Second Interim Report July 2010 Contents

Second interim report July 2010 Contents

Executive summary of the Second Interim Report of the Safe Abortion Action Fund (SAAF) 5

1·1 Brief history of SAAF 5

1·2 Achievements 5

1·3 Recommendations 7

1 Introduction 8

2 Development of the Fund 10

2·1 Support and leadership 10

2·2 Allocation of SAAF funds 11

3 Achievements of the fund: indicators from the grantees’ ﬁ nal reports 13

3·1 Increased access to safe abortion and post-abortion services 13

3·2 Effective advocacy for safe abortion 15

3·3 Research 19

3·4 Management and ﬁ nancing of SAAF projects 23

4 Progress and lessons to date 25

4·1 The 2009 external evaluation why SAAF is needed 25

4·2 The regional grantees meetings: strengthening networks of abortion champions 26

4·3 Lessons learnt for future grants 26 Safe Abortion Action Fund: Interim report – July 2010 3

5 On-going project activities 28

5·1 The African DFID projects 28

5·2 The NORAD extended projects 28

6 SAAF is evolving into a better structured fund 29

6·1 A pro-active Board 29

6·2 SAAF at the Women Deliver Conference 29

6·3 A new round of funding for South Asia 30

7 Conclusions and recommendations 31

7·1 Recommendations 31

8 Annexes 32

8·1 Financial statement at 31 December 2009 32

8·2 SAAF Board members as of 31 March 2010 33

8·3 Technical Review Panel members 33

8·4 List of the funded projects 2007-2009 34

8·5 List of the funded projects in Africa for the period 2008-2011 (DFID extra funding for Africa) 36

8·6 List of the extended projects 2010 (NORAD funding) 36

8·7 SAAF logical framework for the next round of funding 37 4 Safe Abortion Action Fund: Interim report – July 2010

Safe Abortion Action Fund: Interim report – July 2010 5

Executive summary of the Second Interim Report of the Safe Abortion Action Fund (SAAF)

The Safe Abortion Action Fund (SAAF) is a multi-donor funding mechanism that supports in-country initiatives for increasing access to safe abortion services. It provides small ﬂ exible grants to non-governmental organizations (NGOs) to do policy advocacy, innovations in service delivery and research. SAAF focuses on the needs of the marginalized and most vulnerable women and girls, within a comprehensive package of sexual and reproductive health services, including post- abortion family planning.

Hosted by the International Planned Parenthood Federation (IPPF), SAAF has a governing board made up of donors, activists and representatives of international NGOs: it is a collaboration of experienced actors to support new grassroots efforts in abortion.

SAAF’s capacity to empower new local voices and support a network of champions in a straightforward and ﬂ exible way – an added and unexpected value – makes it an important global funding mechanism for abortion work.

A 2009 external evaluation of SAAF recommended that “SAAF should continue to be funded in the short to medium term; it should be a global level fund and should continue to be managed by IPPF and apply the lessons learned in the ﬁ rst two years of the grant mechanism.” (HLSP)

1·1 Brief history of SAAF SAAF was established in 2006 with the support of donor governments from Denmark, Norway, Sweden, Switzerland and the United Kingdom. The initial fund totalled some US$11.6 million and this was supplemented by a further US$1.5m contribution from the United Kingdom for work in Africa. Fifty projects have been carried out worldwide and 12 of them are being extended with additional funding provided by Norway. The grantees supported during the ﬁ rst phase have delivered very encouraging results and outputs, and a second round of funding will be organized later this year thanks to continuous donor support.

1·2 Achievements (A) SAAF Projects

Women reached

During the ﬁ rst phase of SAAF, and despite various challenges encountered in countries, 49 new abortion-related services have been established and more than 300,000 women have beneﬁ ted from safe abortion-related services. Of the 30 projects focusing on service delivery, 86 per cent have reached or surpassed their targets. 6 Safe Abortion Action Fund: Interim report – July 2010

Health workers trained

Some 5,200 health providers have been trained (or had refresher training) in manual vacuum aspiration (MVA) and about 300 in medical abortion.

Advocacy activities

Globally, around 7,500 people beneﬁ ted from advocacy training and more than 200 networks were created or revitalized.

Research undertaken

The research projects that have been conducted in Thailand and South Africa have increased the quality of abortion care in their target clinics. Results from these researches have been published in professional journals (two articles in Reproductive Health Matters) or presented at international conferences and/or seminars.

Close collaboration and partnerships

Where SAAF grantees have been located in the same country (e.g. Argentina, Colombia, Mexico and South Africa), the organizations have pooled their resources and worked together to achieve their aims, providing mutual support to each other. This has strengthened partnerships and resulted in closer collaboration among many NGOs. The regional grantees meetings in early 2010 also enabled grantees to increase collaboration with others.

In a short period of time, SAAF has effectively strengthened, legitimized and promoted the work of networks working on safe abortion.

Small grantees managing funds

The majority of the grantees are small organizations that have little experience managing international funding. As unknown entities, they may have been viewed by major donors as potential risks. Yet, they have been as successful as the largest organizations in managing the resources provided, implementing their activities, achieving their annual objectives and meeting the reporting requirements.

(B) SAAF Management and Administration

The SAAF is administered by the International Planned Parenthood Federation. A Board governs and oversees the work of SAAF; it is composed of representatives of larger NGOs working in the ﬁ eld of abortion, donors and individuals with relevant experience. A Technical Review Panel (TRP), comprised of 15 international experts from all over the world, ensures the transparency of the proposal selection process by reviewing the submissions and making recommendations to the Board on which proposals should be funded. The agreed ‘light touch’ approach of managing the Fund has proved to be successful and the relationship between the grantees and the Fund is seen as one which is supportive and collaborative, but at the same time it ensures that objectives are met and ﬁ nances are appropriately managed.

Capacity building

As the majority of the grantees were local organizations, some of them with limited experience in abortion work, the SAAF Coordinator provided ongoing support to grantees. Being able to communicate with grantees in the three working languages of the Fund, she assisted them in improving their narrative reports and provided detailed feedback on their ﬁ nancial reporting. She also advised on how to report information in an articulate and logical way, and on effective project management. The SAAF Coordinator also enhanced the value of the SAAF projects by facilitating knowledge transfer among the grantees. Safe Abortion Action Fund: Interim report – July 2010 7

Reporting

To date 96.3 per cent of the committed funds have been expended and 75 per cent of grantees submitted their reports on time.

1·3 Recommendations ■ The replenishment of SAAF by both current and new donors is a priority. Ensuring the continuity of certain projects and opening the fund to new projects is critical to reduce mortality and morbidity associated with unsafe abortion.

■ Donors should recognize the toll of unsafe abortion and inequity of access to safe abortion services in regions such as Latin America and Eastern Europe and ensure that organizations working in these areas are not excluded from SAAF.

■ The future round of funding should maintain the ﬂ exible, ‘light-touch’ approach which worked so well in the ﬁ rst round, but it is also important to prioritize and support local organizations with initiatives which will be innovative, strategic and sustainable.

■ SAAF should provide technical assistance through innovative channels (e.g. use of a website) to optimize the potential of limited funding.

■ Service delivery projects should place greater emphasis on the provision of post- abortion family planning.

■ Grantees should use a new logical framework to improve monitoring and evaluation, and to improve the reporting of project achievements. • A new round of projects should be organised, incorporating the recommendations from the evaluators, from the grantees and from the lessons learnt during the ﬁ rst round of projects. This new round will ensure that the projects selected will have the following characteristics: • Innovative and strategic • Implemented by local organizations or a consortium of international and local organizations • Good reporting systems, including service statistic collection • Focused on reaching the most vulnerable women and girls • Systematic provision of post-abortion family planning (service delivery projects)

■ A new logical framework will ensure that monitoring and reporting are improved. 8 Safe Abortion Action Fund: Interim report – July 2010

1 Introduction This interim report covers the period January 2009 to July 2010 and highlights the achievements, impacts and lessons from projects supported by the Safe Abortion Action Fund (SAAF).

Abortion remains one of the most sensitive and unspoken maternal health issues worldwide, yet unsafe abortion accounts for at least 13 per cent of all maternal deaths.1 Reducing unsafe abortion-related complications is one of the most important ways to lower overall maternal morbidity and mortality, since nearly all deaths from unsafe abortion are preventable. Methods for termination of unwanted or unintended pregnancies have been known since ancient times,2 and yet abortion remains a taboo issue in most societies. This silence, coupled in many countries with restrictive laws, forces 19.7 million women each year to seek an unsafe abortion,3 leading to 67,000 maternal deaths,4 while an estimated fi ve million are treated for complications.5 Behind these fi gures are women who live in developing countries, almost exclusively, and are too poor to seek services from a qualifi ed provider.6

In many countries the restrictive laws that prevent women from accessing legal and safe abortions are compounded by ignorance, misinformation and misunderstanding about the legality of abortion, which in practice further restricts the use of services women are entitled to receive by law. Women are not aware of their rights; providers may not be aware of the law and/or are not skilled. This lack of information, together with a lack of public discussion, leads to tragic consequences for women. Moreover, in certain countries, the right to a safe abortion embedded in a liberal constitution, law or policy is not always translated into safe, accessible and affordable services. Women are therefore deprived of their right to health, and the right to control their own fertility and make choices about their own body, which leads them to seek illegal and unsafe abortions.

Globally the stigma around working in abortion is high and although the public health needs remain great, most developing countries governments are unlikely to spend their already stretched health budgets on abortion care. Funding NGOs is a good option to increase access to safe abortion services as they are more willing and able to take risks and focus on stigmatized issues. However, the overall funding is limited and some governments which are important donors for sexual and reproductive health, such as the United States, still refuse to support safe abortion services. In the current economic climate, even the traditional donors for abortion work (e.g. Some European governments, US foundations, etc.) have reduced their support for abortion programmes.

In this context, NGOs are often the only actors in the abortion ﬁ eld, and for many smaller organizations, SAAF may be one of their only opportunities to obtain funding to work on abortion. This is particularly true for regions which are not a priority for donors, such as Eastern Europe and Latin America and the Caribbean.

The Safe Abortion Action Fund works to reduce abortion stigma and to legitimize abortion. It encourages safe abortion to be provided to the fullest extent of any national law and at the highest possible standards of care, and for legal and policy reforms to be implemented in countries where abortion is restricted. SAAF supports in-country organizations – which often best understand the needs of women in their communities – to inform discuss and study abortion and provide high quality services to the most vulnerable women.

SAAF has now become a valued mechanism for supporting local action on abortion within the sexual and reproductive health and rights landscape. It has increased access to safe abortion-related services for more women through innovative strategies, and it

1 WHO. Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003. Fifth Edition. 2007. p 16. 2 Ibid, p.1. 3 Singh S. at al., Abortion Worldwide: a Decade of Uneven progress, New York: Guttmacher Institute, 2009. Singh S, Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries, Lancet,2006, 368(955):1887-1892. 4 Ibid,p.17. 5 Singh S. at al., Abortion Worldwide: a Decade of Uneven progress, New York: Guttmacher Institute, 2009. 6 Cohen S, Facts and Consequences: Legality, Incidence and Safety of Abortion Worldwide, Guttmacher Policy Review, Volume 12, Number 14, Fall 2009. Safe Abortion Action Fund: Interim report – July 2010 9

has inspired new networks of abortion champions which help to support and advocate for safe abortion worldwide. This report describes the background and development of SAAF, and documents key lessons and achievements and challenges. The added value of this unique Fund – its capacity to empower new voices and support new organizations in a straightforward and ﬂ exible way – is an important characteristic of SAAF. 10 Safe Abortion Action Fund: Interim report – July 2010

2 Development of the Fund

2·1 Support and leadership Thirteen per cent (178 women each day) of the more than 500,0007 annual maternal deaths worldwide are due to complications from unsafe abortion; this fi gure is as high as 50 per cent in some developing countries. SAAF was developed and launched as a direct response to the lack of attention and dedicated means to support action to reduce unsafe abortion. While world leaders reaffi rmed their commitment to the Millennium Development Goals (MDGs), including the goal of reducing the number of maternal deaths and improving women’s health, during the September 2006 United Nations World Summit, little recognition was given to abortion as a key determinant of progress on MDG 5. Funding for family planning also declined in this period. Moreover, the Mexico City Policy (also known as the Global Gag Rule) – which prevented U.S. government reproductive health funding going to non-governmental organizations that provided abortion care of any kind –resulted in signifi cant losses for organizations working in abortion and sexual and reproductive health and rights.

The UK Department for International Development (DFID) tasked IPPF to produce the publication Death and Denial: Unsafe Abortion and Poverty8 in 2006, in order to highlight the consequences of unsafe abortion worldwide and demonstrate the need for action. IPPF was then asked to take a leadership role in establishing a funding mechanism to support all NGOs able to make a contribution to reducing unsafe abortion. Since then, the Safe Abortion Action Fund (SAAF) has operated as a ‘light-touch’-managed fund to disburse grants to non-governmental organizations working on abortion. DFID’s initial contribution was supplemented by contributions from the governments of Denmark, Norway, Sweden and Switzerland. DFID then made a further £1 million contribution earmarked for Africa (See Table A).

Table A: Donors contributions to the fund for the ﬁ rst round (at 31 December 2009)

Contributions (US$) Donor Original Earmarked Extensions TOTAL Governments contribution Africa

Denmark 1,533,268 1,533,268 Norway 1,636,260 1,756,500 3,392,760 Sweden 2,882,970 2,882,970 Switzerland 59,571 59,571 United 5,438,321 1,812,774 7,251,095 Kingdom TOTAL 11,550,390 1,812,774 1,756,500 15,119,664

A number of donors have demonstrated their continued support with further funding. At the end of 2009, the Norwegian Agency for Development Cooperation (NORAD) contributed NOK 10,000,000 (US$1,756,500) to extend project implementation and provide technical assistance.

In 2010, DFID committed a further £900,000 (US$1,358,730) to support a new round of projects in South Asia.9

7 Maternal Mortality in 2005, Estimates developed by WHO, UNICEF UNFPA and the World bank, WHO, Geneva, 2007. 8 Death and Denial: unsafe abortion and poverty, IPPF, London, January 2006. http://www.ippf.org/NR/ rdonlyres/8D4783F5-D516-47D3-8B34-61F6D510202A/0/Death_Denial_unsafe_abortion_poverty.pdf 9 The South Asia focus countries are Afghanistan, Bangladesh, India, Nepal, Pakistan and Sri Lanka. Safe Abortion Action Fund: Interim report – July 2010 11

As a grant-making mechanism, SAAF supports projects and initiatives to increase access to safe abortion services within a comprehensive package of reproductive health care, with particular regard to the needs of marginalized and vulnerable women. It supports in-country initiatives from non-governmental organizations which demonstrate an ability to improve access to safe abortion, with a focus on advocacy, research and service delivery. The SAAF operates on an open and competitive basis and is overseen by a multi-agency board of leaders and experts in the ﬁ eld of reproductive health (See annex 2), with an independent Technical Review Panel (TRP) providing advice on investment decisions (See annex 3).

The SAAF Board is the highest decision-making body of SAAF and is accountable to donors and other stakeholders. Its purpose is to provide strategic oversight, to set policy and guidelines and to consider, discuss and approve applications eligible for funding. The Board includes representatives from the NGO community, abortion activists, professional organizations and the donors.

The Board appointed the TRP, made up of 15 experts from different countries and with diverse skills and expertise in the ﬁ eld of safe abortion. The role of the TRP is to score and assess the proposals received along the lines of the SAAF guidelines. The TRP works remotely (on-line) in teams of two and then meets for one day to jointly consider all the proposals. It then makes recommendations to the Board, which makes the ﬁ nal decisions regarding funding of projects.

The high demand for support, together with demonstrable results reported by grantees, illustrates the value added of even modest levels of support speciﬁ cally directed to local organizations through a dedicated funding mechanism.

2·2 Allocation of SAAF funds Over 170 proposals were submitted to the SAAF from 63 countries in the ﬁ rst call for proposals. This unanticipated level of interest in the new fund demonstrated the importance of safe abortion as a critical health and rights issue, and signiﬁ cant unmet demand for abortion services worldwide. The origin of the submitted proposals is in Table B.

Table B: Origin of the 172 proposals by region

Region Number of proposals received

Africa 42 Arab world 1 East and southeast Asia 14 Europe 14 South Asia 50 Latin America and Caribbean 51

The use of three working languages was key in reaching all these local organizations and is an important lesson learnt. The application and reporting documentation available in English, French and Spanish is an asset to allow a large number of local organizations to apply and work in their native language. This is not a common feature with global funding mechanisms.

The demand for funding; totalling US$42,101,596; represented four times the initial amount available ($11,550,390) and the TRP recommended reducing the ceiling available for each grant to expand the reach of the fund and the portfolio of projects. Given the level of need and demand for support in Africa, DFID provided an additional £1,000,000 speciﬁ cally for projects in this continent.

The breakdown of the funded projects is shown in Table C. 12 Safe Abortion Action Fund: Interim report – July 2010

Table C: Countries of the funded projects by region

Africa Asia Latin America Eastern Europe Burkina Faso Bangladesh Argentina x 3 Albania Côte d’Ivoire Cambodia Bolivia x 2 Kazakhstan Ethiopia China Brazil x 3 Kyrgyzstan Ghana Mongolia Chile x 2 Kenya India Colombia x 2 Lesotho Nepal x 2 Costa Rica Mozambique Philippines Mexico x 4 Nigeria Thailand x 2 Peru South Africa x 3 Vietnam Uruguay x 2 Sudan Uganda

Looking at the types of activities by region (See Figure A), it can be seen that advocacy and service delivery make up the majority of the projects. Only four projects focused solely on research. Service delivery activities have almost always been provided with complementary advocacy and/or training.

Figure A: Type of activities for the 44 initial projects by region

Africa

Asia

Latin America

Easter Europe

0 5 10 15 20

Service delivery Service Research Advocacy and advocacy delivery Safe Abortion Action Fund: Interim report – July 2010 13

3 Achievements of the fund: indicators from the grantees’ ﬁ nal reports

3·1 Increased access to safe abortion and post- abortion services With the support of the SAAF, considerable progress has been made with regard to extending service delivery. Out of the 30 projects delivering services:

■ 5 (16.7 per cent) projects have results10 signiﬁ cantly above their projections.

■ 21 (70 per cent) projects reached their targets.

■ 4 (13.3 per cent) projects did not reach their targets.

Bangladesh

In Bangladesh, the Bangladesh Women’s Health Coalition (BWHC), a consortium of three local organizations, provided more than 8,000 menstrual regulations for women and 2,578 for adolescents. New clinics have been set-up and are offering services that were not available in rural areas before the project. Activities such as paid lab services have been developed to address the sustainability issue.

9000

8000

7000

6000

5000

4000

3000

2000

1000

0 Safe MR Performed Post MR Method Safe MR Performed Post MR Method (for RH women) (for RH women) (for Adolescent) (for adolescent)

2 years’ target Achievement

Despite the variability in quality and availability of baseline information, data from the grantees ﬁ nal reports allow us to highlight the following results from SAAF projects (see below).

10 Not all the projects have clear service delivery indicators. These ﬁ gures are based on the results table from the grantees reports. 14 Safe Abortion Action Fund: Interim report – July 2010

SAAF service delivery More than 300,000 women have beneﬁ ted from safe abortion services 49 new abortion-related services have been established Some 5,200 providers have been trained (or had refresher training) in manual vacuum aspiration (MVA) and about 300 in medical abortion

An important issue for service delivery activities is their long-term sustainability and one of the key enabling factors is the training of service providers. Overall, SAAF projects trained 5,200 providers in counselling, post-abortion care and safe abortion techniques. These providers are now able to provide MVA and some are training other providers in the use of this technology. In addition to the technical aspect of abortion procedures, trainings also included counselling and post-abortion family planning.

Two projects (India, Thailand) also created training centres which will continue to be used after the end of the funding. The Pathﬁ nder project in India developed a comprehensive manual on how to set-up training centres.

In terms of new technologies, about 300 providers have been trained in medical abortion. As drugs become registered in more countries, medical abortion should become increasingly available to women as alternative to surgical methods or as a ﬁ rst access method when nothing else is available. Moreover, many women in highly restricted countries are using medical abortion drugs even though they are not registered, and it is essential for the providers and the pharmacists to become familiar with these methods in order to assist women most effectively.

3·2 Effective advocacy for safe abortion By giving a voice to many organizations and by legitimizing the work on abortion, SAAF already positively contributes to the international debate on abortion.

Advocacy is a cross-cutting activity for most of the projects and a key issue to advance the debate and improve legislation on safe abortion worldwide. The monitoring and measurement of advocacy networks is a complex task when it comes to diverse small scale projects. For example, it can be difﬁ cult to attribute drivers of legal or policy change with regards to abortion. SAAF grantees have been on the front line to publicly address the abortion issue in their country or region as some of the case studies show, and have contributed to change (see below).

Achievements of the advocacy projects 200 advocacy networks created or revitalized worldwide. 7,500 people beneﬁ ted from advocacy training worldwide.

Globally, around 7,500 people beneﬁ ted from advocacy training and more than 200 networks were created or revitalized. The nature of these networks varies greatly from one project to another. In Asia, advocacy networks have been supported in Bangladesh, India, Nepal and the Philippines at community level, while the Latin American networks work mostly at a national or regional level. Ninety per cent of the projects focusing on advocacy successfully carried out their planned advocacy activities according to the implementation scoring table of the grantees reports.11

11 The SAAF report template includes a results table with an achievements assessment column where the grantees indicate if the objectives are: 1-fully achieved; 2-largely achieved; 3-partially achieved; 4-achieved Safe Abortion Action Fund: Interim report – July 2010 15

The diversity of the projects and of the advocacy activities is as extensive as the variety of audiences they reach. Campaigns have been developed around medical abortion in Southeast Asia, sexual violence in South Africa or contraception in several countries. Training sessions have brought together youth, community leaders, teachers, parliamentarians, legislators, lawyers, religious leaders, indigenous women and refugees. They have been sensitized to the abortion issue and taught how to advocate efﬁ ciently for it.

Case study: Chile

Chile is one of the few countries in the world where abortion is prohibited under any circumstances and until recently there was no public debate on abortion and no organized movement to put the issue on the public agenda. With an estimated 120,000 to 160,000 (unsafe) abortions performed each year and 30,000 women being hospitalized for complications from unsafe abortion, it is an important issue in Chile. The Latin American and Caribbean Women’s Health Network (RSMLAC) and Asociación Chilena de Protección de la Familia (APROFA), have combined efforts on some components of their projects to build a citizens’ network and to create the conditions for a public debate on the decriminalization of therapeutic abortion in Chile.

The objective of creating a network with a large and varied audience at national level was very ambitious and without the SAAF funding it would have not happened. Building alliances and agreeing uniﬁ ed strategies and action plans takes time and meetings, and funding for such essential activities is scarce. The SAAF grant provided a unique opportunity, and allowed these organizations to dedicate time to bring together various actors from civil society to create the Citizens’ Networks for the Right to Decide in ﬁ ve towns in the country (Antofagasta, Concepción, Santiago, Temuco and Valparaíso).

These networks identifi ed individuals and organizations in favour of freedom of choice and started a process of sensitization and empowerment with technical and political information and arguments about unsafe abortion. The alliance produced a ‘consensus document’ which was the basis for their advocacy work. Spokespersons have also been identifi ed and trained to address the media and public decision makers. Through the fi ve city networks, the issue of abortion is raised throughout the country at diverse opportunities and abortion was a major issue into the presidential election debate.

As an example of the public exposure, the launch of the book produced by APROFA, ‘Aborto en Chile, Argumentos y Testimonios para su Despenalización en Situaciones Caliﬁ cadas’, with the support of Senator Fulvio Rossi, was a real success in terms of media coverage and in bringing to public attention social, medical, economical and religious arguments in favour of the decriminalization of abortion.

The law might not change in the next few months and the networks will have to organize many more events, but the SAAF funding was key in building the foundations of a strong advocacy movement which will be sustained by all its member organizations.

to a very limited extent or 5-not achieved at all. Activities which are assessed with 1 and 2 are considered to be carried out successfully. 16 Safe Abortion Action Fund: Interim report – July 2010

One of the most signiﬁ cant outcomes of the advocacy projects is in Uruguay, where the two SAAF projects have been leading a coalition which succeeded in bringing the abortion issue into the presidential election campaign and forcing the candidates to publicly take a position on the subject.

Case Study: Uruguay

In Uruguay, 2010 could be the year of many changes with regard to the decriminalization of abortion. The recently elected President José Mujica declared during the campaign he would not veto a bill decriminalizing abortion. The advocacy work done by Mujer y Salud en Uruguay (MYSU) has been central in bringing the issue of abortion into the election campaign.

Using new communication technologies and involving young people, MYSU developed a highly visible campaign for legal abortion.12 Iniciativas Sanitarias, the pioneer of the ‘harm reduction model’, has been a key actor in piloting the integration of abortion-related services in the public health sector. (Iniciativas Sanitarias is a well-respected organization whose Executive Director, Leonel Briozzo, received the Ministry of Health Prize for Medicine in October 2008.) Both organizations participate in the changes that might occur in the next months in Uruguay, which could become pivotal for other countries in the region.

Other projects succeeded in bringing the abortion issue to public attention. In Argentina for example, the SAAF grantees collaborated on some of their activities to optimize their impact. The Centro de Estudios de Estado y Sociedad (CEDES)13 established a multidisciplinary team of medical and legal experts to produce a technical guide for integrated abortion care and an advocacy campaign to decriminalize abortion. Led by the Católicas por el Derecho a Decidir (CDD), the National Campaign for Legal, Safe and Free abortion joined 250 organizations which consistently mobilized public and political opinion. This action has resulted in the presentation14 in March 2010 of a draft law for the decriminalization of abortion, a project supported by 33 deputies from all political parties.

12 http://www.hacelosvaler.org/-English-version-.html 13 Which was awarded the distinction of the most inﬂ uential think tank in Argentina by a panel of experts in 2009 14 This project had already been presented to the chamber on 28 May 2007, but had been put on hold and never debated. As a consequence, the draft lost its legislative status in March 2010, thus the new presentation by the coalition on 16 March 2010 , this time with direct deputies support (draft law 0998-D- 2010 ) Safe Abortion Action Fund: Interim report – July 2010 17

In some areas, SAAF has enabled the ﬁ rst- ever activity around abortion. SAAF enabled the Albanian Centre for Population and Development (ACPD) to begin work dedicated to abortion. Throughout the course of the project, ACPD conducted a national Knowledge, Attitudes and Practices (KAP) study on the situation of abortion in Albania, examining problems around access and quality of care in particular, and disseminated the results during the National Conference on Public Health in Tirana in May 2009. This was followed by a highly publicized National Conference on Unsafe Abortion where ACPD presented its study and launched the ﬁ rst national coalition on abortion. Following this major step, ACPD worked with journalists to raise awareness of the issues, participated in a TV broadcast on safe abortion, and encouraged women to claim their rights by disseminating a Charter on the Client’s Right to Abortion. This included an anti-corruption campaign (the KAP study had shown that many providers were asking for illegal fees to provide services). Through its high visibility advocacy efforts, ACPD secured extra funding to continue work on the issue and is planning to begin provision of abortion services to scale-up best practices.

In Africa, the main advocacy project is implemented by the African Network on Medical Abortion (ANMA), the most recent regional chapter of the International Consortium on Medical Abortion (ICMA) to be created.15 One of the major roles of this network is to advocate for medical abortion and to disseminate information across the continent. The ﬁ rst year of implementation was slow as it took more time than expected to set-up a new regional network covering such a vast area, but its potential is substantial for Africa as medical abortion is a promising innovative technology for low resource settings. By training members on medical abortion and attending international conferences, ANMA participates in bringing this new technology to Africa.

Many other countries conducted advocacy activities within their projects as part of other activities. For example, the project conducted by the Association Ivoirienne pour le Bien- être Familial (AIBEF) introduced abortion into the public debate in Côte d’Ivoire through a dedicated TV programme.

The new Women’s Health and Reproductive Rights Foundation of Thailand (WHRRF) used the SAAF funding to start-up training activities throughout the country in government hospitals. They also co-organized the fi rst international Congress on Women’s Health and Unsafe Abortion16 in Bangkok, Thailand (20-23 January 2010), which was offi cially opened by the Prime Minister and attended by close to 600 international delegates. This is a signifi cant achievement in bringing greater public attention to the issue of unsafe abortion.

The advocacy projects have been implemented in very different contexts and their activities tailored to address some speciﬁ c local, national or regional issues. However, some common components have been identiﬁ ed in designing a successful abortion advocacy activity.

Some lessons for successful abortion advocacy activities

■ Involve women and the general public in your activities. Women need to be empowered.

15 Regional networks have been started in the past few years in Latin America, Eastern Europe and Asia. Africa was the only region without a network. 16 http://www.womenhealth.or.th/congress/welcome.html 18 Safe Abortion Action Fund: Interim report – July 2010

■ Involve young people, as they are generally keen to bring change.

■ Involve service providers in the activities.

■ Work with the press and media to sensitize them on abortion issues and make sure they communicate the issues accurately.

■ Research, or commission research, to collect data on the local context to support your arguments.

■ Know the position of the politicians, particularly those with signiﬁ cant decision- making power, to identify champions for your cause.

3·3 Research SAAF has also supported a small number of research projects, although other projects have included surveys to gather data and document progress. These studies are proving to be vital in many countries as they can often be the only reliable source of information about the situation regarding abortion. Used to alert the authorities, to develop guidelines and protocols or to develop advocacy strategies, these activities are essential to inform both the abortion community and the wider health sector.

In Burkina Faso, Costa Rica, Côte d’Ivoire and the Philippines, the projects have produced comprehensive studies at national level about abortion in their countries. They all aimed to produce quantitative and qualitative data on the issue to alert health authorities, open the debate and reach the general public as well.

Costa Rica

In Costa Rica, the Asociación Demográfi ca Costarricense (ADC) produced much-needed research on the relationship between unsafe abortion and maternal mortality in Costa Rica.17 It won the IPPF/WHR WestWind Awards for excellence and improvements made in the area of safe abortion. Using a methodology designed by the Guttmacher Institute and adapted to the country, ADC provided fi gures which had not been updated since 1994, estimating that 27,000 induced abortions occurred in Costa Rica annually, representing a ratio of one abortion for three births. Most of them are illegal and the role of this study was to reposition the abortion issue in the public domain and highlight its public health consequences. With scientifi c and accurate data, ADC hopes to be able to advocate more strongly for provision of safe abortions and to address the root cause of unwanted pregnancies.

In Côte d’Ivoire, the Association Ivoirienne pour le Bien-être Familial (AIBEF) produced a national Knowledge, Attitudes and Practices study18 in partnership with the Ministry of Health. AIBEF initially planned to survey a specifi c region, but due to interest from the Ministry of Health, the research became a national level study. The SAAF project acted as a catalyst for moving this issue forward. The study was published as a book and was followed by an important dissemination and advocacy programme. The main fi ndings show that about two in fi ve women who became pregnant had an induced abortion, making it a very common practice in Côte d’Ivoire. The study explains in detail the causes, the various methods used and the consequences of unsafe abortion. Recommendations to the public health sector have been widely disseminated, which included a one-hour television programme on unsafe abortion.

The Institut Supérieur des Sciences de la Population (ISSP) in Burkina Faso conducted, in collaboration with the Guttmacher Institute and the French National Institute for

17 Cristian Gómez Ramírez, Estimación del aborto inducido en Costa Rica, 2007, Asociación Demográﬁ ca Costarricense, San José, Costa Rica, 2008. 18 Association Ivoirienne pour le Bien Etre Familial, Connaissances, Attitudes et Pratiques de l’avortement provoqué en Côte d’Ivoire, 2008, Abidjan, Côte d’Ivoire. Safe Abortion Action Fund: Interim report – July 2010 19

Demographic Studies (INED), an extensive national study on the incidence of unsafe abortion. In Burkina Faso, procedures are not recorded in offi cial health records; therefore there are no offi cial statistics on induced abortions. The Institute produced some valuable demographic data on the incidence of abortion in Burkina Faso by region, the characteristics of the women receiving abortions and other demographic data. Some preliminary results were presented at the XXVI IUSSP International Population Conference in Marrakech, Morocco, 27 September – 2 October 2009. The positive outcome of this project is the fact that not only did the Institute produce some valuable data – the fi rst of its kind in the country — but the partnership with international research centres contributed to building the in-country capacities for further research and studies on the issue.

In 2006, a publication for the Guttmacher Institute highlighted the link between unintended pregnancies and the widespread incidence of induced abortion in the Philippines.19 The work of Gabriela-Negros went further and tried to give a qualitative approach to the issue, focusing less on the global ﬁ gures and more on women’s stories.

“A book which consolidates the long-kept stories and silenced pain of women who had an abortion in the Philippines.” Nenita L. Cherniguin

In the Philippines,Gabriela-Negros conducted a research20 aimed at capturing the state of abortion in the country, describing the context, incidence, issues, actual practice and the legal environment. They also planned to determine the impact of unsafe abortion on women, identify resources for groups working in abortion and identify interventions to promote access to and improve delivery of services for safe abortion and post-abortion care.

The project produced an original and unique national qualitative study which created great controversy when it was launched. In the Philippines, due to the strong inﬂ uence of the Catholic Church, abortion is publicly regarded as immoral, and religion does play a part in a woman’s decision about whether or not to have an abortion. Abortion is, however, increasingly accepted within families and within communities.

Gabriela-Negros has now secured additional funding to advance this important work, particularly to translate the research into advocacy activities and make sure that the ﬁ ndings of the studies are widely disseminated.

SAAF has also supported research to better understand the political environment on abortion, such as that undertaken by Reproductive Health Uganda (RHU). During its ﬁ rst year of project implementation, RHU conducted a study on the knowledge, attitudes and practices of Members of Parliament (MPs) in Uganda on issues of unwanted pregnancies, abortion and post-abortion care. This was an important ﬁ rst step in opening political dialogue, a prerequisite to generating political priority for meeting women’s needs.

19 Singh S et al., Unintended Pregnancy and Induced Abortion in the Philippines: Causes and Consequences, New York: Guttmacher Institute, 2006. http://www.guttmacher.org/pubs/2006/08/08/PhilippinesUPIA.pdf 20 Virgilio R. Aguilar, Rowena V. Bañes, The realities and Experiences of Women on Unsafe Abortion in the Philippines, Bacolod City, 2009. 20 Safe Abortion Action Fund: Interim report – July 2010

What Ugandan MPs think about abortion…

According to the study, the Members of Parliament recognize that unwanted pregnancies and unsafe abortions are common in Uganda; however they underestimate the impact of unsafe abortions on maternal mortality and are eager to address these issues through sex education and family planning. Many of them possess limited medical information about abortion and have not been sensitized about safe procedures. Eight in 10 believe abortion could be justiﬁ ed in cases of rape and nine in 10 believe post-abortion care provision is inadequate and should be improved. They want to see information about safe abortion in the community.

Projects in South Africa, Nigeria, Thailand and Sudan have conducted operations research to improve the delivery of services in speciﬁ c settings.

The research by Ibis Reproductive Health aims to produce data on the management of second trimester abortion in South Africa, which represents a signiﬁ cant proportion of all the terminations of pregnancy. This very speciﬁ c and unique research is much needed as very little data exists on this topic; not only in South Africa, but worldwide.

In South Africa, the Ibis research is ﬁ lling a gap

“An abortion provider interviewed emphasized how shocking the current second trimester abortion conditions are currently, with traumatized women expelling the fetus in the waiting room with no support. The Ibis research has documented clear deﬁ ciencies in the South African system, which had not been done before, including the safety of dilatation and evacuation (D&E) and the limitations of only using medical abortion for second trimester abortions. In addition, it has brought up issues to do with better management for the client such as pain management, the best way to do cervical preparation before the procedure and the importance of giving women accurate information and emotional support during a difﬁ cult procedure. It has also documented many issues needing further research. The Department of Health has already demonstrated its interest in this information and a journal has express interest in publishing the work.”

– SAAF evaluation, 2009

Following the analysis of the baseline study results, Ibis developed a training programme for providers and medical staff in the study sites to improve services for both medical and D&E methods.

The preliminary results have enabled Ibis to obtain additional funding from the Society of Family Planning for complementary research.21

In Thailand, in collaboration with the University of Darwin, the Mae Tao clinic is working to improve access to abortion care for Burmese refugees in a public hospital in the border town of Mae Sot. Previous studies have shown that Burmese women would attempt to induce abortion with herbs and sticks, and women who were admitted to Mae Sot Hospital received dilatation and curettage (D&C), very little education or counselling and no modern method of contraception (except sterilization) after unsafe abortion. The providers’ lack of training and lack of understanding of the cultural and social norms of the Burmese women complicated the delivery of high quality post-abortion care.

21 The grant announcement can be found at http://www.societyfp.org/research/abstracts/grossman2009.asp Safe Abortion Action Fund: Interim report – July 2010 21

Using bi-cultural workers (Burmese refugees who have been living in Thailand for years and understand both cultures and speak several local languages), the study ‘Cross- cultural Post-Abortion Care on the Thai-Burma Border: Testing Improved Care in Hospital’ was conducted and some of the preliminary ﬁ ndings were presented at the First Congress on Women’s Health and Unsafe Abortion (Bangkok, January 2010) through four different presentations. A paper will be submitted this year for publication.

Cross-cultural post-abortion care on the Thai-Burma border

By training the local staff in modern post- abortion care (PAC) methods and using bi- cultural workers, the project aimed to change clinical practices. The team conducted a study, ahead of project implementation, on the quality of care and access to services for Burmese women, followed-up by training, information sessions and more importantly by the introduction of bi-cultural workers in the public hospital. Thai and Burmese health workers collaborated to produce simple, clear and appropriate sexual and reproductive health information for women and men to make better health choices. Creating an enabling environment where senior obstetric and nursing staff work in a more collaborative way and use modern methods, increases access and quality of care for Burmese and Thai women.

The interesting aspect of the Thai-Burma border project intervention is its potential for replication in many different settings. Linguistic and cultural barriers are common to many contexts worldwide, and this intervention shows that changes can be brought with simple activities and limited funding.

Saving women’s lives is not always about complex processes: this project shows that by introducing trained staff to provide information to women in their own language can make an important difference.

In Nigeria, the Women’s Health and Action Research Center (WHARC) produced a needs assessment study22 for safe abortion care in four Niger-Delta states (Edo, Delta, Bayelsa and Rivers states). From the results, they developed training tools, and then trained and equipped 40 doctors to provide medical abortion, MVA and post-abortion family planning. About 7800 women benefi tted from safe abortion services, out of which 73.5 per cent accepted post-abortion family planning. The project also helped reactivate the Association of Private Obstetrical Providers, which acts as an advocacy and peer support network, in the four states. The fi ndings of the study were presented at the International Seminar on Interrelationships Between Contraception, Unintended Pregnancy and Induced Abortion, organized by the Scientifi c Panel on Abortion of the International Union for the Scientifi c Study of Population (IUSSP) and Ipas-Ethiopia (Addis Ababa, Ethiopia, 1-3 December 2008). The project focused principally on private providers in the fi rst phase, but government health authorities have since approached WHARC with an interest in involving public sector providers in project activities. As such, it has the potential to become an interesting and sustainable public-private partnership.

Another outstanding piece of work on abortion care in low-resource settings has been produced by the Planned Parenthood Federation of America International’s Sudan ofﬁ ce. Their study23 looked at the treatment of complications of unsafe abortions in ﬁ ve hospitals in Khartoum and highlighted enormous unmet need for safe abortion services and the urgent need to allow mid-level providers to provide services.

22 “A survey of the attitudes and practices relating to reproductive health and family planning services among private medical practitioners in four states of the Niger-Delta region of Nigeria” presented at the Intentional Seminar on Interrelationships between contraception, unintended pregnancy and induced abortion, Addis-Ababa, Ethiopia, 1-3 December 2008. 23 Joyce Kinaro, Tag Elsir Mohamed Ali, Rhonda Schlangen, Jessica Mack, Unsafe abortion and abortion care in Khartoum, Sudan, Reproductive Health Matters 2009;17(34):71–77. 22 Safe Abortion Action Fund: Interim report – July 2010

Post-abortion care in Sudan

“Abortion is legally restricted in Sudan to circumstances where the woman’s life is at risk or in cases of rape. Post-abortion care is not easily accessible. In a country struggling with poverty, internal displacement, rural dwelling, and a dearth of trained doctors, mid-level providers are not allowed to provide post-abortion care or prescribe contraception. The vast majority of the 726 abortion patients in the ﬁ ve hospitals were treated with dilatation and curettage (D&C), and only 12.3 per cent were discharged with a contraceptive method. Some women waited long hours before treatment was provided: 14.5 per cent of them had to wait for 5-8 hours and 7.3 per cent for 9-12 hours. Mid-level providers should be trained in safe abortion care and post-abortion care to make these services accessible to a wider community in Sudan. Guidelines should be developed on quality of care and should mandate the use of manual vacuum aspiration or misoprostol for medical abortion instead of D&C.”

Using different approaches, locations and cultures, the research demonstrates the importance of obtaining evidence about abortion from the local context in order to inform advocacy and service delivery efforts. It is also clear that poor and vulnerable women, despite religious, cultural and societal pressure, will resort to unsafe abortion, while women who have greater means will be able to have a safe, albeit illegal, abortion.

3·4 Management and ﬁ nancing of SAAF projects The SAAF was established to be a highly ﬂ exible and responsive funding mechanism, with an emphasis on supporting local organizations to develop or expand advocacy and services for safe abortion. It was also agreed that IPPF would adopt a ‘light touch’ approach to administering the fund.

By the end of 2009, US$10.9 million had been committed to round one projects and the high level of spending seen in Table D indicates the vitality of the fund.24

Table D: Grants spending level at 31 December 2009 in US$

Committed funds Spent funds Percentage

44 initial projects 10,972,910 10,568,590 96.3% 6 Africa projects25 1,561,750 1,230,510 78.8% TOTAL 12,534,660 11,799,110

Of the committed funds, 96.3 per cent were expended; this is above the original 85 per cent from the logical framework. There was also a high level of grantee compliance with project reporting and ﬁ nancial management requirements (See Table E).

24 The funds received in December 2009 from the government of Norway to extend some projects were sent to the selected projects in 2010. They therefore do not appear in this table. 25 The six African projects have not been fully implemented Safe Abortion Action Fund: Interim report – July 2010 23

Table E: Compliance in reporting

Narrative reports Financial reports

Received complete within 1 week of the 58% 50% deadline Received complete within 1 to 2 weeks of 14% 22% the deadline Received complete within 3 to 4 weeks of 3% 3% the deadline Not received on time 25% 25%

As seen in Table 7, 75 per cent of the narrative and ﬁ nancial reports were submitted on time (meeting the target as deﬁ ned in the logical framework). This excellent performance demonstrates the high degree of motivation and commitment of the SAAF grantees.

The SAAF Secretariat supported the above performance by providing a signiﬁ cant amount of information and advice to smaller organizations regarding the reporting requirements. Grantees, upon request, were provided with guidance on project management, ﬁ nancial reporting and improving their narrative reports.

Not all the projects have been able to implement the totality of their activities during the original agreed timeframe and several no-cost extensions have been granted.

The main reasons for no-cost extensions have been disruption to project implementation due to political instability (e.g. Kenya after the elections in 2007), natural disasters (e.g. ﬂ oods in Bihar, India, in 2008) and administrative delays in country. Research projects requiring authorization from Health Departments or Ethical Review Committees took longer than anticipated to get underway once approved for SAAF funding.

The Board therefore agreed that projects should be offered an implementation period of up to three years. To identify delays in implementation, a six-month ﬁ nancial reporting system was instituted to improve monitoring while maintaining a ‘light-touch’ approach. 24 Safe Abortion Action Fund: Interim report – July 2010

4 Progress and lessons to date SAAF grantees have reported positive and encouraging results worldwide. SAAF has demonstrated the value of supporting ‘high-risk’ small organizations and has proven itself as an important instrument for funding abortion-related advocacy and services.

For some organizations, SAAF is unique in being often the only abortion-speciﬁ c fund to which they can apply, and grantees have shown great commitment to the fund. Many went beyond the reporting requirements to send additional updates and extra information on project progress. The regional grantee meetings have also been important for sharing lessons among grantees.

4·1 The 2009 external evaluation: why SAAF is needed In order to reinforce and support the encouraging results obtained after the ﬁ rst 18 months of implementation, SAAF commissioned an external evaluation of the fund. HLSP assessed whether SAAF-funded projects have been successful in reaching their objectives and are contributing to SAAF’s purpose. Nine projects have been evaluated in four countries (Bangladesh, Ethiopia, Mexico and South Africa), representing 20 per cent of the projects implemented.

DFID commissioned a second review on behalf of the donors to evaluate the relevance, effectiveness and efﬁ ciency of the SAAF and IPPF’s administration of the fund.

The ﬁ ndings of these two components were presented in a consolidated report26. Below are the highlights of some of the main ﬁ ndings and conclusions of the evaluation:

■ SAAF helped to legitimize abortion by visibly funding projects on an international scale

■ It has the potential to play a bigger role in international advocacy for safe abortion and could be an important leader in legitimizing funding for safe abortion

■ It can fund the smaller NGOs and encourage joint working

■ IPPF has managed SAAF efﬁ ciently and effectively, with only a few easy-to-resolve start-up issues

■ External evaluations (of nine projects) found that the projects were contextually relevant and addressing a real need of target beneﬁ ciaries.

■ Most projects reached the majority of their objectives, most of which will be sustained after SAAF funding ends.

■ New types of NGOs working on safe abortion were funded and new people were empowered. These encouraging and positive ﬁ ndings fed into the following recommendation:

Overall recommendation of the 2009 external evaluation

The SAAF should continue to be funded in the short to medium term, it should be a global level fund and should continue to be managed by IPPF and apply the lessons learned in the ﬁ rst two years of the grant mechanism.

The evaluators also proposed detailed recommendations which have been analysed and agreed by the Board in order to improve the functioning of the fund in the future rounds.

26 Safe Abortion Action Fund (SAAF) Evaluation Consolidated Report, Carol Bradford and Georgia Taylor, HLSP, July 2009. Safe Abortion Action Fund: Interim report – July 2010 25

4·2 The regional grantees meetings: strengthening networks of abortion champions One of the main outcomes of this fi rst phase of implementation has indisputably been the ‘legitimizing’ factor that the SAAF brought to the grantees and their partners. For the fi rst time, a global fund was set-up to work specifi cally on abortion and this in itself had a huge impact. As stated by the external evaluation:

“The SAAF helped to legitimize abortion by visibly funding projects on an international scale. It made the issue of abortion ‘less of a dirty word’ and it gave people courage to work on a controversial topic (“a jolt of energy as well as a jolt of funding”).”

This achievement has been extremely important for most of the grantees, who felt supported and free to implement the activities they thought were needed for the women and the communities they work with.

In order to build on this strong feeling and to summarize the main achievements, strategies and lessons leant from the grantees; four regional grantees fora were organized.27 Linked to existing regional SRH events or conferences (for cost-effectiveness reasons) and chaired by SAAF Board members, these meetings have been a unique opportunity for both the grantees and the Board members to learn more about all the achievements, the national contexts and also to create a momentum for collaboration and support. Moreover, the grantees have been very proactive in making recommendations for future rounds of funding, should support become available.

4·3 Lessons learnt for future grants Every project learnt some lessons and highlighted important issues from their own experiences or contexts. Below are some key points (although not an exhaustive list) which will contribute to improving the fund in its next phases.

Flexibility: an important and unique feature

The ﬂ exibility of the fund and its light touch administration has been cited by almost all the grantees as a real advantage that has helped them to implement their activities, especially the advocacy ones, appropriately and effectively. Rapid decision-making and responsiveness, particularly when grantees are working in constantly changing environments, has enabled grantees to reorient their activities and amend a budget line as necessary.

Projects would beneﬁ t from a longer timeframe

Most of the organizations have raised concerns about the length of the projects. The research projects, in particular, have needed no-cost extensions, but this issue applies to advocacy and services delivery projects as well. The sustainability of the projects would be greater with more time to implement the activities.

The service statistics and/or processes should systematically be reported

It was interesting to notice that not all the organizations reported or classiﬁ ed the services they provide in the same way, making it difﬁ cult to determine whether the services could all labelled as comprehensive abortion care. In order for SAAF projects to deliver a uniformly high standard of care in service delivery, there needs to be clarity – both on the part of the SAAF administration and on the part of the grantee – on what SAAF expects and what is acceptable.

27 Bangkok (23-34 January 2010), Addis-Ababa (14-15 February 2010), Lima (23-24 February 2010) and Lisbon (5 March 2010). 26 Safe Abortion Action Fund: Interim report – July 2010

The guidelines for future calls for proposals should be amended accordingly, while the indicators for service delivery should also be clearly explained. Moreover, a revised logical framework developed in partnership with the donors will be used in the future to ensure better monitoring and to facilitate reporting (see annex 7).

Make family planning an integral part of post-abortion care

As part of high-quality care, post-abortion family planning should be a systematic and integral component of the services. As this specifi c issue was not part of the indicator requirements during the fi rst round, it is diffi cult to measure its incidence within the projects. However, some of the projects which reported on it did not achieve great results with regard to post-abortion care. This is an important issue which needs to be addressed for the future rounds.

Smaller organizations are performing well

As part of the risk-taking strategy, some organizations received funding which represented a large percentage of their overall organization budget. Such a scenario could have proved to be unsuccessful as some of the organizations might not have been able to manage such signiﬁ cant budgets. However, it was reassuring and exciting to see that the smaller organizations delivered their planned activities just as effectively as the larger ones. Furthermore, their respect for deadlines and the level of attention in their reports tended to be higher than for organizations for which SAAF funding was a small fraction of their overall budget.

This ﬁ rst round proved that when supported and encouraged, small, local organizations can deliver good outcomes.

Rethinking the technical assistance

In its guidelines and application templates, the secretariat stated the possibility for the grantees to access technical assistance funded by SAAF from a pool of experts (the Technical Review Panel). However this component of the fund was under-used by the grantees which used in-country technical assistance.

SAAF might therefore imagine a different role and process to provide technical assistance in the future, including doing more via internet and conference calls.

We need to capitalize on the momentum of the ﬁ rst round

The enthusiasm and dedication of the grantees really reached their pinnacle during the regional grantees’ meetings. Giving the grantees the opportunity to exchange ideas and results, to discuss approaches and methodologies and to also share their challenges in working on such a sensitive issue was very powerful. It gave them a real sense of belonging and they felt proud to be part of such an initiative. The African meeting was particularly dynamic and grantees are still communicating about various topics. The meetings were chaired by Board members which also added to the cohesion of the Fund, bringing together all the main actors. It is important that this momentum be kept up and used for further rounds of projects, to create a network of champions made of past and future grantees.

A grantees forum will facilitate knowledge exchange on a regular basis

One of the rather strong recommendations coming out of the regional grantees meetings, in addition to keep the momentum, was to dedicate a space for the grantees to share their experiences, lessons learnt as well as technical tools. The idea of having a SAAF-dedicated website emerged as a potential way of addressing this issue.

All these issues have been discussed by the Board and the necessary amendments are being made to the logical framework, application guidelines and report templates. The criteria for selection are also being amended in order to emphasise certain aspects of project design. Safe Abortion Action Fund: Interim report – July 2010 27

5 On-going project activities The majority of the projects funded during the ﬁ rst phase have now ended. However, SAAF is still an active fund in transition.

5·1 The African DFID projects The additional £1,000,000 (US$1,500,000) funding from DFID dedicated to Africa is close to being fully allocated. Two projects started in September 2008, in Western Kenya and Francophone Western Africa (regional project covering Benin, Burkina Faso, Mali and Senegal) and will be ending in the next several months.

Four other projects started in early 2009 in various parts of the continent: Nigeria, Sudan, Uganda and a regional project covering Africa. Results of these different projects have been discussed in the previous sections as part of the ﬁ rst phase.

5·2 The NORAD extended projects The Norwegian Agency for Development Cooperation (NORAD) sustained its support to the SAAF by committing NKR 10,000,000 (US$1,500,000) at the end of 2009 to support some projects for an extra year. The funding includes technical assistance and an impact evaluation component.

Working within a very short timeframe, SAAF ensured that the selection process for these extended projects included both the recommendations of the Board and requirements of the donors. Thus, the main criteria for project selection were as follows:

■ Projects that performed well over the previous two years and had the potential to either scale-up or strengthen their results

■ Projects based in African and other priority countries

■ Small grassroots organizations

■ Countries with high maternal mortality and/or a high rate of sexual and reproductive morbidity among women28

■ Timeliness (sense that changes are possible within the society)

■ Countries where the legal and policy environment around abortion is very restrictive The proposed list of projects for extension is available in Annexe 6.

28 A measure of survival, calculating women’s sexual and reproductive risk, PAI report card 2007. http://www. populationaction.org/Publications/Reports/Measure_of_Survival/mos.pdf 28 Safe Abortion Action Fund: Interim report – July 2010

6 SAAF is evolving into a better structured fund SAAF is evolving to adapt to the needs of the grantees and towards even more efﬁ cient processes.

6·1 A pro-active Board The SAAF Board has decided to implement some changes, with regard to its composition and its role, in order to be more effective. The Board will recruit additional members who will be expected to be fully committed to their role and bring speciﬁ c technical expertise and geographical representation. The original Board was established in order to include major players and relevant activists, to ensure that the fund engaged many different actors and stakeholders. But after the ﬁ rst phase, it is important to achieve a balance of technical expertise and interested parties.

SAAF is also encouraging Board members to get involved in promoting SAAF and disseminating lessons learnt. This is essential to good advocacy and fundraising, and to the sustainability of SAAF.

6·2 SAAF at the Women Deliver Conference As part of efforts to promote the fund, the SAAF was present at the Women Deliver Conference in Washington DC, on 7-9 June 2010. The Fund was well advertised at the conference in many different ways: a dedicated session, the participation at a press conference and the participation of several SAAF grantees. A four page brochure was also circulated to highlight the main achievements of the Fund.

The SAAF panel was chaired by Joar Svanemyr from NORAD, representing the donors, with Kelly Culwell, IPPF Abortion Senior Adviser and a SAAF board member presenting the history, processes and achievements of the fund to date. Grantees from Kenya, Uruguay and Thailand then shared their experiences in implementing a SAAF grant, their achievements, challenges and lessons of working with this innovative fund. The panel was a great illustration of the diversity of the SAAF projects, in terms of contexts and activities, and the grantees were very good advocates for their abortion activities:

■ In collaboration with the Ministry of Health, KMET is promoting and providing Post- Abortion Care in rural areas of Western Kenya. Its tools to reach the most vulnerable women: working with an army of community based health workers and involving men.

■ In the course for the presidential election in Uruguay in 2009, MYSU did implement an innovative advocacy strategy to bring the abortion issue in the electoral debate. Involving young people and using the latest communication technology were decisive for this project.

■ On the Thai-Burma border town of Mae Sot, Burmese refugees could not access post- abortion care and other SRH services in the local public hospital because of cultural and language barriers. This pilot project which involved bi-cultural workers has started to improve the care for both Thai and Burmese women. Following the panel, the grantees were approached by several journalists/ contacts to discuss issues such as male involvement, countries implementing SAAF in Africa, types on programs in Africa and any challenges with the anti-choice movements.

Monica Oguttu represented the SAAF grantees in a joint press conference organised between Ipas, IPPF, MSI and SAAF on the funding situation for abortion: how abortion is a grossly neglected and underfunded area of global health; how we cannot meet MDG5 without investing in safe abortion care and how a little investment goes a long way (SAAF example). Safe Abortion Action Fund: Interim report – July 2010 29

Among the representatives of the main NGO players in the abortion ﬁ eld, Monica Oguttu talked about her experience in Kenya as a SAAF grantee. She highlighted the importance of supporting local organizations and investing directly in the communities and explained that the SAAF ﬂ exibility allowed this type of actions.

Finally, several SAAF grantees were present at the conference and some presented their SAAF-funded activities and advertised the fund during different abortion sessions. Leonel Briozzo, former Director of the organisation Iniciativas Sanitarias (Uruguay) and currently Director of Strategic Programming, Ministry of Health, presented the harm reduction model which he pioneered. SAAF has been supporting Iniciativas Sanitarias and the Fund was advertised during the presentation. Dan Grossman, Senior Associate, Ibis Reproductive Health, presented the results of a SAAF funded operation research in South Africa on management of second trimester abortions in the Western Cape Province.

The participation at Women Deliver was a good opportunity to advertise SAAF at a global level and demonstrated how grants to local organisations can be a very good complement to other types of funding mechanisms to increase access to safe abortion.

6·3 A new round of funding for South Asia Thanks to the recent DFID funding of £900,000 dedicated to South Asia, a new round of funding will be soon put in place, incorporating the recommendations from the evaluators, from the grantees and from the lessons learnt during the ﬁ rst phase of implementation. This new round will focus on more innovative and strategic projects which will emphasise collaboration with local organizations. Focus on the most vulnerable women as well as on post-abortion family planning will also be strongly encouraged. 30 Safe Abortion Action Fund: Interim report – July 2010

7 Conclusions and recommendations After its ﬁ rst phase of implementation, the SAAF has proven to be a very successful fund. Grantees worldwide have realized great achievements over a short period of time and the ongoing projects are implementing promising activities.

What was originally designed to be ‘one-off’ funding has since become a unique and recognized funding mechanism dedicated to abortion. Thanks to the SAAF, new actors have emerged or have been strengthened in their abortion-related activities and they are part of a cohesive and supportive network of organizations working on one of the most sensitive issues in the ﬁ eld of sexual and reproductive health and rights.

The SAAF is different because it reaches in-country organizations which might not otherwise receive any funding to work on abortion. Without SAAF, more than 300,000 women worldwide would not have benefi ted abortion services delivered by 5,500 trained providers through 49 new services. This ‘risk-taking’ Fund has demonstrated that when committed organizations, even with limited experience in abortion, are given the opportunity and the fl exibility to implement activities within the communities, they can achieve great results. The fl exibility of SAAF is vital for advocacy activities which often require quick adaptations to the changing environments, and also to the research projects which have diffi cult access to funding.

SAAF grantees have tried and often succeeded in pooling their resources and working together to achieve their aims, providing mutual support to each other. This has strengthened partnerships and resulted in closer collaboration among many NGOs. The regional grantees meetings in early 2010 also enabled grantees to increase collaboration with others. In a short period of time, SAAF has effectively strengthened, legitimized and promoted the work of networks working on safe abortion.

Building on the momentum of this ﬁ rst round is important to keep abortion, a chronically under-funded issue, in the spotlight and to make sure that organizations worldwide can work to reduce maternal mortality and ensure that women’s rights are respected. In 2000, 189 UN member states pledged to reduce maternal mortality by 75 per cent by 2015, and it is obvious that this goal will not be achieved if the issue of abortion is not addressed. SAAF is well placed to be a key part of this effort.

7·1 Recommendations ■ The replenishment of SAAF by both current and new donors is a priority. Ensuring the continuity of certain projects and opening the fund to new projects is critical to reduce mortality and morbidity associated with unsafe abortion.

■ Donors should recognize the toll of unsafe abortion in regions such as Latin America and Eastern Europe and ensure that organizations working in these areas are not excluded from SAAF.

■ The future round of funding should maintain the ﬂ exible, ‘light-touch’ approach which worked so well in the ﬁ rst round, but it is also important to prioritize and support initiatives which will be innovative, strategic and sustainable.

■ SAAF should provide technical assistance through innovative channels (e.g. use of a website) to optimize the potential of limited funding.

■ Service delivery projects should place greater emphasis on the provision of post- abortion family planning.

■ Grantees should use a new logical framework to improve monitoring and evaluation, and to improve the reporting of project achievements. Safe Abortion Action Fund: Interim report – July 2010 31

32 Safe Abortion Action Fund: Interim report – July 2010

8 Annexes

8·1 Financial statement at 31 December 2009

INCOME US $

Contributions to the Fund 14,698,178.34 Government of Denmark 1,533,268.35 Government of Norway 2,971,274.09 Government of Sweden 2,882,969.81 Government of Switzerland 59,571.09 Government of United Kingdom 7,251,095.00 Interest Earned 293,093.44 Total Contributions to the Fund 14,991,271.78

EXPENDITURE

Grants to implementing Organizations 11,762,335.00 First round of projects 10,531,816.00 Africa projects 1,230,519.00 Fund Operating Costs/ Board Meetings 401,017.94 IPPF Review & Support 203,499.37 Board meetings 20,942.62 SAAF Audit 5,057.93 SAAF Print Materials 15,284.32 Bank Charges 16,371.52 External Evaluation 2009 139,862.18 Total Grants & Expenditures 12,163,352.94

Closing Balance December 31 2009 2,827,918.84 Funds Committed (Grants) 2,102,329.00 Grants committed ﬁ rst round 441,096.00 Grants committed Africa 331,233.00 Grants committed Extension NORAD 1,330,000.00 Technical assistance 162,500.00

Board Meetings 10,100.00

Final Evaluation (Africa projects 2010) 100,000.00

Impact assessment study 110,000.00

Publication 30,000.00

Audit 6,000.00

Anticipated Fund Operating/Review Costs 154,000.00

Regional meetings 2010 62,000.00

Women Deliver 15,000.00

BALANCE OF FUND AT DECEMBER 31, 2009 after Commitments 75,989.84 Safe Abortion Action Fund: Interim report – July 2010 33

8·2 SAAF Board members as of 31 March 2010 Over the last reporting period, several Board members stepped down and have been replaced. The current composition of the Board is as follows:

■ John Worley Global Advisor: Public Policy and acting Director of Operations , IPPF (Co- Chair)

■ Liz Maguire President and CEO, IPAS (Co-Chair)

■ Joar Svanemyr Senior Adviser, Global Health and AIDS Department, NORAD

■ Nel Druce Health Adviser Sexual and Reproductive Health, AIDS and Reproductive Health Team Human Development Group, DFID

■ Kelly Culwell Senior Adviser Abortion, IPPF

■ Monica Uguttu Executive Director KMET, Kenya

■ Yasmin Ahmed Senior Regional Director – Asia, Middle East, Eastern Europe, Marie Stopes International.

8·3 Technical Review Panel members During its ﬁ rst meeting in January 2007, the Board appointed a Technical Review Panel (TRP), made up of 15 experts from different countries and with diverse skills and expertise in the ﬁ eld of safe abortion, who all gave their time free of charge:

■ Anibal Eusebia FAUNDES (Brazil)

■ Ann FUREDI (UK)

■ Daniel GROSSMAN (USA)

■ Selma HAJRI (Tunisia)

■ Mary KHACHIKYAN (Armenia)

■ Frances KISSLING (USA)

■ Patricia LARUE (Canada)

■ Maria Consuelo MEJIA PIÑEROS (Mexico)

■ Roland MHLANGA (South Africa)

■ Susheela SINGH (Guttmacher Institute)

■ Margaret SPARROW (New Zealand)

■ Joar SVANEMYR (Norway)

■ Marcel VEKEMANS (IPPF)

■ Cristina VILLAREAL VELASQUEZ (Colombia)

■ Carine VRANCKEN (Belgium) 34 Safe Abortion Action Fund: Interim report – July 2010

8·4 List of the funded projects 2007-2009

Country Organization Project Title

Albania Albanian Centre for Population and The creation of an improved environment for women from Development (ACPD) vulnerable groups to exercise their rights for safe abortion in Albania through the support of governmental institutions Argentina Católicas por el derecho a decidir (CDD) Acceso al aborto legal, seguro y gratuito Córdoba Argentina Centro de Estudios de Estado y Sociedad Hacia el acceso al aborto no punible en la Argentina (CEDES) Argentina Centro de Estudios Sociales y Políticos para Acceso al aborto seguro y a la anticoncepción de las mujeres el Desarrollo Humano (CESPPEDH) del Partido de San Miguel Bangladesh Bangladesh Women’s Health Coalition Reduction of Unsafe Abortion in Rural Bangladesh (BWHC) Bolivia Ipas Bolivia Improving Sexual Violence Response and Abortion Care in Bolivia Bolivia Católicas por el derecho a decidir Incremento el acceso de las mujeres al aborto legal y seguro en Bolivia Brazil Centre for Research in reproductive Health Overcoming barriers to provide legal abortion in Brazilian Campinas (CEMICAMP) Hospitals Brazil Feminist Center for Studies and Advisory Defence and promotion of legal abortion in the Brazilian Services (CFEMEA) National Congress Brazil Cunha Coletivo Feminista Advocacy Actions for Safe Abortion and for changing opinion Burkina Faso Institut Supérieur des Sciences de la Avortements et santé des femmes au Burkina Faso Population Cambodia, China, Marie Stopes International Vietnam To improve demand, access and safety of medical abortion in Mongolia, Vietnam Viet Nam, Cambodia, Mongolia and China Chile Red de Salud de las Mujeres Construcción de redes de ciudadanas y ciudadanos y Latinoamericanas y del Caribe (RSMLAC) generación de condiciones en el espacio público para una discusión socialmente validada hacia la despenalización del aborto terapéutico Chile Asociación Chilena para la protección de la Generación de una agenda publica para la despenalización Familia (APROFA) del aborto por indicación médica en Chile: formación de capacidades para una acción sostenible de instituciones privadas de interés público en aborto terapéutico Colombia Fundación Educación para la Salud Manejo integral del embarazo indeseado y el aborto seguro en reproductiva (ESAR) Latinoamérica Colombia Oriéntame Fundación Unidad de Orientación y Asistencia Materna – Oriéntame Costa Rica Asociación Demográfi ca Costarricense Estimación del Aborto Inducido en Costa Rica (ADC) Côte d’Ivoire Association Ivoirienne de Bien-être Familial Soins après avortements (SAA) dans les activités de Santé (AIBEF) Sexuelle et de la Reproduction de l’AIBEF Ethiopia Marie Stopes International Ethiopia Strengthening access to safe abortion services within MSIE’s Comprehensive Package of Sexual Reproductive Health services Ghana Pathfi nder International Ghana Saving Women’s Lives: Increasing Access to and Quality of Safe Abortion Services in Northern and Upper East Regions of Ghana India Pathfi nder International India Access to Safe Abortion in Bihar, India Kazakhstan Kazakhstan association on Sexual and Only wanted pregnancies reproductive Health (KMPA) Kenya Planned Parenthood Federation of America- Enhancing access to safe abortion and post abortion care International (PPFAI) services in Kenya Kyrgyzstan Reproductive Health Alliance Kyrgyzstan Safe Abortion and Counselling Centre (RHAK) Safe Abortion Action Fund: Interim report – July 2010 35

Lesotho Lesotho Planned Parenthood Association Rights-Based Approach to Safe Motherhood (LPPA) Mexico Comunicación, Intercambio y Desarrollo Acceso a servicios de salud reproductiva de calidad y aborto Humano en América Latina (CIDHAL) seguro para mujeres del estado de Morelos Mexico Grupo de Información en reproducción Building a National Pro-Choice Alliance in Mexico: Improving Elegida (GIRE) conditions for women’s access to safe and legal abortion in two Mexican states Mexico Centro Integral de Atención a la Pareja Llevando servicios integrales de salud reproductiva y aborto a (CIPA) las mujeres jóvenes y mujeres pobres de zonas marginadas de la ciudad de México Mexico Fundación Mexicana para la Planifi cación Promoviendo la disminución del aborto en condiciones de Familiar (Mexfam) riesgo en áreas rurales y urbanas marginadas en donde operan los programas comunitarios de Mexfam, a través de las promotoras comunitarias de salud Mozambique Pathfi nder International Mozambique Increasing Access to Safe Abortion Services in Gaza Province Nepal Centre for Research on Environment Health Advocacy and Behavior Change Intervention (ABCI) Project : and Population Activities (CREHPA) Enabling rural and marginalized women to access safe abortion care in Nepal Nepal Sunaulo Parivar Nepal (MSI) Improving Awareness and Increasing Access to Safe Abortion for Adolescents and Youth in Nepal Nigeria Women’s Health and Action Research Expanding Access to Safe Abortion Care for Young, Under- Centre (WHARC) served and Vulnerable Women in the Niger-Delta region of Nigeria through Private Practitioners initiative Peru Centro de la Mujer Peruana Flora Tristán Abogacía por el derecho a decidir: acceso al aborto legal y seguro Philippines General Assembly Binding Women for Abortion in the Philippines: Contexts, Issues and Prospects Reforms, Integrity, Equality, leadership and Toward a Culture of Safe Abortion and Promotion of Action (GABRIELA) Reproductive Health Rights South Africa Mosaic Training, Service and Healing centre Mosaic Integrated SRH Project for Women South Africa Pathfi nder International South Africa Bringing Safe Abortion Services to the Poor, Young and HIV- Positive of Khayelitsha, South Africa South Africa Ibis Reproductive Health Improving access to high quality second trimester termination services in the Western Cape Province of South Africa Sudan Planned Parenthood Federation of America- Increasing access to safe abortion/post abortion care services in International (PPFAI) Khartoum Thailand Mae Tao Clinic Cross-cultural post-abortion care on the Thai-Burma border: Testing improved care in hospital Thailand Women’s Health and Reproductive Rights Increase access to Safe Legal Abortion for young, underserved Foundation of Thailand and vulnerable women in Thailand Uganda Marie Stopes International Uganda Reducing Maternal Mortality in Uganda to poor and underserved people of reproductive age in the districts of Apac, Masindi, Nakasongora, Hoima, Kiboga and Soroti Uruguay Servicio de Atención Integral de Iniciativas Iniciativas Sanitarias – Sociedad Civil Sanitarias Contra el Aborto Provocado en Condiciones de Riesgo Uruguay Advocacy Campaign to guarantee the Mujer y Salud en Uruguay (MYSU) rights of women to decide on abortion in Uruguay 36 Safe Abortion Action Fund: Interim report – July 2010

8·5 List of the funded projects in Africa for the period 2008-2011 (DFID extra funding for Africa)

Country Organization Project Title Africa International Consortium Promoting access to medical abortion in the context of safe abortion in Africa on medical Abortion 2009-2010 (ICMA) Benin, Mali, Burkina Ipas Africa Alliance Expanding access to safe abortion in Benin, Burkina Faso, Mali and Senegal. Faso , Senegal Kenya Kisumu Medical and Expanding access to safe abortion through a network of PAC providers in Education Trust (KMET) western Kenya Nigeria Planned Parenthood Expanding Access to safe abortion and post-abortion care (PAC) services in Federation of America- Nigeria International (PPFAI) Uganda Reproductive Health Saving Women’s Lives: Tearing Down the Barriers to Unsafe Abortion in Uganda Uganda (RHU) Sudan Planned Parenthood Ensuring access to comprehensive reproductive health care and support for Federation of America- displaced women in Darfur International (PPFAI)

8·6 List of the extended projects 2010 (NORAD funding)

Country Organization Project Title Bangladesh Bangladesh Women’s Health Coalition Reduction of Unsafe Abortion in Rural Bangladesh (BWHC) Brazil Feminist Center for Studies and Advisory Defence and promotion of legal abortion in the Brazilian Services (CFEMEA) National Congress Chile Red de Salud de las Mujeres Construcción de redes de ciudadanas y ciudadanos y Latinoamericanas y del Caribe (RSMLAC) generación de condiciones en el espacio público para una discusión socialmente validada hacia la despenalización del aborto terapéutico Ghana Pathfi nder International Ghana Saving Women’s Lives: Increasing Access to and Quality of Safe Abortion Services in Northern and Upper East Regions of Ghana Kenya Family Health Option Kenya Increasing Access to Comprehensive Abortion Care Services Mozambique Pathfi nder International Mozambique Increasing Access to Safe Abortion Services in Gaza Province Nepal Centre for Research on Environment Health Advocacy and Behavior Change Intervention (ABCI) Project : and Population Activities (CREHPA) Enabling rural and marginalized women to access safe abortion care in Nepal Nigeria Women’s Health and Action Research Expanding Access to Safe Abortion Care for Young, Under- Centre (WHARC) served and Vulnerable Women in the Niger-Delta region of Nigeria through Private Practitioners initiative Philippines General Assembly Binding Women for Abortion in the Philippines: Contexts, Issues and Prospects Reforms, Integrity, Equality, leadership and Toward a Culture of Safe Abortion and Promotion of Action (GABRIELA) Reproductive Health Rights South Africa Mosaic Training, Service and Healing centre Mosaic Integrated SRH Project for Women South Africa Pathfi nder International South Africa Replicating Pathfi nder’s Integrated Youth-Friendly Abortion Services Model in the Northern Cape, South Africa 8·7 SAAF logical framework for the next round of funding This new logical framework was developed in partnership with donors based on the lessons learnt from the fi rst round of funding. It should signifi cantly improve the monitoring of the program and facilitate reporting. Because we do not know beforehand what type of projects will be selected (advocacy, service delivery or research) it is not possible to indicate beforehand the targets and objective for the next round.

PROJECT TITLE Safe Abortion Action Fund 2008 – 2013

GOAL Indicator Baseline 2008 Milestone 1 Milestone 2 Target 2012

Reduced maternal mortality % of maternal deaths due Africa, Asia and Latin America n/a n/a through increased access to to unsafe abortion in SAAF Source safe quality abortion and post funded regions WHO – Guttmacher unsafe abortion estimates 2008 (to be published mid 2010) abortion care, and prevention Data collected every 4-5 years of further unwanted pregnancies, for poor and marginalised women Safe Abortion Action Fund: Interim report – report Interim Fund: Action Abortion Safe July 2010

37 38

Safe Abortion Action Fund: Interim report – report Interim Fund: Action Abortion Safe PURPOSE Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 Assumptions

NGOs funded to Number of countries 0 Round 1 – 10 countries/ Round 2 – x countries/ Round 2 to start Round 3 Absence of natural make innovative and where increased public localities (% of countries localities disasters or security strategic contributions visibility for abortion or where projects funded) (% countries where threats/conﬂ ict in to supportive legal and steps taken to improve projects funded) countries/localities where policy frameworks and national, federal or local Source projects funded improved service delivery legislation Project reports, documentation related to parliamentary procedure, press coverage, Countdown 2015 reports (Round 1 – 50 two (69 countries) to three year projects funded) Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013

Number of countries 0 Round 1 – 10 countries/ Round 2 – x countries/ Round 2 ongoing Round July 2010 where national/local localities (% of countries localities (% of countries 3 policy framework, where projects funded) where projects funded) guidelines and protocols Source developed and/or National/local ofﬁ cial documentation (policy, guidelines, protocols) implemented Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 Number of service 0 N/a Round 2 Round 2 ongoing agreements/partnerships Source with government Projects reports and agreements authorities OUTPUT 1 Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 Assumptions Safe abortion legislation, Number of advocacy 0 200 Round 2 National institutional/ policy and services networks/coalitions/ Source legal framework permits are improved through groupings created or NGO advocacy activities Project reports, network etc minutes, media coverage effective advocacy efforts maintained at regional/ by projects national/local levels Round 1 – 12 projects Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 advocacy focus; 50 Number of countries 0n/aRound 2 projects with some where NGOs achieve including advocacy Source shared positions/ Project reports, media statements and coverage consensus on approach to abortion law or policy reform IMPACT WEIGHTING Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 20% Number of media 0n/aRound 2 reports/interviews Source RISK RATING covering abortion issues Project reports, media reports Medium Safe Abortion Action Fund: Interim report – report Interim Fund: Action Abortion Safe July 2010

39 40

Safe Abortion Action Fund: Interim report – report Interim Fund: Action Abortion Safe OUTPUT 2 Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 Assumptions Reproductive health Number of studies 0 At least 10 Round 2 National ethical review policy, legislation and conducted Source committees approve service delivery informed research protocols in Project reports, study documentation by research into abortion timely manner at countries or local level Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 Round 1 – 4 projects Number of reports/ 0n/aRound 2 with research focus; publications in media, Source some other projects conference presentations included research Media reports, copies of published article, conference posters etc IMPACT WEIGHTING Indicator Baseline2007 Milestone 2009 Milestone 2011 Target 2013 20% Number of ofﬁ cial 0n/aRound 2 July 2010 documents citing/ Source RISK RATING including research results Ofﬁ cial documents High (policy, guidelines etc)

OUTPUT 3 Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 Assumptions Increased access to Number of women 0 Approx 300,000 women Total number CAC of Political and policy abortion and post receiving safe abortion received services, Round which x MA PAC Number environment abortion care services care or PAC (per number 1 49 new abortion of new/improved Staff security issues (comprehensive abortion of new/improved facilities in Round 1 (six abortion facilities Effective national care) facilities) in 2009) commodity supply Round 1 – 10 projects Source system in place with service delivery Project and facility reports focus; 24 other projects including service delivery Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 Proportion of women 0 n/a Round 2 Round 2 in receipt of services Source adopting post abortion Project and facility reports family planning IMPACT WEIGHTING Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 20% Number of staff trained 0MVA 5200Round 2 Round 2 in new abortion MA 300 technologies and Source RISK RATING techniques (MVA and Project and facility reports Medium MA) OUTPUT 4 Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 Assumptions SAAF grants delivered % of SAAF funding 0 96% disbursed approx Round 2 Round 2 IPPF continues to host and managed in disbursed to and 80% expended SAAF accordance with agreed expended by projects Source standards Project reports and accounts, sample of project audits Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 % six month ﬁ nancial 0 75% Financial reports Round 2 Round 2 and annual narrative 75% Narrative reports reports received on time Source (within 2 weeks) SAAF management records IMPACT WEIGHTING Indicator Baseline 2007 Milestone 2009 Milestone 2011 Target 2013 40% % SAAF funded projects 0 N/a Round 2 Round 2 promote SAAF objectives Source RISK RATING (innovative, strategic, TRP, Board, SAAF Sec reports, project reports Low sustainable) Safe Abortion Action Fund: Interim report – report Interim Fund: Action Abortion Safe July 2010

41 Safe Abortion Action Fund Second Interim report July 2010

Published in The Safe Abortion Action Fund (SAAF) is a multi-donor funding mechanism that August 2010 supports in-country initiatives for increasing access to safe abortion services. It provides small ﬂ exible grants to non-governmental organizations (NGOs) to do policy Contact the advocacy, innovations in service delivery and research. SAAF focuses on the needs Safe Abortion Action Fund of the marginalized and most vulnerable women and girls, within a comprehensive 4 Newhams Row package of sexual and reproductive health services, including post-abortion family London SE1 3UZ planning. United Kingdom Hosted by the International Planned Parenthood Federation (IPPF), SAAF has a tel governing board made up of donors, activists and representatives of international +44 (0)20 7939 8254 NGOs: it is a collaboration of experienced actors to support new grassroots efforts in abortion. email [email protected] This interim report covers the period January 2009 to July 2010 and highlights the achievements, impacts and lessons from projects supported by the Safe Abortion Action Fund (SAAF).