effective solutions to end unwanted pregnancy exist, social, political and economic barriers mean nearly half of all abortions are unsafe. Thousands die and millions are hospitalised, some with life-changing injuries.

Since 2019, Grand Challenge Canada’s OPTions Initiative has given seed funding to organisations pioneering approaches that give more people access to quality, safe abortion information and services.

These social entrepreneurs, feminist research and academic institutes, start-ups, and national and grassroots organisations are trialling a spectrum of solutions, from telemedicine services to clinical research. In 2020, as COVID-19 spread worldwide, the OPTions Learning Platform (OLP) became the first global technical support platform and accelerator exclusively focused on abortion innovation. Led by Options, it has provided technical assistance, coaching and mentoring to OPTions Initiative-funded innovators running projects in Africa, Asia, the Americas and Europe.

Drawing from Options’ experience in at least 60 countries, the OLP has become a convening space for innovators, experts, funders and researchers.

This is what we have learnt so far:

1. Donors must prioritise safe abortion innovation.

Abortion innovators, with varying experience and resources, compete for limited funds.

They also often work in restrictive settings, which hampers their ability to raise their profile, promote their innovation and partner with local health providers.

The OLP team helps them overcome this by enhancing opportunities to safely network, peer learn, and showcase impact.

OLP directs innovators to technical networks, learning events and funding opportunities, and facilitates introductions to external experts who advise on business development, digital health, regulatory matters and more.

Grand Challenges Canada is now exploring how these connections can continue when grants to innovators end.

2. Trialling bold innovations in restrictive settings requires robust risk management and safeguarding strategies.

Innovators should research and implement risk management and safeguarding strategies from the start to ensure quality of care and safety for all involved in the innovation.

To support that strategy development, OLP organises online sessions and directs innovators to existing tools, frameworks and safeguarding support hubs which operate globally.

Some innovators, such as Vitala Global Foundation, have since developed their learning on digital data collection and risk management for cyber security and safe abortion accompaniment apps.

3. Safe abortion innovators must monitor, evaluate and learn to avoid dangerous failures.

Learning from failure is celebrated in design and innovation, but failing in a safe abortion context can be dangerous.

Agile monitoring, evaluation and learning (M&E) systems are a must to help innovators identify what isn’t working and react quickly. These systems require piloting to test what data and indicators are relevant and can be captured, as well as how to adjust tools and approaches to meet evidence thresholds.

OLP has supported this process by hosting an online series outlining key considerations when building a strong M&E system for safe abortion innovation (such as those around conceptual frameworks and indicators). One-to-one coaching helped define innovations’ parameters and establish learning agendas that will inform adaptive design of innovations.

“Having adapted our app to meet our users’ need for real-time support, we are strengthening our cyber security and safeguarding protocols for our team and users worldwide”

– Genevieve Tam, co-founder of Vitala and its Aya Contigo abortion accompaniment app

4. Securing funding to scale a safe abortion innovation should always be part of the plan.

Investment sources for the scaling of safe abortion innovations are limited.

To help innovators navigate this challenge, OLP horizon scans for possible investors, shares market intelligence with innovators and builds their planning capacity.

Innovators are encouraged to consider alternative investment sources, such as feminist or digital health funders, private sector health providers, and government funds, depending on the setting.

OLP also organised online ‘fireside conversations’, which gave innovators a rare opportunity to ask donors what they’re looking for in funding applications.
And at OLP-organised ‘pitching clinics’, innovators presented their innovation to a feedback panel. OLP’s experts also reviewed innovators’ funding applications and mapped their investment opportunities.

5. Smart partnerships are vital to implementing and scaling safe abortion innovations.

Strategic partnerships are crucial to safe abortion innovators’ scaling success.

Organisations working on digital accompaniment or telemedicine, for example, needed support from grassroots organisations, public and private health sector networks, cybersecurity and legal experts, regulatory bodies, commodity suppliers and advocacy groups.

Some telemedicine pilots implemented under research settings needed commodities such as multi-level pregnancy tests to scale, which required national approval.

Other organisations needed formal partnerships with sexual and reproductive health organisations to reach marginalised women. And those conducting pre-clinical and clinical trials needed links with regulatory experts and those generating research they could build on.

OLP facilitated introductions and drew on its consortium management expertise to guide innovators on formalising these partnerships.

But donors must recognise this crucial relationship-building takes time.

6.  The Covid-19 pandemic may prove a milestone moment for safe abortion access.

COVID-19 has exacerbated unsafe abortion risks.. Estimates suggest, it has prevented 12 million women accessing family planning services, resulting in 1.4 million unintended pregnancies.

But social distancing requirements have also seen some governments fast-track policy and guideline revisions for safe, self-managed medical abortions.

In the Republic of Moldova, for example, positive preliminary results from the Reproductive Health Training Center’s telemedicine study during the Covid-19 pandemic led to the Ministry of Health supporting the service, organising online training for providers and including a chapter on medical abortion via telemedicine in its revised National Safe Abortion Standards.

This piece was written by Leah Oatway.

The OPTions Learning Platform (OLP) is supported by the Options for Pregnancy Termination Initiative (OPTions Initiative) and Grand Challenges Canada. It is managed by Options Consultancy Services.   

To find out more about our innovators, read:

• Reproductive Health Training Center (RHTC): How telemedicine is transforming women’s abortion access in Moldova
• TANADGOMA: How two Georgian organisations designed a gamec-changing telemedicine service for the nation’s women