
SAFE ENGAGE Partners Reflect on Project’s Impact
Date
November 4, 2021
As the four-year SAFE ENGAGE project ends, partners reflect on the impact and legacy of the project, the importance of data and evidence in building effective policy communication, and the value of partnerships and collaboration toward a common vision of improved access to safe abortion.




Guide de référence : l’interruption sécurisée de grossesse selon la loi au Burkina Faso
Le PRB et l’Association Burkinabè pour le Bien Être Familial ont créé un guide de référence visant à permettre aux principales parties prenantes (prestataires de santé, agents de l’action sociale, magistrats, patientes) de connaître le processus pour l’accès à l’interruption sécurisée de grossesse dans le cadre de la loi au Burkina Faso.
En 2020, le PRB et l’Association Burkinabè pour le Bien Être Familial (ABBEF) ont créé, avec le soutien du groupe de travail du projet SAFE ENGAGE Burkina Faso, un outil de plaidoyer multimédia appelé « Préserver la santé et bâtir l’avenir du Burkina Faso : rendre accessible l’avortement sécurisé. » À la suite de l’élaboration de cet outil de plaidoyer important, l’ABBEF a jugé nécessaire de concevoir et de diffuser un manuel de référence destiné aux praticiens (magistrats, forces de l’ordre, agents de santé et de l’action sociale) et aux bénéficiaires qui énumère clairement les étapes à suivre afin d’obtenir une interruption sécurisée de grossesse (ISG) pour les cas particuliers autorisés par la loi. De plus, ce manuel souligne les conséquences de l’inaction concernant l’enjeu de l’avortement non sécurisé au Burkina Faso. Le guide de référence s’inscrit dans le cadre des efforts de plaidoyer pour améliorer l’environnement juridique et social en faveur de l’accès à l’ISG afin de lutter contre la mortalité et la morbidité liées à l’avortement non sécurisé.
Au Burkina Faso, le Code pénal et la loi portant sur la Santé de la Reproduction de 2005 constituent les deux principales sources de loi en matière d’accès aux services d’ISG. Mais en dépit de ces textes, de nombreuses filles et femmes éprouvent des difficultés à accéder aux services d’ISG même lorsqu’elles sont éligibles au regard de la loi. Cette situation s’explique entre autres par :
- La méconnaissance de la loi et des politiques, normes et protocoles par les prestataires de santé et autres parties prenantes (agents de l’action sociale, magistrats, etc.) ;
- Les réticences de certains prestataires à offrir les services ;
- La méconnaissance des dispositions et des procédures par les victimes.
En vue de permettre aux principales parties prenantes de maitriser le processus pour l’accès à l’ISG dans le cadre de la loi, le PRB et l’ABBEF ont élaboré un guide décrivant la procédure pour avoir accès aux services d’ISG au profit des praticiens (magistrats, forces de sécurité, agents de santé, agents de l’action sociale) et des patientes. Ce guide permettra à ces personnes de connaitre le processus, les étapes, les actes administratifs à établir et les délais requis pour l’accès à l’ISG dans le cadre de la loi. Et d’autre part, cet outil servira de guide pour les prestataires de santé en énumérant les étapes et les protocoles à suivre concernant l’offre de services d’ISG décrits dans les politiques, normes et protocoles du ministère de la Santé, que l’intervention soit médicamenteuse et/ou chirurgicale.

Contribution Tracing Confirms Role of Project in Policy Change: Lagos State
Date
November 2, 2021
Through contribution tracing, PRB evaluated the role of the SAFE ENGAGE project in policy change in Lagos State, Nigeria. Contribution tracing assesses a contribution claim through a causal chain of events produced by an intervention. Did SAFE ENGAGE influence the Lagos State commissioner of health to require public health facilities to provide safe abortion services to the full extent allowed by law?
To learn more, read the web article and technical case study.
Article
Case Study

Au Compte Rendu: Comprendre l'avortement sécurisé et médicamenteux
De Sources Officielles : Comprendre l’avortement médicamenteux
Cette fiche d’information donne un bref aperçu de l’avortement médicamenteux, comment il fonctionne, et des raisons pour lesquelles une personne peut choisir d’interrompre sa grossesse en utilisant cette méthode.
De Sources Officielles : Comprendre l’avortement sécurisé
L’avortement non sécurisé est l’une des principales causes de mortalité maternelle dans le monde. Cette fiche d’information traite des méthodes d’avortement sécurisé et explique pourquoi certaines femmes enceintes pourraient chercher à avoir recours aux méthodes non sécurisées.
Les deux fiches comprennent également une liste de questions connexes que les journalistes doivent prendre en compte lorsqu’ils font des reportages sur le sujet.

SAFE ENGAGE Drives Dialogue Around Safe Abortion Policy in Lagos State
Contribution tracing demonstrates PRB’s role in policy dialogue.
Date
October 26, 2021
Heidi Worley
Program Director
In Nigeria, a country with one of the highest maternal death rates in the world at 67,000 maternal deaths per year, it is crucial that the crisis of unsafe abortion—a preventable cause of maternal death—be addressed.
PRB’s SAFE ENGAGE project recently contributed to a key policy dialogue about how to do just that. Through the SAFE ENGAGE co-creation process for developing an advocacy tool and dissemination strategy, stakeholders influenced the Lagos State commissioner of health to require medical directors and staff of public health facilities to provide safe abortion services to the full extent allowed by law—that is, to preserve a woman’s life and physical health.
Intervention Paves the Way for Improved Access Amidst Challenges
In his role as the chair of a high-level SAFE ENGAGE task force, the commissioner heard details of the 2011 Lagos State Criminal Code update that expanded the legal provisions of abortion but had not been widely recognized or implemented in practice. Until 2011, access to safe abortion in Lagos State was governed by a 95-year-old state law that only permitted abortion to save the life of the woman. In 2011, the Criminal Code was updated to also allow abortion to protect a woman’s physical health. Because of severe penalties under the old law, service providers were reluctant to do more than offer postabortion care. Ensuring providers had this updated information would give them confidence to extend legal abortion services.
Through the SAFE ENGAGE intervention, PRB works to advance policy dialogue and strengthen the capacity of advocates, government representatives, and the media to communicate information on abortion to national and subnational policymakers. PRB collaborates with local partners to develop an advocacy tool that can help showcase the latest evidence, frame the dialogue, influence resource investments, and guide policy action. Key to the process is establishing a task force that includes high-level advocates who understand data and services, and policymakers from government ministries. These individuals come together to deliberate and jointly create a multimedia presentation—a compelling portrayal of the evidence conveying the incidence, trends, causes, and consequences of unsafe abortion. PRB’s partners in Lagos State, the Society of Gynaecology and Obstetrics (SOGON), helped convene the task force and navigate the policymaking landscape.
Contribution Tracing Demonstrates PRB’s Role in Policy Dialogue
To evaluate the project’s role in policy change, evaluators used contribution tracing, a technique that links outcomes through a causal chain of events produced by an intervention. The technique assesses a contribution claim that an intervention—in this case the SAFE ENGAGE co-creation and dissemination process—led to an outcome of interest through a specific pathway. The contribution claim in Lagos State was:
The SAFE ENGAGE co-creation process influenced the commissioner of health of Lagos State to issue an official circular (memorandum) with a directive calling for secondary and tertiary public health facilities to provide access to safe abortion within the full extent of the current law, which includes providing access to legal abortion to preserve a woman’s life and physical health.
In Lagos State, the causal chain began with the commissioner chairing the SAFE ENGAGE task force. Credible evidence shows that he, or his representative, was present at meetings where the existing laws were clarified and information was shared that abortions permitted by law were not actually being performed in public clinics. He actively participated in dialogue and deliberation around the multimedia presentation content and embraced its key messages, including that “secondary and tertiary medical facilities in the State of Lagos should expand provision of abortion services in alignment with the provisions of the law.”
In addition, the SAFE ENGAGE team organized a dinner with the commissioner where two members of the task force suggested that he issue a directive as a means of educating public health facilities that they could provide legal abortion to the full extent of federal and Lagos State laws without fear of punishment. Finally, the commissioner announced the memo at a meeting of medical directors shortly before his retirement, where he also showed a version of the SAFE ENGAGE presentation. The official memorandum was distributed shortly thereafter.
Contribution Tracing Is a Valuable Tool in Complex Policy Environments
Evaluating policy change is not easy. Nevertheless, it is critical to understand which factors influence changes in policy when lives are at stake. It is vital for advocates, program planners, and service providers to learn from and adapt their strategies, and crucial for all stakeholders to understand which investments lead to the impact they are seeking.
In addition to analysis for Lagos State, the SAFE ENGAGE project conducted contribution tracing for its work in Côte d’Ivoire. In both cases, the goal was to evaluate the role of the intervention in the project’s efforts to improve access to safe abortion.
In Lagos State, our contribution tracing provides high levels of confidence in the project’s effect on policy dialogue and modest levels of confidence in its effect on policy change. A key takeaway from the analysis is that unexpected windows of opportunity exist when a ministry official might be changing jobs or retiring, as she or he might have more latitude to support a policy change that is not popular or one that has been historically challenged.
Drawing from lessons in Lagos State, change in the law is not the only meaningful outcome. SAFE ENGAGE’s intervention, through sharing information and influencing perceptions, can help ensure that practitioners offer safe legal abortion as directed by law.
The technical report is available for more information.

SAFE ENGAGE Examines Program Impact
Date
October 26, 2021
SAFE ENGAGE is pushing the envelope in applying new evaluation methods to test theories of policy change. Under this project, we are using contribution tracing to determine the causes, or likely causes, of observed policy outcomes related to safe abortion in Lagos State, Nigeria, and Côte d’Ivoire. To our knowledge, this is the first time that contribution tracing is being applied to evaluate policy reform related to reproductive health.
As the four-year SAFE ENGAGE project ends, partners reflect on the project’s impact and legacy.