Major Achievement

Lesson Learnt

Strong Coordination and collaboration among various government and non government organizations is essential for effective implementation of the project and increasing access of safe abortion services in project districts. The registration of the four clinics and participation in the medical abortion study provided important opportunities for establishing important contacts and networking

Strong engagement with communities and gatekeepers is essential for reducing stigma, fear and misinformation on abortion on abortion at community level. Information and awareness raising activities explaining the importance of accessing safe abortion services and where to find these services that target gatekeepers such as school teachers, community leaders, women activists and local authorities can provide an important entry for increasing demand for and uptake of safe abortion services at FPAN clinics. This is especially important in the project areas where FPAN clinics have just introduced abortion services including post abortion contraception.
Information and awareness raising activities among community gatekeepers to explain the importance of accessing safe and comprehensive abortion care and where such services are available, helped to increase demand for and uptake of services at FPAN clinics.

Electronic media is more effective than print media to raise community level awareness in low literacy setting.Most women in rural area can easily access simple abortion related message when broadcast by radio.Hence, the clinics that are the part of the project will focus on radio programmes and street drama to increase awareness.  

Abortion is sensitive issues and therefore, system and training for respecting clients rights to privacy and confidentiality in the clinics and during outreach services need to be constantly reviewed so that IPPF quality of care standards are achieved

The operational research activities and overall review of service statistics revealed that activities for raising awareness at community level have been more successful in increasing client load than the national level advocacy efforts in the project.As described above, awareness raising programmes undertaken in collaboration with female community health volunteers, community counsellors and peer educators have proven to be an effective means of creating a positive attitude towards safe abortion services and increasing acess to related services.

National level efforts have been crucial for increasing access to medical method of abortion .(MMA) and developing partnership with high level obstetricians/gynaecologists fro working on longer term initiative to increase access to safe abortion services

Challenges

The law of second trimester abortion is restrictive in Nepal, allowing it only to be performed in government clinics in case of a threat to the women's life and health, rape and incest. Unfortunately, women living rural areas tend to be less aware of their gestation period and as a result often seek services later than twelve weeks

High turnover of doctors in the project clinics continues to be an enormous challenges to the provision of CAC services and identifying full time doctors or consultants able and willing to provide CAC services in often remote clinics has required considerable effort.

Recruiting technical staff particularly service providers to work in peripheral districts vulnerable to conflict and political unrest is a challenge in Nepal

High salary expecatations of technical staff are yet another constraint in staff recruitment.To overcome this challenge, FPAN is now revising the salary structure in the hope that this will help to retain experienced staff and attract new staff to work in the remote districts

Frequent strike and demonstration have constrained the efficient implementation of activities as planned including monitoring and supervision visits from the head quarters to district branches. Whilst  these constraints are beyond the control of FPAN.