Using Mobile Health to Address Safe Abortion Information Gaps in South Africa

safe abortion information gaps in south africa

Picture Credit -Phephisile Mathizerd

While safe2choose.org operates globally, we recognize that not every woman in the places where our services are needed has internet access. With this in mind, we began building a team in South Africa over six months ago and have been investigating the specific problems that exist with the South African systems of service delivery, and began brainstorming ways to improve our global model to help the thousands of women currently flocking to illegal providers in the country. As a social enterprise, we are part of an international non-profit movement whose mission is to provide evidence-based information and counseling on how to have a safe abortion with pills, and to facilitate access to safe and affordable abortion pills to women who want them. In South Africa, safe2choose is piloting ways for women to interact with our services without the internet through low tech options like SMS. To begin, we are launching a mobile health (mHealth) campaign that will refer women to the closest abortion service provider to them.

After an assessment trip in May of 2016, safe2choose decided to pilot a three phased approach to service delivery in South Africa that we believe can address the barriers women face to accessing safe abortion care services. safe2choose planned to launch its mobile health (mHealth) project in August 2016. The launch date was pushed back as the team worked to build internal capacity on the ground in South Africa in order to carry out the three proposed phases: 1) Information, 2) Counseling, and 3) Distribution. Having now on-boarded two new staff members, we are ready to push forward with phase 1: the referral campaign, which uses SMS on standard or smart phones to help women find the service provider nearest to them who provides a legal termination of pregnancy.

The new safe2choose team in South Africa made a second round of visits with stakeholders this December to assess the feasibility of our new project, and was met with positive feedback. A packed week in Cape Town included meetings with stakeholders from the Sexual and Reproductive Justice Coalition (SRJC), Cape Town University faculty, grassroots advocacy organizations, researchers, and multiple service providers. The general response to our mHealth project was overwhelming support and included sentiments about how the service we are providing is “much needed” in South Africa where abortion is legal, but still heavily stigmatized, and where safe options are underutilized.

During our meetings we learned that the process for terminating a pregnancy in a public health facility can be convoluted and long. Stakeholders reiterated to us that we should pay careful attention to our audience and their specific lifestyles and needs, making sure to cater to a variety of populations, and to think especially about the language we use. We also learned that one of our greatest sources of advertising will be women themselves—who often feel more comfortable discussing topics like abortion in their existing female-centered community spaces.

We walked away from our meetings with a list of action items and ideas to continue improving phase 1 before our planned January 15, 2017 launch date, including conducting focus groups to test the SMS flow, fresh ideas for how and where to advertise, and with ideas for future campaigns. A change we have already begun making is to keep the referrals we provide contained to public and private health care facilities, at least to start.

We are also shifting the focus of our referral campaign to early detection of pregnancy. It was a recurring theme throughout our conversations with stakeholders, since a positive pregnancy test is a prerequisite to receiving abortion services at a health facility. By encouraging women to test early for pregnancy soon after sexual activity, they are not only better positioned to utilize our services, but also to access all of the options available to them, as well as to have a healthy pregnancy if they carry it to term.

The s2c team left Cape Town feeling inspired, informed and energized to continue on to Johannesburg where another week of visits with stakeholders took place, and where our mHealth tool will ultimately launch.

*By Hilary Towle – December 2016*