In a region where in-clinic access to safe abortion is extremely limited, a harm-reduction model of care is helping women safely self-induce—and take back their reproductive freedom.
The Instituto Peruano de Paternidad Responsable (INPPARES), a reproductive health organization that provides services for women and men in Peru, first implemented a harm-reduction framework in 2006 centered around providing women with reliable information about the use of misoprostol—a safe and effective self-induction drug—as well as access to pre- and post-abortion counseling and support. Following the success of a similar model implemented in Uruguay, INPPARES connects women with counselors and nurses who can provide them with accurate, non-judgmental information about safe and unsafe abortion methods—including protocols, dosing of misoprostol, what to expect when self-inducing and when to seek care should they choose to take misoprostol on their own. Women are encouraged to follow-up with an in-person visit or telephone call, either for post-abortion or antenatal care depending on their decision.
In Peru, like most of Latin America, abortion is almost entirely illegal. Such restrictions invariably lead women with unwanted pregnancies to seek out illicit providers or to self-induce abortion, which can be both unsafe and ineffective. Acknowledging that women will in fact turn to abortions as a reproductive right, regardless of the legal, economic or social barriers, INPPARES’ harm-reduction model aims to reduce the risks associated with abortion and make safe, accurate information as accessible as possible.
This model has since been adopted by multiple clinics across Lima, as well as in one in Chimbote, a small coastal town in northwestern Peru. And a new study by Ibis Reproductive Health, University of California San Francisco and the International Planned Parenthood Federation/Western Hemisphere Region found not only proof of the program’s success, but potential pathways for broadening the scope and effectiveness of harm-reduction care as well.
Of the 220 women who reported taking misoprostol, 89 percent reported having a completed abortion. With in-person and telephone counseling options at their disposal, 77 percent of women followed-up with harm-reduction counseling—a number that jumped by nearly 50 percent when telephone follow-ups were introduced in 2011. When women were asked by Ibis if they would be interested in a text message follow-up program, roughly three-quarters said yes, which signals a potential for increased participation and higher rates of successful reproductive care. Women who followed-up were more likely to obtain an ultrasound and know with confidence whether or not their abortion was completed; they were also more likely to recommend the service to a friend. The harm-reduction model thus not only helps women obtain safe abortions, but inspires them to share healthy reproductive choices in the future.
At the end of the day, what this model boils down to is access to information as a human right. “The use of a human rights framework to empower women with information if they are going to have an abortion on their own,” Sarah Baum, Associate at Ibis and co-author of the study told Ms., “means bringing that information through a clinic setting to the hands of women.” INPPARES’ harm-reduction model avoids the chokeholds of restrictive laws by channeling information through minimal clinic involvement in the form of legal pre- and post-abortion care, which in turn provides women with essential clarity and support.
In Uruguay, this framework inspired even larger, institutional changes that eventually led to the decriminalization of abortion within the first 12 weeks. But the push for legal reform is a long journey—one that requires a great many stakeholders to recognize that safe abortion is a fundamental component of women’s reproductive rights. While policy reform for legal abortion is the aim of reproductive rights advocates in Peru, harm-reduction provides increased access to safe abortion until that goal is met in the same environment where advocates and other stakeholders can simultaneously push for legal reform.
Although the harm-reduction model doesn’t necessarily works on it’s own to change the legal landscape, “it certainly contributes to women’s access to safe abortion while that work is being done,” says Baum. In the interim, she says, “women need access to safe abortion services in order for their reproductive rights to be fully realized”—and this harm-reduction model demonstrates how and why access to increased safe abortion can be rightfully achieved.
