Impact Case Study: Understanding barriers to post-abortion care in humanitarian settings

Background

Complications from miscarriage and unsafe abortions account for 8% of maternal deaths globally, with fragile settings like South Sudan facing significant barriers to lifesaving post-abortion care (PAC). This mixed-methods study, conducted between 2017–2020 by Columbia University and International Medical Corps, highlighted major barriers to PAC, including inadequate service provision, lack of training and stigma, while also revealing community support for PAC despite these challenges.

The study

This mixed-methods study aimed to generate evidence on barriers to accessing PAC, understand and enhance service delivery, and integrate findings into national health strategies. Conducted in health centres in four internally displaced person and refugee camps in South Sudan, the research focused on understanding the client journey and building capacity for quality PAC services in humanitarian settings. The study’s goal was to identify factors influencing access to, use and provision of PAC services.

The study’s impact was enhanced by the need for evidence to prioritise PAC in SRH services and South Sudan’s commitment to improving SRH. Shifting attitudes toward abortion also created a receptive environment, and the expertise of UNFPA and the principal investigator helped to amplify the research, supporting its integration into national health strategies.

Findings and impacts

• Implementation of revised PAC registers in South Sudan,  

• Improved training materials, contributed to attitudinal shifts among healthcare providers

• Raised awareness among the UK’s Foreign, Commonwealth, and Development Office (FCDO) advisers.

• Enhanced research skills, benefited over 200 trainee midwives and nurses, and influenced clinical practices  

Lessons Learnt

• Sustained personal engagement is important for policy influence  

• Engaging operational organisations in research is key, but their participation requires sustained funding

Partners

Columbia University, International Medical Corps

Methodology

R2HC captures detailed case studies through a process that triangulates and validates evidence on uptake and impact. The case study methodology and full version of this summary case study including references are available on request. Outputs and resources from this study are available on the project page.