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Principal Investigator: Tamara Fetters, Ipas

Purpose

The study will describe and estimate the burden of all postabortion complications, particularly severe complications, near-miss complications and deaths, and factors associated with severe morbidity among women admitted for postabortion care (PAC) in four Médecins Sans Frontières (MSF) facilities in Africa.

Expected Outcomes

The research is expected to generate evidence highlighting the magnitude and severity of abortion-related complications and will provide extensive details on the trajectories that led women to experience severe and near-miss abortion-related complications in four African humanitarian settings. The research will highlight the challenges and barriers to health care experienced by women seeking PAC in these settings.

Seed Funding Case study: Q&A with Tamara Fetters, Principal Investigator with Ipas

What were the details of the Seed Funding awarded?

Seed Funding Grant:  £5,242
Start date:  12th October 2017  End date:  31st December 2017
Grant recipient: Ipas   Partners: MSF & Guttmacher Institute
Activity: Partnership workshop held in Paris

How did you use seed funding?

Research team members from Ipas, the Guttmacher Institute and Médecins Sans Frontières (MSF) met in Paris at the end of November 2017 for a two-day partnership workshop. We were able to bring together core members of the research consortium to discuss the proposal in more detail.

We have 8 senior, seasoned research staff from each of the three organizations included in the study, as this will be the first research study of its kind, and will be on a sensitive topic in fragile conflict-affected and challenging settings. We have included high-level staff from each organization to ensure that the research will be of the highest quality; that the findings will be reported effectively; and that research uptake will be taken seriously in the humanitarian sector.

Our consortium includes clinician-researchers, social scientists and epidemiologists from each of our organizations to bring broad high-level skills to this research.  However, a multi-disciplinary team requires more time to share expertise and discuss methods and ensure that each voice is heard and new ideas are not overlooked.  The seed funding gave time to the epidemiologists to discuss sampling and data collection.  It gave time to the social scientists to discuss interviewing techniques and content analysis.  We had time to discuss inclusion and exclusion criteria for women with a wider range of complications of abortion, pregnancy and miscarriage.  All of these details helped us learn as a team and find a shared vision for the study, in addition to creating a stronger application.

The flexibility of the Seed Funding allowed us to select the final workshop venue and dates once the grant was awarded. By optimising our travel arrangements, we were able to involve more people from the humanitarian organizations by meeting at their headquarters. This allowed us to give short in-service presentations to a larger group of the staff and to have a more developed exchange of information and capacity-building on the research methodologies among the core team than originally anticipated.

What benefits did you get from seed funding?

The meeting was vital as it allowed us to review, revise and complete the proposal application. To maximize our time together, we also worked to proactively develop the research protocol. We held a discussion about how we might sustain our momentum to move this research to the field as quickly as possible and our study team continues to be in close contact sharing new and related research and protocols.

Convening this meeting with several different MSF researchers and technical experts gave us a broad view across their different programs and the time we needed to discuss inclusion and exclusion criteria for study sites. The workshop also allowed us to confirm our study investigators, review the methodology, examine the conditions and locations for the multi-country site selection and discuss implementation with the technical experts closest to the MSF field sites.

Our implementation partner (MSF) has a very decentralized global structure.  This in-person meeting gave them time to explain their organization to the other partners.  This understanding was crucial for developing our methodology and ensuring that our research would serve MSF as well as the broader research community.  We were also able to think through the time involved and the tools that could help our MSF investigators navigate obtaining their organizational permissions at the field and headquarters levels.

We met as a team and used the two days to gather data on the potential sites.  We developed inclusion criteria including, the collected caseload data, our perceptions on the severity and likely extent of unsafe abortion in the site, as well as more qualitative measures such as the Operations Center affiliated with the field site and the presence of an SRH and abortion task force member aiding the team.  We also discussed the generalizability of our country selection and whether a more international multi-country approach or a multi-country selection based in Africa would generate more persuasive evidence and weighed this against our generalizability concerns.

How do you think the seed fund activities will help you deliver the study now you have secured funding?

Seed Funding has helped strengthen the commitment of partners to the research as we were able to discuss detailed aspects of the proposal with them before we submitted the final application to R2HC. The workshop activities also facilitated greater clarity regarding the potential study sites and helped crystallise the final research methodology. This preparatory work has provided us with an excellent framework from which to move forward with the implementation of the research over the next two years. We would highly recommend applicants to the R2HC programme to consider the benefits and opportunities offered by a Seed Funding grant.

We were able to make a good deal of progress during and just after the seed workshop and during the application process toward the development of a research protocol. We have continued to do our own internal advocacy in our organizations. We have also continued to share resources amongst our team as new publications and tools arise. During the workshop we also developed a timeline that was quite ambitious. Because we made such progress during the application phase, we are able to begin work swiftly on site preparation, data collection tools and protocols for the 6 IRB submissions. This was something we agreed to during the seed grant meeting even prior to submitting the application.

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