ICWRSA Annual Report January 2020 – December 2021 - International Campaign for Women's Right to Safe Abortion

This report covers the two-year period from January 2020 to December 2021.

ICWRSA is an international, membership-based network

ICWRSA is an international, membership-based network with local, national, regional and international members, both groups and individuals who are working actively for and/or support the right to safe abortion. It was launched on 28 May 2012 by many of the advocacy groups involved in the International Consortium for Medical Abortion as a broader-based advocacy and information sharing network for universal access to safe abortion on public health and human rights grounds.

In February 2020, the Campaign became a charity under the aegis of the Charity Commission, England.

Structure
In 2020-21, the Campaign consisted of:
– An international coordination team with staff based in the UK, India and Peru.
– Five trustees and an International Advisory Board that included the leaders of our affiliated youth network, regional networks and the heads of several national NGO members, coming from Argentina, The Gambia, India, Kenya, Malaysia, Moldova, Palestine Occupied Territories, Peru and Tunisia in 2021.
– Affiliated regional networks in Latin America, Southeast Asia, sub-Saharan Africa, Middle East & North Africa, Central & Eastern Europe.
– Young Activists Network for Abortion Advocacy – a youth network launched in 2019 at the recommendation of a workshop for young members during the Campaign’s international Forum in October 2018.
– Partners who organise jointly for International Safe Abortion Day, including the Women’s Global Network for Reproductive Rights (WGNRR), Asia Safe Abortion Partnership (ASAP), Asian-Pacific Resource & Research Centre for Women (ARROW), Astra Central and Eastern European Network for Sexual and Reproductive Health & Rights, Latin American Consortium against Unsafe Abortion (CLACAI), Eastern European & Central Asia Abortion Network (CIDSR), Africa Coalition for Safe Abortion (ACSA), Ipas Africa Alliance, and Right & Access for Women to Safe Abortion in the Middle East & North Africa Region (RAWSA MENA).
– Members in 132 countries in all world regions, ranging from international agencies and INGOs to regional CSOs and networks, national and grassroots level coalitions and groups, and many individuals working for the right to safe abortion, including legal experts, human rights defenders, health care professionals, policymakers, researchers, academics, students and many others.

What we stand for

Goals
− Safe abortion as a universally accessible, publicly available and funded healthcare service.

− Full social and legal decriminalisation of abortion.

Mission
To bring together organisations and individuals who support and promote the right to safe abortion through knowledge creation and sharing, network and coalition building, and advocacy.

Intended outcomes
− Increased attention to and support for the right to safe abortion in key international, regional, and national decision-making spaces.
– Support for the work of our members in improving law, policy, services and access for women and girls to safe abortion in their countries, where change must take place.
− Increased public awareness of the negative impact of unsafe abortion.
− Contribute to the reduction of stigma around obtaining an abortion and around the provision of safe abortion care.
− Greater understanding that the right to decide whether and when to have children is a critical aspect of gender equality, sexual and reproductive autonomy, and the right to life and health.

Trustees (2020-21)
– Susana Chavez, Consorcio Latinoamericano contra el Aborto Inseguro (CLACAI), Peru
– Jane Fisher, Antenatal Results and Choices, UK
– George Hale, Finance Director, Promsex, Peru
– Sivananthi Thananthiran, Asian-Pacific Resource and Research Centre for Women (ARROW), Malaysia
– Beverly Winikoff, Gynuity Health Projects, USA

International Advisory Group (2020-2021)

Heads of affiliated regional networks

– Shruti Arora, India, Coordinator, Young Activists Network for Abortion Advocacy (YANAA)
– Susana Chavez, Promsex/Consorcio Latinoamericano contra el Aborto Inseguro (CLACAI), Peru
– Rodica Comendant, Central European/Western Asia Regional Network (CIDSR), Moldova
– Selma Hajri, Right and Access for Women to Safe Abortion in the Middle East & North Africa (RAWSA MENA), Tunisia
– Suzanne Majani, African Coalition for Safe Abortion (ACSA), Kenya
– Sivananthi Thananthiran, Asian-Pacific Resource and Research Centre for Women (ARROW), Malaysia

Leaders of other member networks/groups

– Ammal Awadallah, Palestinian Family Planning and Protection Association, Palestine Occupied Territories
– Sonia Corrêa, Sexuality Policy Watch, Brazil (2020)
– Soukeyna Ndao Diallo, Association des Femmes Juristes Senegalaises, Senegal (2020)
– Inna Hudaya, Samsara, Indonesia (2020)
– Kinga Jelinska, Women Help Women, Netherlands (2020)
– Satang Nabaneh, Think Young Women, The Gambia
– Mariana Romero, Centro de Estudios de Estado y Sociedad (CEDES), Argentina

Members

Members of the Campaign include international, regional and national networks; abortion rights advocates and those working for sexual and reproductive health and rights; women’s rights groups and organisations; youth organisations and a range of other health and rights-oriented civil society organisations; international and national policymakers and leaders; abortion providers and other health care professionals; legal and human rights advocates, organisations and experts; and researchers, academics and students. New members either directly register their interest to join the Campaign via our website or by writing directly to us, and we also send an email invitation to groups/individuals that we have identified as advocates for the right to safe abortion.

Communication between members, and between Campaign staff and members, has grown substantially over time, and national coalitions have formed in many countries. Members ask for a wide range of information on abortion issues, share important news from the work they are doing, their countries and networks, e.g. working for changes in national abortion law and policy and/or abortion service delivery, which we then share in the Campaign newsletter, on our website and via our social media. They also get in touch to request and/or respond to solidarity requests when something positive or something negative is happening, and also to collaborate on key events in the international women’s rights agenda.

At the end of 2020, we had 1,530 members in 129 countries, covering all world regions, of whom there were 222 new groups and individuals who joined during the year. As at 14 November 2021, we had 1,591 members in 132 countries.

There is always a surge in new members in the lead-up to International Safe Abortion Day (28 September) each year, as well as following solidarity requests, e.g. for Poland at the beginning of 2021, and during abortion rights campaigns, e.g. in Latin America and by other social justice movements.

Charity registration

In February 2020, the Campaign became a registered charity in England.

Activities of the Campaign’s affiliated regional networks in 2020-21: some examples

The regional networks affiliated to the Campaign (in Eastern Europe/Central Asia, Latin America, Middle East & North Africa, Sub-Saharan Africa and Asia) represent an important tier of membership at the regional level in support of collective involvement in the work of making abortion safe, legal and accessible. We believe it is one of the most important achievements of the 20 years since the International Consortium for Medical Abortion (ICMA) was launched in 2002 that regional networks focusing on abortion rights have been formed and become focal points for advocacy, working collectively, and creating and sharing information and experience. ICMA and the Campaign which followed on from it from 2012, have been instrumental in supporting regional networks and agendas both politically and financially.

At the international level, the Campaign has created a common space and a rich source of experience and knowledge. Yet issues related to abortion that need to be addressed differ substantially between the different world regions, such that in each region, groups and networks are often most interested in working and meeting others within their region as well as at national and sub-regional level. Shared language also plays a part, e.g. in Latin America and French-speaking West Africa. Groups in each region tend to know far more about what is happening in their own region than in the rest of the world, and with many problems in common, they are more able to to take joint action. Thus, a solidarity request from Honduras in January 2021 garnered signatures from some 220 groups in the Latin American region within just a few days, double the number from all other regions together.

Even so, solidarity requests have sometimes succeeded in garnering very widespread international support from many regions – for example, Argentina in 2019-20 and Poland in 2020-21.

Here are some examples of what some of the regional networks affiliated to the Campaign were doing in 2020-21:
– Africa Coalition for Safe Abortion (ACSA)
The Center for Health, Human Rights and Development (CEHURD) Uganda and the Coalition to Stop Maternal Mortality Due to Unsafe Abortion, in partnership with Ipas Africa Alliance, under the aegis of the Africa Coalition for Safe Abortion, held a regional exchange learning webinar on 25 August 2021. ACSA is a broad-based coalition of regional health and human rights civil society organizations committed to advocate for access to safe and legal abortion services in line with the Maputo Protocol, and provides a platform for national and regional CSOs to provide support and sustain the African Commission on Human and Peoples Rights (ACHPR) Campaign for the Decriminalization of Abortion in Africa. The aim of the regional exchange learning webinar was to engage with sexual and reproductive health rights champions from Kenya, Rwanda, Mozambique, and Ethiopia to share strategies used, lessons learnt and best practices that enabled them to achieve progress in the laws and policies on abortion in their countries. There were 70 participants from East, Central and Southern Africa.

– Asian-Pacific Research & Resources Centre (ARROW)
In July 2020, ARROW published an SDG monitoring report entitled Affirming Rights, Accelerating Progress and Amplifying Action: Monitoring SDGs in Asia-Pacific. The Asia-Pacific region has seen uneven and very slow progress in its pathway to achieving gender equality…. This regional brief monitors the implementation of SDG 5 on gender equality in the Asia-Pacific region…. The objective of the brief was to shed light on the progress made by countries in the region on a set of key transformative gender equality targets and indicators linked to SDG 5, and to identify the challenges in achieving these commitments. The predictions of the lengthy amount of time it would take were shocking!!

For 28 September 2021, ARROW called upon governments in Asia and the Pacific to recognise and ensure universal access to safe abortion. Here is the statement by the Safe Abortion Advocacy Initiative Global South Engagement (SAIGE). The statement was also delivered by ARROW at the 48th Session of the Human Rights Council in Geneva, 2021. The statement closes: “As advocates, we call upon all states and governments to recognise the reproductive health rights and ensure universal access to quality safe abortion services and post-abortion care for pregnant people. We call for abortion decriminalisation and the adoption of legal frameworks that enable pregnant persons to exercise their right to bodily autonomy, health and life.”

– Latin American Consortium against Unsafe Abortion (CLACAI)
The Latin American Consortium against Unsafe Abortion (CLACAI) produced a framework document in June 2020 in Spanish, entitled in English: “Reproductive Health as an Essential Health Service: An Analysis of Recommendation 54 of the Inter-American Commission on Human Rights (IACHR) Resolution 01/2020”. The document was signed by more than 90 organisations in the region, and was presented to representatives of the IACHR’s Rapid and Integrated Response Coordination Unit on Covid-19. CLACAI was also engaged in mid-2020 in developing a regional advocacy strategy on human rights and sexual and reproductive health; monitoring national reproductive health policies in nine Latin American countries on their responses to the Covid-19 pandemic; developing advocacy for strengthening of access to essential reproductive health services at the national level; and a communications campaign to disseminate the results of this work and their recommendations.

In 2021, CLACAI published Guidelines for the Design of a Care Protocol for Girls and Adolescents under 15 Years of Age with Unintended Pregnancy, which was supported by the Latin American Federation of Ob/Gyn Societies (FLASOG). CLACAI member organisations are currently using these Guidelines for the development of protocols and advocacy activities in their respective countries.

CLACAI is also currently focussing on the strengthening of two of its members’ working groups:

Group on Telehealth for Access to Safe Abortion – This group is conducting research on the state of telehealth for access to abortion in Latin America.
Self-Care and Support Group for Providing and Accompanying Safe Abortions (AAPAAS) – This group is doing workshops for abortions providers and companions of safe abortions to develop guidelines that will help organisations to develop protocols for self-care and prevention of professional burnout.

– Eastern Europe and Central Asia Regional Reproductive Health and Rights Coalition (CIDSR)
The CIDSR coalition achieved many important milestones in 2020 in advancing abortion rights and creating the conditions for improved quality of abortion services. As part of the SAAF-funded project, “Bringing the WHO Recommendations on Safe Abortion and Family Planning Closer to Women in Countries of Eastern Europe and Central Asia,” five countries from across the region (Uzbekistan, Turkmenistan, Armenia, Moldova and Kyrgyzstan) revised their national clinical guidelines and protocols on abortion and obtained approval from their Ministry of Health. In addition, Azerbaijan and Kazakhstan are expected to present the final versions of their respective national protocols/clinical guidelines to their Ministries in the near future. Some key improvements contained in the protocols that have been approved thus far include detailed pre- and post-abortion counselling guidance, raising the upper time limit permitted for medical abortion, banning both D&C (dilatation and curettage) and instillation abortion in the second trimester, and, in the case of Moldova and Kyrgyzstan, guidance for medical abortion via telemedicine.

Furthermore, four countries (Armenia, Kyrgyzstan, Uzbekistan, Moldova) organised online dissemination meetings with medical providers to discuss modifications/additions and the most recent safe abortion recommendations from WHO, including those specific to Covid-19, which emphasise the importance of self-managed care.

Medical abortion has been provided by the Reproductive Health Training Center (RHTC) Moldova since the end of March 2020 as part of the pilot project “Medical abortion via telemedicine for women and adolescents in rural Moldova: breaking barriers with technology,” supported by the OPTions Initiative. Since initiating study enrolment, providers from RHTC and a partner centre in the north of Moldova, the Women’s Health Center “ANA”, have together counselled over 400 women and adolescents in medical abortion and provided them with pills for pregnancy termination. Preliminary results of the pilot project show a high rate of effectiveness without the need for in-person care, a high level of satisfaction among clients and significant cost savings. With the recent inclusion of medical abortion via telemedicine in the National Safe Abortion Standards in Moldova, the service is expected to continue to grow in popularity as more and more women find out about it. The RHTC team hopes to begin scaling up the service in 2021.

– Right and Access for Women to Safe Abortion in the Middle East & North Africa Region Network (RAWSA MENA Network)
On 8 March 2021, the RAWSA MENA Network published a “Policy Brief on Abortion”, which reported that the impact of illegal abortion on women’s health in the Middle East and North Africa is understudied, and that reliable data are limited or non-existent because where abortion is illegal, data are not collected. The Occupied Palestinian Territories are often absent from official statistics altogether, as they are not formally recognised as a State. Wars and displacement in the MENA region contribute to high levels of maternal deaths (including unsafe abortions). The Fragile States Index, produced by the Fund for Peace, currently places five MENA countries (Afghanistan, Iraq, Sudan, Syria, and Yemen) on “very high alert” or “high alert”. Most abortion laws in the region are punitive and were promulgated during the colonial period, when French and British regimes supported patriarchal policies to increase the population. As colonial laws criminalising abortion became entrenched in society, legal and medical services for women needing abortions have remained restricted.

In July 2021, the RAWSA Network did a webinar on “How journalists can act as advocates for safe abortion in the MENA region. Then the last week of September they launched a communications campaign on the abortion situation in the region with the broadcast of six video testimonies from Morocco, Algeria, Egypt, Lebanon, Iraq, and Syria, during the week leading up to 28 September. On 28 September itself, they showed a final video gathering together all the testimonies and calling for action to make safe abortion accessible across the region. These videos are available on their YouTube channel.

In October 2021, RAWSA launched a training programme with four sessions for 20 activists involved in defending the right to safe abortion in their countries in the region. The training, carried out by regional and international experts, was to strengthen their capacity to build strong advocacy campaigns in their countries. The issues covered were advocacy, communications, clarification of values for attitude change on abortion, and the means to bring abortion out of illegality. At the same time, in October 2021, the need to do something about the lack of data and research on abortion was prioritised, as this information is necessary in order to build strong advocacy campaigns that ensure women’s rights. RAWSA MENA advertised for two graduate students from the MENA Region to carry out research on safe abortion in the region and the barriers to accessing safe abortion.

They have also received a grant from the Campaign for a project to “increase awareness of barriers to access to safe abortion in the MENA region and publish two reports – one on the feasibility of telemedicine for counselling and administration of medical abortion and one on the impact of Covid-19 and its consequences for accessing sexual and reproductive health services and safe abortion. Lastly, they are working on four mini videos on: sexual education, medical abortion, key messages for safe abortion, and telemedicine for safe abortion . They will present these at a regional press conference at the end of November 2021. The reports will be in Arabic and English and sent with the five mini-videos on a USB key by mid-December to organisations and activists in the region.

– European Safe Abortion Networking Group
This is an informal discussion group of ±25 senior staff from national and international NGOs based in Europe, including in Belgium, Denmark, France, Netherlands, Norway, Poland, Romania, Spain, Sweden, Switzerland, and UK, and from two Eastern European/Central Asian regional networks (English and Russian speaking). It was launched by the Campaign coordinator in July 2019 and has held online meetings in 2020 and 2021. Discussion topics at meetings have included European elections, ICPD Nairobi 2020, Generation Equality Forum 2021, universal health coverage, national legislation on abortion, the influence of Polish anti-abortion/anti-SRHR/anti-gender policies on other Eastern European countries, the effects of Covid-19 on access to abortion, telemedicine provision of abortion pills, women travelling between European countries for abortions, and growing activities of right-wing anti-abortion groups, especially in Eastern Europe. The group created a statement on abortion in Europe for 28 September 2020, signed by a larger list of Europe-based groups supporting safe abortion. We supported fundraising for the Polish Abortion Dream Team, and a lot of groups got involved in solidarity with Poland for the rest of 2020, as well as sharing news re the Trump-inspired anti-abortion activities and statements. In the December 2020 meeting, national news was the main subject, including threats to the Istanbul Convention by Hungary and Turkey, as well as the Covid-19 Special Session at the UN General Assembly and CSO participation.

In February 2021, we discussed a European Parliament document on SRHR in Europe that includes a list of recommendations to member states regarding safe and legal abortion, anchored in women’s health and rights, and background information on the UNECE Regional Forum on Sustainable Development. We also heard that other European countries were accepting Polish women seeking abortions. We shared a report on the response to Covid-19 of European countries, and their different approaches to changing abortion regulations and practices – an incoherent picture. In March 2021, we had a speaker from Spain on women travelling across borders in Europe for abortions. In April 2021 we discussed that the European Parliamentary Assembly will choose new judges for the European Court of Human Rights and supported solidarity work on this. In May 2021, we discussed the fact that Poland, Hungary, Croatia, Italy and Portugal have proposed that the Holy See should be treated as a voting member country in the World Health Assembly, and the Global Abortion Dialogue, to which not all of us were invited.

– Young Activists Network for Abortion Advocacy (YANAA)
YANAA is committed to advancing abortion rights globally for young people, developing advocacy initiatives and ensuring inter-generational dialogue. They aim to bring youth perspectives on abortion and develop youth-led advocacy strategies on all aspects of safe abortion, from parental consent to access to abortion pills to decriminalisation. As a project of the Campaign, YANAA’s strategies are aligned with the overall aims of the Campaign.

YANAA focuses on how abortion stigma impacts safe abortion access and education for young people, as well as highlighting the advocacy work our members and other young activists are doing on abortion, which means sexual health and relationships education are also a key focus.

In mid-2020, YANAA commissioned two YANAA members to create short videos with young people’s accounts of access to safe abortion during Covid-19. One was from France, the other from Sri Lanka; they were published on International Youth Day on 12 August 2020.

In September 2020, YANAA celebrated its first year. The Steering Committee, with members from different regions, began meeting on a monthly basis to organise activities for their small but growing community of members.

To mark International Safe Abortion Day in 2020, YANAA hosted a Twitter Chat, collaborated with ARROW on a personal testimony series on Instagram, and published a video about young people’s access to abortion in India during Covid-19. YANAA members from the states of Gujarat, Assam, Jharkhand and Punjab sent short videos that were circulated on Instagram, highlighting the gaps and need for information and services for young abortion seekers in the country.

Funding for Campaign members’ activities

Following the International Forum that we organised in Lisbon in October 2018, we put out a call for proposals to members for grants to organise national coalition-building meetings, with funds from the David & Lucille Packard Foundation. We funded five very successful meetings, which took place in 2019 in Ecuador, Gabon, Gambia, Madagascar and Peru, and a report on those meetings was published in the Campaign newsletter in January 2020. This created a precedent for us to continue to fund the work of some of our members and in late 2020, we published a call for proposals from members working on safe abortion access and advocacy, which have been arriving during 2021.

The following grants were funded from our core funding from the Netherlands Ministry of Foreign Affairs:

RAWSA MENA, our affiliated regional network in the Middle East & North Africa did research and wrote a report on the impact of the Covid-19 pandemic in the region, including restrictions on access to safe abortion and all sexual and reproductive health services.
Gozarte in Montevideo, Uruguay, worked to strengthen youth action in defence of sexual and reproductive rights by democratising and decentralising peer-to-peer information on legal abortion and sexual and reproductive health services throughout the country.
Taller Salud in Puerto Rico worked on the Project “Campamento Intensivo Pro Derecho a Decidir (Verano 2021)” through local work in Loíza on the northeastern coast and nationally. The project aimed to increase awareness of safe abortion through boot camps to train 5-10 multi-generational abortion doulas on companionship and support, workshops on advocacy issues surrounding abortion, and a national advocacy campaign. One of the highlights of the project was bridging the inter-generational gap with both age groups together demanding access to safe abortion.
A group who initiated a project on breaking the silence on safe abortion and increase awareness of young people regarding abortion and the use of contraceptive methods to protect and promote healthy relationships.

Réseau d’Afrique Centrale pour la Santé Reproductive des Femmes (GCG) in Gabon. A grant to assess the impact of Covid-19 on women’s access to post-abortion care in hospitals and the availability of treatment for incomplete abortions during the pandemic, whether the profile of the women seeking services changed, and how the staff have adapted during the pandemic. The aim was to encourage healthcare staff and health facility managers to keep these services open, to reassure women it was safe to come and use them, especially the most vulnerable, so that they continue to seek post-abortion care during the pandemic. A second grant later in the year was to organise in the region of the three adjoining borders of Cameroon, Gabon and Equatorial Guinea, ten days of awareness-raising workshops for adolescent girls, both in school and not in school, of education around sexuality, sexual health, menstrual hygiene and rights – with the aim of making them stronger and more informed. In addition, to provide three days of training on post-abortion care and management of complications for a group of untrained midwives.
SOFA, Haiti – A project to develop cooperation between health professionals and feminist organisations in Haiti and the Dominican Republic, initially to train three Haitian health professionals in manual vacuum aspiration and insertion of Copper-T IUDs as a first step in launching an ongoing collaboration to provide clinical training on dealing with complications of spontaneous and induced abortion and post-abortion contraceptive provision in Haiti. The collaboration will reinforce a multi-faceted Caribbean Initiative to link health services, research, and advocacy for women’s rights.
The Fundación ECOS in Argentina worked to strengthen the provision of abortion services in accordance with the new legal framework in force in the country and in the context of the Covid-19 pandemic.
A YANAA Steering Committee member from the YP Foundation in India initiated an open online course aimed at training young people in India (especially in Assam and Kerala) on the basics of abortion rights as well as in advocacy, national law and policy on abortion, access to abortion services within the health system, and abortion stigma. The course used a rights-based, intersectional and youth-friendly approach that enabled the creation of a safe space and stigma-free environment to discuss abortion rights and develop a more comprehensive understanding of abortion discourse. The course was offered in English, Malayalam and Assamese and was partially funded by the Safe Abortion Action Fund.
A YANAA Steering Committee member worked with the For Youth Initiative Kuala Lumpur (FYIKL) on ‘Sembang Malam Jumaan’, a podcast series in the Malay language on abortion, based on the findings of a survey they did on the challenges that young people face in terms of access to safe abortion services in Malaysia. The aim was to increase their outreach to the youth population in Malaysia, as podcasts have emerged as a popular medium for broadcasting messages and storytelling.

We also received a two-year grant for 2021-22 from the Global Fund for Women for a YANAA project that in 2021 supported several youth-centred initiatives by YANAA members, as follows:

Nifin’Akanga, a youth network in Madagascar, developed an art competition on the decriminalisation of abortion and continued their national mobilisation of young people to expand and strengthen their national safe abortion coalition, the launch of which we had funded previously.
CLACAI in Latin America in 2021 developed a project to strengthen their focus on youth, incorporating their youth organisations’ inputs on safe and legal abortion for girls and adolescents in their regional events, connecting youth across the region, strengthening youth-led actions through advocacy training and local initiatives on youth-specific access barriers to safe abortion, and connecting young advocates in the region to YANAA as a worldwide network.

These groups all faced many challenges during the year due to Covid-19 restrictions, especially in the absence of public transportation, and the need to avoid exposure to the virus. Their willingness to continue these projects has shown the strength of their commitment to promote access to safe abortion.

Coordination of 28 September 2020 and 2021
In both 2020 and 2021, 28 September, International Safe Abortion Day, was coordinated with the Asian-Pacific Resource & Research Centre for Women (ARROW); Asia Safe Abortion Partnership (ASAP); ASTRA – Central and Eastern European Network for Sexual and Reproductive Health and Rights; Latin American Consortium against Unsafe Abortion (CLACAI); Eastern Europe and Central Asia Abortion Network (CIDSR); Ipas Africa Alliance; Right and Access for Women to Safe Abortion in the Middle East & North Africa Region Network (RAWSA MENA Network); and Women’s Global Network for Reproductive Rights (WGNRR). The theme for International Safe Abortion Day, 28 September 2020 was “Self-Managed Abortion” and for 2021 it was “Make Unsafe Abortion History”.

As with every passing year, in spite of the pandemic, there were a wide range of activities including demonstrations, webinars, Twitter Chats, Facebook and Instagram Lives, many fact-based campaigns, testimonies and photo actions showing solidarity where people were not able to gather in public due to Covid-19. The hashtag for 2020 was #IManageMyAbortion which was widely used alongside other annual hashtags: #InternationalSafeAbortionDay, #SafeAbortionDay, #MedicalAbortionNow and #28Sept.

For 28 September 2020, during a week-long series of activities, the Campaign hosted a webinar on 23 September 2020, a twitter chat and shared an in-depth paper about telemedicine and self-managed abortion. We also circulated a Campaign statement on abortion law and policy and highlighted the 100th anniversary of the first law making abortion legal, in the Soviet Union. Shilpa Shroff participated in a SAIGE webinar, which discussed the WHO standards on medical abortion, and trends and use of medical abortion in the Asia region and globally. The presentation highlighted the disproportionate impact on marginalised women when there is no or restricted access to medical abortion. It also emphasised the need to strengthen public health systems and increase accountability of governments in enabling access.

Marge Berer represented the Campaign in a FIGO webinar on a 100 years of abortion policy; she discussed the implications of self-managed abortion with pills and telemedicine for both law and policy and health professionals, and the importance of mid-level providers at primary and community level in de-medicalising provision of abortion pills and taking these abortions out of hospitals.

In 2021, the hashtag #MakeUnsafeAbortionHistory was widely used and took on different meanings in different contexts: some centred their demands on service provision, facilities and training while others focused on legal barriers to abortion access and the current backslide of sexual and reproductive health rights (SRHR). #MakeUnsafeAbortionHistory conversations around the world highlighted that the COVID-19 pandemic has exposed and exacerbated health inequalities. Another recurring message was that financial inequality, stigmatisation and criminalisation all pose barriers to safe abortion. Moreover, the tagline “Abortion is Essential Healthcare” was also very widely used.

Campaigning groups and activists hosted a range of activities on and around 28 September. These included over 30 webinars and virtual panels that we heard about, many fact-based campaigns, letter-writing actions and online knowledge-sharing campaigns. This was the second year that Covid-19 impacted plans for 28 September; the greater diversity of online actions and events suggests that campaigning groups and activists have continued to adapt to pandemic constraints with creativity. In comparison to last year, when many countries were in strict Covid-19 lockdowns, it seems that more people were able to take to the streets to mark 28 September 2021; social media activity, therefore, also focused on sharing images from in-person demonstrations and events. Annual hashtags included #InternationalSafeAbortionDay, #SafeAbortionDay, #28S and #28sept. These tags allowed for conversations to continue across social media platforms and for members of the public to join in, by following the hashtag from one post to another.

In 2021, the Campaign coordination team took more of a facilitating role and focused on supporting members and other partners in their social media actions and campaigns. Together with the 28 September working group, we created an International Safe Abortion Day Toolkit and social media resources in English, French and Spanish. We also lent our platform to groups around the world, transforming our social media pages into a directory for online events commemorating 28 September. Our two best performing Twitter posts in the lead up to 28 September were the ‘#InternationalSafeAbortionDay events thread’ and toolkit posts, which gained over 10,000 impressions altogether.

See the events thread: https://twitter.com/Safe_Abortion/status/1436284257127780364

On 25 September 2021, five YANAA Steering Committee members conducted a 3-hour Values Clarification and Attitude Transformation (VCAT) workshop on Zoom, with youth advocates participating from USA/Bhutan, Italy, Malawi (x 2), Kenya (x 4), and Indonesia. The six sessions covered were:

a case study of why a young woman died from an unsafe abortion,
the false myths circulating about abortion and what is correct,

a rights-based approach to abortion,
particularly barriers to safe abortion for young women, including parental involvement laws, and how paternalistic ideas regarding young people’s sexuality make it difficult for providers and policymakers to understand young people’s realities,
a brainstorming on all the reasons why young women have sex, get pregnant, and terminate or continue an unwanted pregnancy, and involving young people in decision-making. Full text of this report.

Also for 28 September 2021, Marge Berer did a presentation about the safety of medical abortion pills and the growing prevalence of their use around the world for a webinar organised by the group Action for Safe Abortion in Japan. She argued that although not all medical professionals are happy about medical abortion pills, as they shift the locus of control from providers to women in some ways, their use is increasingly preferred by women. She said the Campaign promotes the use of medical abortion pills in line with the guidelines of the World Health Organization published in 2018 and will support their new guidelines, due to come out soon. She pointed out that deaths and complications from unsafe abortions have fallen worldwide since medical abortion pills became available, even in countries where not all abortions are legal, as they have replaced dangerous invasive methods carried out by unskilled providers. Postscript: At the end of November 2021, a pharmaceutical company was given permission to apply for approval for their combined mife-miso product, which we reported in the newsletter.

Shilpa Shroff was a speaker on a webinar in September 2020 called “Access to medical abortion: global south perspectives”, organised by the Safe Abortion Advocacy Initiative – A Global South Engagement, and the South Asia Reproductive Justice and Accountability Initiative, on the trends and utilisation of medical abortion pills in the region and globally, and the socio-cultural, economic and legal hurdles impacting women’s access to safe abortion.

In October 2020, Shilpa Shroff was one of the speakers in a programme on the TV channel Democracy New Live, on the subject “My body, my decision: abortion in India” regarding the new amendments to the Medical Termination of Pregnancy Act and the continuing social stigma attached to abortion in India.

The Campaign has promoted the slogan “Safe abortion is essential health care” around the world, especially in light of the Covid-19 pandemic, throughout both 2020 and 2021. It has become a widely used slogan, perhaps the most important one we have promoted.

Leading up to the day in both 2020 and 2021, we published four monthly calls for action starting around International Women’s Health Day, 28 May. Then, in October of both years, we published four newsletters with all the reports we had received about activities around the world, as well as a newsletter listing all the media reports we were sent in 4-5 languages about the day. Lastly, in November 2021, we published a detailed social media report from the day.
Solidarity requests in 2020

In 2020, we shared the following requests from Campaign members for solidarity:

In April 2020, the International Pharmaceutical Federation’s call to action to support pharmacists and pharmacy workers on the Covid-19 frontline.
In April 2020, following the decision by a court in the Netherlands earlier this month not to approve telemedicine for first trimester abortion, a petition has been posted calling on the parliament in the Netherlands to support telemedicine for abortion pills during the time of Covid-19.
In May 2020, an open letter in support of SRHR and safe abortion, in response to Donald Trump’s letters to the Director-General of the World Health Organization and to the Secretary-General of the United Nations, addressed to Dr Tedros and Mr Guterres, was written by a number of INGOs for signatures.
In Thailand, in May 2020, Choices Network Thailand, Tamtang and other Thai NGOs drafted a letter to the Thai Department of Health calling for access to contraception and safe abortion to be ensured during the Covid-19 pandemic. It was addressed to the Director of the Department of Health of Thailand. It called on them to ensure women’s access to safe abortion, which has decreased in several places since the pandemic began.
In June 2020, the Civil Society Network of 41 organisations in Thailand has a new petition calling on the Thai government to decriminalise women who seek and have an abortion; and permitting abortion up to 24 weeks on the woman’s request, and after 24 weeks in the few cases that occur, on the following grounds – to protect the woman’s health, grounds of rape, serious fetal anomaly, contraceptive failure, and socio-economic reasons.
In September 2020, we published a call from these US-based human rights groups – Human Rights First, American Jewish World Service, Amnesty International, Council for Global Equality, Equity Forward, Global Justice Center and Human Rights Watch – to all human rights supporters, to contact their governments and ask them to reject the US Government State Department’s Report of the Commission on Unalienable Rights at the UN General Assembly and not to support the US Secretary of State’s private UNGA event.
In December 2020, the National Campaign for the Right to Legal, Safe and Free Abortion of Argentina has asked everyone to call on the Chamber of Deputies to pass the bill on Law on Regulation of Access to Voluntary Termination of Pregnancy and Post-Abortion Care .

Solidarity requests in 2021

In January 2021, in Honduras, one of the few countries in the world where abortion is completely banned, a new clause was proposed as part of current constitutional reform whose aim was to ensure that any attempt to decriminalise abortion in the future would be impossible. We shared a petition in three languages developed jointly with IPPF that gathered hundreds of signatures within a few days, but unfortunately it did not stop the vote going through.
In January 2021, we published a call from the Mouvement Français pour le Planning Familial to ask women in France who had to go abroad for an abortion or have an abortion beyond the legal time limit, to sign a declaration calling on the government to permanently extend the upper time limit for abortion beyond the first trimester.
In March 2021, the Women’s Coalition Turkey, invited all global, regional and local women’s and LGBTI+ organizations, feminists, advocates of women’s rights and human rights, and everyone campaigning against violence against women, to show solidarity to defend women’s and LGBTI+s’ right to live in every platform and geography, with regards to the Istanbul Convention against violence against women and domestic violence as a human rights issue.
In April 2021, we shared a petition from Northern Ireland after the NI Human Rights Commission launched legal action against the Secretary of State, the NI Assembly executive and the Department of Health over continuing delays in commissioning abortion services.
From October 2020, when the Polish court effectively banned almost all abortions, throughout 2021, there have been protests and solidarity actions across Europe, including by European MEPs, which we have reported in the Campaign newsletter. In April 2021, we circulated a petition from Polish members to reject the appointment of a judge to the European Court of Human Rights because he is anti-human rights in his politics. In June 2021, we published a request for solidarity from Defend the Defenders for those who were facing violence from law enforcement and far-right groups, as well as smear campaigns in state-controlled media and excessive criminal charges. We have also published requests for funds by the six groups in Abortion Without Borders who are arranging abortions for Polish women in other European countries, which many Campaign members supported. In November 2021, we publicised the protests at the news of the first death in Poland of a woman who was denied a life-saving uterine evacuation as emergency obstetric care when she was miscarrying an unviable pregnancy and developed sepsis, as had happened in Ireland with Savita Halappanavar in 2012.
In May 2021, the President of the International Confederation of Midwives called on governments and policy makers to act on their recommendations to governments to recognise midwives as autonomous primary care providers who are continually neglected and ignored. “It is time for governments to recognise the evidence of the impact of midwifery care on promoting and saving lives, and for taking action to act on the recommendations of the report on the midwifery profession in the world.”
In June 2021, we shared a petition from Japan: “We demand that Japan abolish the male permission requirement for abortion care!” which was addressed to the Ministry of Health, Labour and Welfare of Japan and was submitted close to 28 September.
WHO was notified in July 2021 that a suspected falsified Cytotec (misoprostol) product was circulating in the Democratic Republic of Congo. After investigating the incident with the manufacturer, it was found that the same batch number was circulating in two other countries and that another batch number was also circulating in two other WHO AFRO countries. A WHO Medical Product Alert was published on 10 August 2021 to make the information public and alert as many people as possible, especially health care providers who are likely to provide this Cytotec product, including for safe abortion.

Knowledge creation and dissemination

Twice weekly newsletter
News about abortion, both from our members and the growing wider movement for abortion rights, as well as in the mainstream media, has grown tremendously in the past five years, and the Campaign and its members have contributed a lot to that. In both 2020 and 2021, we published a growing number of news reports by Campaign members and supporters about successful and unsuccessful reforms to abortion laws and services in their countries; national, regional and international news on abortion and related issues; the work of UN agencies and human rights bodies; the involvement of governments and parliaments; policy and clinical research on abortion; a wide range of abstracts of journal articles; safe abortion information hotlines, and details of webinars, videos and visuals. The Campaign newsletter has also carried information about many aspects of sexual and reproductive health care related to Covid-19 during the pandemic, but especially abortion care.

We have continued to publish the newsletter twice weekly almost every week, reporting as always on advocacy and national and regional campaigns and activities, members’ experiences, publications, research and much more from both national, regional and international levels.

Blogs and feature articles
The following blogs and feature articles were commissioned from or submitted by Campaign members and other abortion rights activists and partners in 2020 and 2021:

Trans Pregnancy Conference 2020: What does reproductive justice look like for trans people? by Camila Ochoa Mendoza, 16 March 2020

Working together to bring abortion services to Poland, by Mara Clarke, 24 March 2020
Pratigya Campaign: overcoming access barriers to safe abortion in India, by Pratigya, 30 March 2020
Abortion Without Borders in the time of Covid-19, by Mara Clarke, 7 April 2020
The Covid-19 lockdown: what it means in India, by Shilpa Shroff, 10 April 2020
Covid-19 and sex: protecting yourself and protecting others, by Rachel Mantock & Elena Michael, 17 April 2020

South Africa: a space of many contradictions – and now Covid-19, by Marion Stevens, 1 May 2020
From Argentina to India: The health of young women and girls always matters, by Lourdes Polo Budzovksy & Shruti Arora, 29 May 2020
Access to medical abortion in Italy is characterised by “unnecessary burdens” and “unjustified barriers” – this has stayed the same during the pandemic, by Elena Caruso & Giulia Zanini, 16 June 2020
Brazil: Access to abortion during Covid-19, by Maíra Marques, 29 July 2020
Telemedicine and self-managed abortion, by Marge Berer, August 2020

Ecuador: An historic achievement to advance access to abortion, by Paulina Ponce, 8 September 2021 (in English & Spanish)
Increase in maternal deaths: the silent impact of Covid-19 on Latin America, by Sonia Ariza Navarrete & Agustina Ramón Michel, with support of Mirelis Morales Tovar, CLACAI, 20 May 2021
Northern Territory, Australia, reforms abortion law in a unanimous win for women’s health (again!), by Suzanne Belton, 10 December 2021

Press/media: report for journalists on abortion with pills
Monitoring of international press coverage found many damaging misconceptions about medical abortion with pills in the media. We therefore decided to develop guidelines for journalists on how to report accurately on medical abortion pills and challenge the misconceptions with accurate information. We published How to Talk about Abortion with Pills: Facts for Journalists in February 2020, prepared by Elena Michael.

Journalists are in touch regularly with questions – Has 2021 been the worst year ever for setbacks on abortion rights? What do we think will happen in the USA to Roe v. Wade and what will the consequences be? What is the historical background to the successful law reform in Argentina at the end of 2020?

We have seen some journalists develop an in-depth knowledge of the issues over time, e.g. journalists from Reuters have written many excellent in-depth reports with abortion news in many different countries. The number of mainstream news reports on 28 September in 2020 and 2021 has also increased substantially compared to previous years as well. But there are also journalists who seem to feel this is a subject worth reporting on, who have no background, and who sometimes publish stories of no use to anyone with little content. In the past they wouldn’t have bothered.

Website

– 2020
The Campaign’s website saw continued growth in reach and engagement, along with some exciting developments – not least a full re-design of the entire website in 2020. We were delighted to launch the new website in October 2020. At over four years of age, our previous website had been in need of an overhaul for some time, so we teamed up with socially-conscious web developers GreenNet and design cooperative Wave to revitalise our digital presence. Development of the site has been ongoing throughout 2021. The new site features better images, easier navigation, optimisation for mobile devices, and more resources to help support our network of member organisations and individuals working tirelessly for women’s right to safe abortion worldwide.

In 2020 the website received 106,000 visitors – an increase of 30% over those in 2019 – and 183,000 individual page views – a 23% increase over 2019. Our audience was international, with the largest representations from the Philippines, India, Kenya, Trinidad & Tobago, Nigeria, Sri Lanka, Pakistan, Jamaica, the USA and the UK. We also saw solid regional growth in audiences from Africa and the Middle East. In 2020, 69% of our website traffic came from users accessing it on mobile devices – an increase of 8% over 2019 – and the vast majority came from an organic search (79% of our total traffic). The highest traffic from social media came from Facebook, Twitter and Instagram respectively, and while social referrals to the website were down on 2019 in reflection of changing social media strategies, we saw an increase in traffic to the website via Pinterest.

The most popular page in 2020, as in 2019, was Safe abortion methods with 26,725 views. That followed by the news pages, where news posts are organised by country and region with as many as 5,500 views of some of the most important news. Other pages that were widely consulted included our Aims and objectives (1.8k views) and Join the Campaign (1.7k views).

International Safe Abortion Day in 2020 was the busiest day in 2020, when the website received nearly 1,000 active users. There was a 150% increase in “traffic” compared to 2019 – and good readership of our four calls to action in the lead-up to the day.

A large majority (79%) of website users were referred directly from organic search sites such as Google. Taken together, all these facts suggest that the site continues to provide a valuable information source for a generalised audience seeking information on abortion. In keeping with wider digital trends, our users are increasingly accessing the Campaign’s website via mobile devices (69.2% of traffic), rather than with desktop or tablet computers (30.7%).

– 2021
The Campaign’s website saw short-term drops in traffic in 2021 as a result of changes in the page taxonomy and search engine listings following the rebuild, with 64,000 visitors and 100, 000 page views. The average page view time was a healthy 2 minutes 37 seconds, and once again users were drawn from a broad geographic spread, with top countries including the US, UK, Trinidad & Tobago, Nigeria, India, Philippines, Kenya, Canada, Germany, and Indonesia. Once again the majority of users visited the site on mobile devices (57%) – in keeping with wider internet usage trends – and the site was also heavily accessed via organic search (72%, versus 21% direct and 3.5% via social media), confirming its ongoing value as a general repository for information about safe abortion.

As in previous years, International Safe Abortion Day on 28 September was our busiest single day for website traffic, with 904 active users. Otherwise, the most popular pages across the year included ‘I Need an Abortion‘, ‘Join the Campaign‘, our first call to action for 28 September 2021, and news pages related to individual countries, particularly Antigua and Barbuda and Trinidad & Tobago.

Social media

It is important for us to maintain and expand our presence on social media, since so much more became virtual in 2020-21 because of Covid-19. We have been very active on Twitter, Facebook and Instagram, and YANAA’s three social media accounts.

Our social media channels publish some or all of the newsletter stories weekly to this different and wider audience, to inform those who follow us across these platforms to get news on policy and advocacy, publications, and stay up to date with members’ and regional networks’ activities. An equally important role to interact with members of the Campaign and participate in their online activities. We participated in the #MarchForEqualChoice in March 2020 alongside IPAS, Safe2choose and Hesperian Health. We organised an Instagram Takeover on 31 July 2020 with members from the Mama Network. Our social media accounts have been a key communication channel during the lockdown. We have focused on increasing our interactions and monitoring members’ activity on social media, as well as ensuring most of the Campaign updates are shared on these platforms.

In December 2020, we had:

19,965 followers on Facebook
4,814 followers on Twitter
1,978 followers on Instagram
73 followers on Linkedin

In 2021, social media continued to be a vital part of the Campaign’s networking activities. Our Facebook, Twitter and Instagram pages garnered increasing followers and engagement with them. We also revitalised our LinkedIn activity and engagement.

For 28 September we transformed our social media pages into a directory for online events marking the day. Similarly, we have promoted our members’ digital events for other international occasions, such as World Contraception Day and 16 Days of Activism against Gender-based Violence. As Covid-19 restrictions continue, our network is devising more imaginative and impactful digital events and actions. This has made for a very active year on social media.

At the end of November 2021, we had:

20,083 followers on Facebook
5,289 followers on Twitter
2,644 followers on Instagram
275 followers on LinkedIn

Funding
The Campaign is grateful to the Netherlands Ministry of Foreign Affairs for core funding in support of our work for the period from 1 January 2019 to 31 December 2021 in two parts, and Marie Stopes International for an enormous amount of help and good will in managing the grant. In addition, we want to thank the Global Fund for Women, who awarded us a grant to support YANAA projects in 2021-2022, and the Safe Abortion Action Fund, who also provided support for a YANAA project.