by Roopan Gill, Amanda Cleeve, Antonella Lavelanet
Sexual and Reproductive Health Matters, 29:1(April 2021)
From the Discussion
This review highlights how context conditions the existence of hotlines; what their objectives are; how they operate; what is their scope of practice; and what issues exist in terms of their messaging and sustainability. Regardless of the legal context, hotlines’ unequivocal objective was to respond to a perceived unmet reproductive health need and thereby improve access to abortion care. Like other models of harm reduction implemented globally, our findings underline how hotlines operating parallel to the formal health system, do so in response to the legal context to facilitate safe self-managed abortions. They do so at the risk of legal repercussions and adapt their services to mitigate this risk of harm to themselves and to the women using their services. Our review sheds light on how hotlines operate in both liberal and restrictive legal settings. However, our findings also illustrate the scarcity of evidence relating to the impact of abortion hotlines in various contexts, as well as on hotline users’ and providers’ experiences.
Over the last decade, abortion hotlines have expanded as an innovative way to address legal and health systems’ shortcomings related to comprehensive abortion care. Similar to harm reduction programmes in Uruguay, Peru, Argentina and Nepal, which were developed to address high maternal mortality and morbidity rates due to unsafe methods, hotlines mitigate risks by providing abortion seekers with evidence-based counselling and information before and after their abortion. Our findings highlight existing knowledge that abortion hotlines in legally restrictive settings are an important example of a harm reduction model, with potential to decrease the negative effects of unsafe abortion and strengthen sexual and reproductive health and rights in the populations they serve, similar to other harm reduction models that have been studied, for example in Uruguay. Although we found that some hotlines struggle to reach marginalised populations, information received through the data extraction form demonstrates the efforts of hotlines to adapt their messaging and increase their reach to also include youth, migrants, sexual minorities and people with disabilities. This underscores their role as one tool that could facilitate a positive high-quality abortion experience. Moreover, community-based models, like those that include abortion hotlines, can facilitate person-centredness, dignity, autonomy, privacy, communication, support, compassionate care and trust. De-medicalising abortion provision in the context of community-based care requires continued work to destigmatise and decriminalise abortion care, so as to entrust women and ensure their reproductive rights are upheld. This not only requires access to evidence-based information and support, as highlighted by models like abortion hotlines, but advocacy at a global and national level to ensure access to affordable and quality assured medications and referral pathways to trusted facilities if and when a person may want or need it.
Though abortion hotlines in some settings are part of a harm reduction model of care, they also represent a low-fidelity, versatile innovation that can address access issues in challenging contexts, especially as they relate to information provision. For example, in humanitarian and fragile settings, and more recently during the pandemic, studies have identified that lessons learned by decades of implementation of innovations like hotlines should be adapted to the complex contexts of these settings. Our findings highlight that there may be a unique opportunity for these innovative models to transform traditional service delivery of safe abortion care, specifically including self-management alongside, rather than separate from, the formal health system.
Our findings suggest that sustainability is an issue for abortion hotlines which requires innovative solutions, although these challenges are not unique to abortion hotlines. Dependence on international funding agencies and varied health system financing structures (i.e. private versus public) are challenges faced by abortion hotlines. Based on our review, little data exists on this topic. By gathering more evidence about the value and impact of these models, governments and health systems may be more encouraged to invest in these models, distributing resources differently, and aligned with shared values and goals of person-centred, dignified and accessible healthcare delivery….