Download reducing the burden of unsafe abortion in tanzania

REDUCING THE BURDEN OF UNSAFE ABORTION IN
TANZANIA
Dr. Peter Wangwe, Dr. P. Muganyizi, Dr Furaha August, Dr A. Pembe
TABLE OF CONTENTS
REDUCING THE BURDEN OF UNSAFE ABORTION IN TANZANIA ...................... 1
Background on Situation analysis on unsafe abortion in Tanzania ............................ 1
ABBREVIATION............................................................................................................... 2
Acknowledgement .............................................................................................................. 3
EXECUTIVE SUMMARRY .............................................................................................. 4
Introduction ......................................................................................................................... 6
The burden of induced abortion in Tanzania ...................................................................... 7
Complications of induced abortion: ................................................................................ 7
REASONS FOR UNSAFE ABORTIONS IN TANZANIA .............................................. 7
Socio-economical factors ................................................................................................ 7
Family planning in Tanzania .............................................................................................. 8
Overview: ........................................................................................................................ 8
1
Access to FP Methods ..................................................................................................... 8
Methods used for induced abortion in Tanzania ................................................................. 9
Post abortion care services in Tanzania .............................................................................. 9
Emergency Contraception ................................................................................................. 10
Comprehensive Sexuality Education in Tanzania ............................................................ 10
Legal framework of abortion in Tanzania ........................................................................ 11
In situations of restrictive laws. ........................................................................................ 11
References ......................................................................................................................... 12
ABBREVIATION
AGOTA –Association of Obstetrics and Gynecology of Tanzania
AIDS-Acquired Immunodeficiency Syndrome
CACs-Comprehensive Abortion Care
FP-Family Planning
HIV- Human Immunodeficiency Virus
IPPF-International Planned Sexually Transmitted Parenthood Federation.
IUCD-Intrauterine Contraceptive Device
LAPMs-Long Acting family Planning Methods
MEWATA-Medical Women Association of Tanzania
2
MoHSW-Ministry of Health and Social Works
PACs-Post Abortion Care
PMTCT-Prevention of Mother to Child Transmission.
RH-Reproductive Health
STD- Sexually Transmitted Disease.
STI-Sexually Transmitted Infection
TB-Tuberculosis
TDHS-Tanzania Demographic Health Survey
TSPA- Tanzania Service Provision Assessment Survey.
UMATI-Uzazi na Malezi Bora Tanzania
UNFPA-United Nation Population Funds
USAID-United States Agency for International Development
VCT-Voluntary Counseling and Testing
WHO-World Health Organization
Acknowledgement
We are grateful to UNFPA for giving us funds to carry out situational analysis on unsafe
abortion in Tanzania. It also supported two AGOTA members to attend regional
workshop held in Johannesburg where our findings were presented and discussed.
We also thanks executive members of MEWATA whose through UNFPA made this
work to be successful.
We also thanks members of AGOTA and Mr. Joseph Msangya Kiriri whose their
contribution were constructive when reviewing situation of unsafe abortion in our
country.
3
EXECUTIVE SUMMARRY
Situational analysis on unsafe abortion is among the FIGO project designed to improve
the quality of PACs and CACs in the countries where abortion has been legalized. It also
entails to discover the extent of the burden of unsafe abortion, the prevalence of FP
within the country as well as the knowledge on abortion law within the country. This
topic was chosen due to the fact that worldwide unsafe abortion is one of the major public
health and human right challenges facing the world today. Unsafe abortion is a procedure
for terminating an unintended pregnancy either by individuals without the necessary
skills or in an environment that does not conform to minimum medical standards or both.
Although the likelihood of a woman having an abortion is similar whether she lives in
developed or developing country, the burden of unsafe abortion (97%) and the
consequences is by far bigger in the latter. It is estimated that five million women are
hospitalized worldwide each year due to the complications related to abortions, and 13%
of maternal deaths are as a result of unsafe abortion.
4
Health statistics in Tanzania is limited by the lack of openness because such termination
of pregnancy is illegal. However hospitals based study reports that induced abortion
among admitted patients due to incomplete abortion ranged from 14%-60%.
It is further estimated that 14% of all pregnancies end up in induced abortion, almost all
being unsafe therefore it was concluded that induced abortion is a major public health
problem in Tanzania. It was estimated that unsafe abortion was responsible for 15% of all
maternal deaths in one district in Dar es Salaam and maternal complication associated
with unsafe abortion was reported in up to 60% of the cases admitted in the ward.
Majority of the patient reported to have unsafe abortion were adolescent, unmarried and
unemployed and their pregnancy was unintended. These indicate the importance of socioeconomic factors in the overall decisions for induced abortions.
It is understood that two thirds of unintended pregnancies in the developing countries
occur among women who are not using any method of contraception. There could be
more reasons for not using these methods, but unavailability of the methods, concerns
about side effects and the belief that one is not at risk of becoming pregnant are more
frequently reported. The unmet need for contraception is present if a woman is sexually
active, is able to become pregnant, do not want to have a child soon or at all, and is not
using any method of contraception either modern or traditional and this was found to high
at 22% in Tanzania
We also found that unsafe abortion is conducted using crude methods which endanger
woman’s life. The methods most commonly used include curettage, inserting roots in the
vagina/cervix, inserting catheter. Other materials and drugs used include drugs like
chloroquine, quinine, Oxytocin, oral contraceptive pills and inserting a loop, cassava
stick.
PAC services were introduced with clear guidelines for use to all health facilities that
provide care to women after abortion. This includes three critical elements which are
emergency treatment for complication of spontaneous or induced abortion, post abortion
family planning counseling and services and linkage to other reproductive health services
such as treatment for STIs. This need to be assessed to evaluate the availability of the
instruments used and the quality of service provision.
The review of syllabus for primary and secondary education revealed some deficient
which need to be reinforced. Sex education with emphasis on safe sex, abortion, family
planning and complication of pregnancy in early age has to be to be given priority. The
consequences of adolescent pregnancy like social stigma, psychological, school drop out
and medical complication associated with adolescent pregnancy were not mentioned at
all. Currently the policy makers are talking about taking back all school girls who have
delivered without putting emphasis how to prevent pregnancy by using the available
methods.
According to Tanzania penal code abortion is illegal, but the law is inefficient in case of
therapeutic abortion. The definition of mother’s health provides a loop hole for
therapeutic abortion. There is still more room to discuss therapeutic abortion in case of
rape patient. Can the possible psychological consequences of rape be interpreted as
5
severe enough to allow for legal termination? This are some of the issues need to be
clarified such that right should be given when it is necessary
.
Introduction
World wide, 48% of all induced abortions are unsafe. However in developed countries
almost all (97%) are safe, whereas in developing countries more than half (55%) are
unsafe.
Unsafe abortion is one of the major public health and human right challenges facing the
world today. WHO defines unsafe abortion as a procedure for terminating an unintended
pregnancy either by individuals without the necessary skills or in an environment that
does not conform to minimum medical standards, or both (WHO, 2006). Although the
likelihood of a woman having an abortion is similar whether she lives in developed or
developing country, the burden of unsafe abortion (97%) and the consequences is by far
bigger in the latter (Sedgh et al, 2007). It is estimated that five million women are
hospitalized worldwide each year due to the complications related to abortions, and 13%
of maternal deaths are as a result of unsafe abortion (WHO, 2004). Almost all abortion
related deaths occur in the developing countries.
6
The burden of induced abortion in Tanzania
Health statistics in Tanzania is limited by the lack of openness because such termination
of pregnancy is illegal. In addition, such data obtained in a hospital setting could be
misleading due to the methodology used in collecting the data. In one study conducted at
three hospitals in Tanzania, the proportion of women with self reported induced abortion
among the patients admitted due to incomplete abortion ranged from 14-60% (Rasch V.
et al, 2000) in a study using different data collection techniques. In another hospital based
study, it was reported that induced abortions accounted for 47% of all incomplete
abortion admissions (Mpangile et al, 1993).
Community based data on induced abortion in Tanzania is lacking. However, Subregional data estimates that 2.3 million abortions occur among women aged 15-44 years
each year in East Africa, which is the highest absolute number among African sub
regions. It is further estimated that 14% of all pregnancies end up in induced abortion,
almost all being unsafe (Sedgh et al, 2007). Estimated from this data, it can be concluded
that induced abortion is a major public health problem in Tanzania.
The scarce available information is based on studies carried out in one or few health
facilities among women admitted for the treatment of incomplete abortion. The period of
observation in these studies varies between two months to one and a half year (Margreth
S et al 2001, Vibeke R et al 2006 and Vibeke R 1999).
Complications of induced abortion:
The complications of induced abortions are common in Tanzania. In one community
based study, it was estimated that unsafe abortion was responsible for 15% of all
maternal deaths in one district in Dar es Salaam between 1991-93 (Urrasa et al, 1996). In
hospital based studies, other complications such as genital trauma, sepsis, severe
hemorrhage were reported in up to 60% of the cases (Rasch et al, 2000; Justensen et al,
1992).
Maternal mortality rate in Tanzania is one of the highest in the world. It is estimated that
578/100,000 live births (TDHS, 2004).
REASONS FOR UNSAFE ABORTIONS IN TANZANIA
Socio-economical factors
Hospital based studies in Tanzania indicate that almost all (up to 99%) of self reported
induced abortions were unintended (Rasch et al, 2000). Community based data has
consistently shown that a quarter of pregnant women are unintended (TDHS 2004/5,
TSPA, 2006).This may be interpreted on the light of the available data, that of the 182
pregnancies that occur in the developing countries, more than a third are unintended and
19% end in induced abortion (WHO, 2004).
In the Tanzania context, when compared with other women attending antenatal clinics,
women admitted to same hospital due to induced abortions were 3 times more likely to be
educated above standard seven 7 , they were also more likely to be younger than 19
years, single or students or employed (Rasch et al, 2000). All these indicate the
importance of socio-economic factors in the overall decisions for induced abortions.
7
Despite all the above factors, it is understood that two thirds of unintended pregnancies in
the developing countries occur among women who are not using any method of
contraception (WHO, 2004). There could be more reasons for not using these methods,
but unavailability of the methods, concerns about side effects and the belief that one is
not at risk of becoming pregnant are more frequently reported.
In one prospective study to assess the need for post abortion contraception, counseling
and provision of contraceptives in the hospital resulted in 90% acceptance, and 86% of
them still used FP methods 6 months later (Rasch,et al 2005). This shows that if the right
information is given to the women concerning contraception then compliance is expected
to be good as evidenced in the above study finding.
It is estimated that, unmet need for family planning in Tanzania is still high at 22%
(TDHS-2004). The unmet need for contraception is present if a woman is sexually active,
is able to become pregnant, do not want to have a child soon or at all, and is not using any
method of contraception either modern or traditional (WHO, 2004).
Family planning in Tanzania
Overview:
Tanzania is the largest country in East Africa with population 34 millions is estimated by
American bureau of Statistics that it will increase by 60% to 52 millions people by 2025.
The prevalence of contraceptive use increased from 15% in 1999 to 22% in 2002 for
modern and natural family planning methods. The use of any modern family planning
method among married women has more than tripled in the past decade increasing to 20
%( TDHS-2004). These improvements are said to be too low to make any visible impact
on pregnancy outcome. The maternal mortality rate has remained 578/100,000 live births.
Urban women use modern contraceptive methods more often (24 percent) than rural
women (8 percent). There is a marked variation among regions that range from less than
5% to over 23%. Current use of modern family planning methods is less than 10 percent
in 6 regions and more than 10 percent in 14 regions. Education is clearly related to the
use of family planning. Women with some secondary and higher education are five times
more likely to use modern methods than women without education 23% VS 5% (TDHS2004).
According to the TDHS (1996) the modern methods of family planning are more
frequently used 23 % than traditional/folk methods 15 %. The modern
methods commonly used by women are pills 15 %, condoms 7 % and injectables 6%;
while traditional methods frequently used are withdrawal9% and calendar/mucus 8%.
The use of contraception is higher for sexually active unmarried women than currently
married women (TDHS, 1996).
Access to FP Methods
8
Engender health and UMATI (affiliate of IPPF) work with the MoHSW to increase
access to permanent and long acting family planning methods (LAPMs). In the first 5
years (1988-1993) teams of physicians and nurses were trained in Mini-Laparatomy. By
1987 service components expanded to include vasectomy, postpartum IUCD, post
abortion care, men as partner and Norplant/Implanon. Eight supervisory teams composed
of a doctor and a nurse were hired to oversee training in clinical contraception and to
facilitate quality improvement in 72 sites, quality improvement tools and approaches
were inco-operated namely, COPE. The program was initially funded by USAID through
AVSC and UMATI. Between 2000-3 the program was taken over by the MoHSW under
the assistance of AVSC. In 2003 ACQUIRE won the bid to support the ministry on the
implementation of the program through Engender health.
The implementation of FP in Tanzania is challenged by poverty, dwindling of donor
funds, and low attention by the government and policy makers. Family planning has
received little attention at individual, social and policy levels due to other competing
priorities such as HIV/AIDS, malaria and TB. Family planning services are donor driven,
uncoordinated, implemented in weak health systems such as poor infrastructure and
inadequate skilled manpower. As a result there is low coverage and poor access
aggravated by cultural and religious perspectives.
Methods used for induced abortion in Tanzania
The methods most commonly used include curettage, inserting roots in the vagina/cervix,
inserting catheter (Rasch et al, 2004). But from clinical experience a variety of other
materials and drugs are usual including drugs like chloroquine, quinine, Oxytocin, oral
contraceptive pills and inserting a loop, cassava stick. More recently Misoprostol.
In a study by Rasch et al 2004 most of the induction 79% took place in a health facility
setting and 34% was done by a doctor, 44% by another health worker and 22% by
unskilled person.
Post abortion care services in Tanzania.
PAC services were introduced with clear guidelines for use to all health facilities that
provide care to women after abortion. The package includes three critical elements which
are emergency treatment for complication of spontaneous or induced abortion, post
abortion family planning counseling and services and linkage to other reproductive health
services such as treatment for STIs. The services are available at many health centers,
district and referral hospitals throughout the country. There are problems for supplies,
and staff training.
9
Emergency Contraception
Several studies done in Tanzania documented high contraceptive acceptance rate among
women having unwanted pregnancies (Vibeke R et al (2005).But data on uses of
emergency contraceptive is lacking and possibly if these women with unwanted
pregnancy were using this method definitely the rate of unwanted pregnancy as well as
unsafe abortion were going to be at a low rate.
Comprehensive Sexuality Education in Tanzania
The review of syllabus for primary and secondary education revealed some deficient
which need to be reinforced. Sex education with emphasis on safe sex, abortion, family
planning and complication of pregnancy in early age has to be to be given priority. The
consequences of adolescent pregnancy like social stigma, psychological, school drop out
and medical complication associated with adolescent pregnancy were not mentioned at
all. Family planning were mentioned with the emphasis on condom use with the intention
of prevention of HIV/AIDS and other STI/STD(Tanzania Ministry of education
2005).The concept of sexuality and sexual health and responsible sexual behavior is
taught in second year of secondary school which seem to be late. The ideal time could be
in standard seven so as to give equal opportunities even for those who miss chances to
attend secondary school (United Republic of Tanzania Ministry of Education 2005)
The teaching of sex education and sexuality need technical people preferably from
Ministry of Health and Social Work (MoHSW). In the rural as well as in the urban area
teachers and in charges of health units especially the one running family planning clinic
in the catchments area should collaborate to conduct that session together.
Young people, especially those who are sexually active, need access to a variety of
reproductive health (RH) and HIV services, including contraception, HIV counseling and
testing, testing and treatment for other sexually transmitted infections (STIs), pre- and
postnatal care, and post abortion care. Frequently youth seek services only when there is
an acute illness or problem such as asymptomatic STI or pregnancy and do not typically
seek preventive services, such as contraception to avoid pregnancy. Also, health facilities
serving youth sometimes offer one primary service or have separate units providing
different types of services. In either situation, to provide comprehensive
care, a provider may need to refer clients between contraceptive and HIV/STI services.
Most young people are at risk of both pregnancy and HIV/STIs, they may receive only
one service while related sexual health needs are not addressed.
More attention is needed to pregnancy prevention and that such services are
feasible to deliver in an integrated manner. Studies done in Tanzania, nearly all providers
discussed condoms, but only about two-thirds discussed pregnancy prevention or fertility
desires (Thomsen S et al 2006). The study recommended that VCT services Implement
screening of youth VCT clients for risk of unintended pregnancy, include contraceptive
counseling in the VCT sessions, and either provide contraceptives or refer clients to
another provider for this service.
10
A strong need for integrated services, especially pregnancy prevention and PMTCT they
indicate the feasibility of reaching youth who engage in risky sexual behavior through
sites that integrate RH and HIV information and services.
Legal framework of abortion in Tanzania
The incidence of unsafe abortion is influenced by the legal provisions governing access
to safe abortion, as well as the availability and quality of legal abortion services. Induced
abortion to terminate an unwanted pregnancy is illegal in Tanzania. The term abortion
has been defined as an indictable offence if a woman is with child and any person
unlawfully administers to her any noxious drug or unlawfully uses any instrument with
intent to procure her miscarriage. Section 150 of the Penal Code has been very clear
about illegal abortion (Tanzania Penal Code 2002).
“Any person who with intent to procure miscarriage of a woman whether she is or is not
with child unlawfully administers to her or causes her to take any poison or noxious thing
or uses any force of any kind, or uses any other means whatsoever, is guilty of a felony
and is liable to imprisonment for fourteen years”.
In accordance with Section 150 the term ‘any other person’ includes the medical
practitioners. However the provision excludes the woman herself. In order to be guilty of
this offence such a person or a medical practitioner must accomplish two elements: - (1)
He must intend to procure miscarriage. (2) He must unlawfully administer to such a
woman or cause her to take any poison or noxious thing or use any force or other means.
Therapeutic abortion is artificial termination of pregnancy in the interest of the mother’s
life or health. Doctors do not hesitate to terminate pregnancy when there is a risk to
maternal life. In order to perform an abortion in such a case, the physician must have
concurring opinions of two other physicians. Even where it is legally permitted, safe
abortion may not be easily accessible; there may be additional requirements regarding
consent and counseling and quality of services offered. In addition, the attitudes of
medical staff may be discouraging, and abortion services may be insufficient to meet the
demand and unevenly distributed. Thus, in Tanzania abortions are medically necessary to
protect the health or life of the mother (Kinemo R. (1997), Kinemo unpublished).
.
In situations of restrictive laws.
Although Tanzanian government has taken initiative efforts to prohibit abortion as a
method of family planning in Tanzania, there is no machinery to investigate, control and
prosecute the offenders.
Tanzania has signed international conventions that protect and safeguard women
reproductive health and bodily integrity such as:
Beijing platform of action
11
CEDAW (convention on the elimination of discrimination against women)
Maputo protocol
The definition of mother’s health provides a loop hole. Can the possible psychological
consequences of rape be interpreted as severe enough to allow for legal termination?
References
World Health Organization. The prevention and management of unsafe abortion. Report
of a Technical Working Group. http://whqlibdoc.who.int/hq/1992/WHO MSM 92.5.pdf
(accessed July 6, 2006).
Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and
associated mortality in 2000. 4th edition. Geneva, Switzerland: World Health
Organization, 2004.
Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH. Induced abortion: estimated rates and
trends worldwide. Lancet 2007; 370: 1338-45
12
Margreth Silberschmidt and Vibeke Rash. Adolescent girls and sugar daddies in Dar es
Salaam: Vulnerable victims and active social agents. Social science and medicine
52(2001)1815-1826
Vibeke Rasch1, Fortunata Yambesi and Siriel Massawe. Post-abortion care and voluntary
HIV counseling and testing an example of integrating HIV prevention into reproductive
health services in Tanzania. Tropical Medicine and International Health 2006 volume 11
no 5 pp 697–704
Vibeke Rasch,Vumilia Mary, Ernest Urassa,Staffan Bergstrom.Sexual history and
contraception among women with induced and spontaneous abortion in Dar es Salaam.
African Journal of Health Sciences 1999;1 vol 6.
Rasch V, Hamed Mohamed, Ernest Urasa, Staffan Bergstrom. Self Report of Induced
Abortion: An empathetic setting can improve the quality of data. American journal of
public health 2000:7:vol. 90
Mpangile GS, Leshabari MT and Kihweli DJ. Factors associated with induced abortion in
public hospitals in Dar es Salaam. Reproductive Health Matters 1993: 2, 21-31
Urrasa E, Massawe S, Lindmark G, Nystrom L. Maternal mortality in Tanzania-medical
causes are interrelated with socio-economic and cultural factors. South African Medical
Journal 199; 86:436-44
Justensen et al, 1992).
Tanzania Demographic Health Survey (TDHS) 1996.
Tanzania Demographic Health Survey (TDHS) 2004/5.
Tanzania Service Provision Assessment Survey (TSPA) 2006.
Rasch V, Massawe S, Fortunata Y and Staffan Bergstrom.Acceptance of contraceptives
among women who had unsafe abortion in Dar es Salaam. Tropical medicine and
international health 2004; 9:3,399-405.
Vibeke R, Fortunata Y and Rose K. Scaling up post abortion contraceptive service-results
from a study conducted among women having unwanted pregnancies in urban and rural
Tanzania. Contraception 2005; 72,377-382).
Tanzania Ministry of Education and Culture –Primary School Science Syllabus
2005.Publisher-Tanzania Institute of Education.
United Republic of Tanzania Ministry of Education and Culture –Biology syllabus for
secondary School 2005 form I-IV .Publisher-Tanzania Institute of Education).
Thomsen S, Lugina H, Katz K, et al. Voluntary HIV Counseling and Testing Services for
Youth and Linkages with Other Reproductive Health Services in Tanzania. Youth
13
Research Working Paper No. 5. Research Triangle Park, NC:Family Health International
(FHI), 2006; Reynolds H, Beauvais H, Boulos LM,et al. Voluntary HIV Counseling and
Testing Services for Youth and Linkages with Other Reproductive Health Services in
Haiti. Youth Research Working Paper No. 6. Research Triangle Park, NC: FHI, 2007)
Tanzania Penal Code 2002 cap 150,151and 152
Kinemo R. Abortion Law in Tanzania, Uongozi Management Journal 1997 vol 7 no 2
1995.
Kinemo R Abortion and family planning in Tanzania (unpublished)
.
PREVENTION OF UNSAFE ABORTION TANZANIA COUNTRY
ACTION PLAN
1. Objective: To increase access to quality of and the number of women who
receive comprehensive post abortion care (cPAC) services.
Activity
Goal
To conduct workshops on
cPAC for Doctors, Clinical
officers, Nurses.
50 workshops
1250 health care providers
trained on cPAC in 25 districts
in Tanzania
To increase health facilities
All health facilities with health
14
Responsible
person
MoH, AGOTA
Time frame Indica
MoHSW,
Dec 2008 –
Dec 2008 –
Dec 2010
Numbe
Numbe
with tr
provid
Numbe
Numbe
providing cPAC services
(infrastructure, MVA kits).
To make Follow up
supervision of cPAC
trainees
care providers trained in cPAC
Supervision of all health care
providers trained in cPAC
MSD,
Ipas
MOH,
AGOTA,
CHMTs
Dec 2010
Dec 2008 –
Dec 2010
50% (?) of women consulting for
abortion receive cPAC according
to guidance
faciliti
service
Numbe
trainee
% of w
abortio
cPAC
guidan
2. Objective: To increase use of long acting and permanent contraceptive
methods (LAPM)
Activity
Goal
To conduct practical
training of all OBGY
PGs on LAPMs in all
medical schools in the
country.
Training workshops on
LAPM for Doctors,
Clinical officers, Nurses
All graduating OBGY PGs
trained in provision of LAPM
(Copper T IUD, implants, long
acting injectables, female and
male surgical sterilization)
30 training workshops
600 health care providers
trained on LAPM in all
districts in Tanzania
15 workshops per year
300 interns trained per year
Training workshop on
LAPM for intern doctors
15
Responsible
person
MoHSW,
MUHAS
All medical
schools
Time frame Indicator
MoHSW,
AGOTA
Four years
MoHSW,
MUHAS
All medical
schools
Continuous
Continuous
Number of t
OBGY PGs
Number of w
Number of t
Number of d
trained prof
Number of w
Number of t
interns per y
Prevalence o
LAPM
3. Objective: To introduce or expand family health and sexual education in
primary and secondary school.
Activity
Goal
Conducting meetings on
advocacy for family life
education to include
sexual and reproductive
health in the primary and
secondary schools
curriculum.
Training of school
teachers on how to teach
responsible sexual
behavior
Two meetings with policy
makers of - MoEVT and
MoHSW
10% of school teachers trained
on how to teach responsible
sexual behavior
Responsible
person
AGOTA,
School health
programme MoHSW,
Time frame Indicator
AGOTA
School health
programme MoHSW
JanDecember
2009
June –
December
2009
Effective teaching of
responsible sexual behavior in
primary and secondary schools
Number of m
conducted
Number of p
makers with
attitude and
toward fami
and sexual e
Number of s
teachers trai
Number of
teaching res
sexual beha
4. Objective: To create awareness on abortion law among health care
providers and the public
Activity
Goal
To conduct sensitization
workshops to increase
awareness,
understanding and
implications of the
abortion law to health
care providers, human
right activists,
parliamentarians, media
Twelve workshops on the
advocacy of the abortion
law to be conducted.
Responsible
person
TAWLA,
AGOTA,
LHRC,
Time frame Indicator
Two years
Number of works
conducted
Number of works
participants
Trained advocates
Number of public
statements by pol
makers
16
and community.
To conduct workshops
on advocacy of the use
of emergency
contraception
Two meetings with policy
makers of MoHSW
AGOTA
December
2008
Number of article
published and rad
programs and
statements
Number of meetin
conducted
5. Objective: To scale up adolescent friendly sexual and reproductive health
(AFSRH) services
Activity
Goal
Responsible
person
Advocacy on policy
Advocacy to all remaining MoHSW,
makers at different levels regions (18) in the country. AGOTA,
to understand the
services
Training of the health
80 training workshop on
MoHSW,
care providers for
AFSRH
AGOTA,
AFSRH services.
1600 health care providers
trained in AFSRH.
Increase in 50% in the
number of young people
attending AFSRH services
17
Time frame Indicator
One year
Number of region
sensitized.
Four years
Number of trainin
workshops conduc
Number of health
providers trained.
Number of young
people attending
AFSRH services
18