Using hotlines to improve women’s access to information in legally restricted settings Bangkok, March 9-11, 2012 Challenges for documenting hotlines’s experiences and new strategies based in new technologies Silvina Ramos

Some entry points Why documenting? Documenting: what for? How to document?: strategies, techniques and indicators Challenges in documenting

Why documenting? Context considerations: MA has radically changed abortion practices in legally restrictive contexts MA has brought in an entirely new phenomenon related to women’s sexual and reproductive autonomy and the role of technology in such a process MA offers a choice for a non-invasive, safe and effective method, more affordable than surgical methods and which does not require third party participation in the procedure

Why documenting? Context considerations:  Most research on MA is situated in legal abortion contexts and focused on trials of regimes and cost-effectiveness of MA compared to SA  Little attention has been paid to women’s experiences, perspectives and preferences (Lie et al., 2008)

Why documenting?  Given the importance of MA in reshaping the “nature” of abortion access and abortion experience in legally restrictive settings it is crucial to have a deep understanding of this phenomenon both quantitatively and qualitatively Hotlines’ work offers an unique opportunity to produce some invaluable knowledge about this new phenomenon

Why documenting? “Internal” considerations:  Use of communicational technologies to improve access to MA need to be assessed since this is a novel public health intervention (privately managed)  Documenting is the best (and only) way of reflecting upon what’s being done, identifying problems and finding solutions which can be tested

Why is it necessary to document? Internal considerations: Knowledge produced in a systematic way –is a powerful tool for service delivery since it helps to take informed decisions –is an effective means for making our work accountable –raises the legitimacy of these efforts –is an ethical imperative for those working in public health interventions

Documenting: what for? Service delivery improvement Advocacy strategies Research outcomes

How to document?: strategies, techniques and indicators Approaches: quantitative and qualitative Each addresses different aspects of the phenomenon Choice of strategy depends on what you are looking for Combination is worth doing (bricolage strategy)

How to document?: qualitative approach In-depth understanding of women’s experiences and histories in the context of their personal circumstances and settings Based on eliciting women’s perspectives on their needs, experience and results Unstructured methods (interview) which are sensitive to the personal, social and cultural context

How to document?: qualitative approach Data is collected in detail Inductive rather than deductive What is, how and why questions are the key questions addressed

How to document?: qualitative approach It is used in evaluations of programs, services and interventions Identifies factors that contribute to successful or unsuccessful delivery Identifies outcomes (intended or unintended) Identifies how they occur and why Helps to examine an issue that is poorly understood

How to document?: quantitative approach Focuses on measurement and on the relationship between factors (e.g. age or education and satifaction or referrals needed) Helps to identify women’s social profile (e.g. socioeconomic status, sexual and reproductive history and/ or cultural background) Helps to collect specific data related to the event (e.g. source of information, motives, pain perception, satisfaction with MA)

How to document: indicators Process  Number of phone calls per women  Need for referral or not  Pain management Outcome  Satisfaction with the procedure  Completed or uncomplete abortion Impact  Post abortion contraceptive use  Woman’s empowerment

Challenges: “internal” –Taking the decision to document is a turning point: assessment of what’s done is possible based on a more objective basis implies a very different mind-set towards what’s done (to look inside instead of looking outside)

Challenges: context-driven –Stigma, distrust and lack of knowledge permeates social interactions related to an abortion experience (to what extent we can rely on what we are told) –Ethical aspects related to informing about how to take a drug and/or providing it (anonymity, confidentiality) come together with political concerns regarding: ….

Challenges : context-driven − How documentation protects information about what might be understood as an illegal action (both the woman and the provider should be taken into account) − How referrals are documented and how those working in the health care sector are protected − To what extent is necessary or possible to make people working in the hotlines be exposed to the public arena

Last message Besides the constrains that current work in the hotlines need to deal with, documenting might be a way for the scaling up of this strategy It will be worth exploring ways in which this task can be done in a more coordinated way among hotlines in the different regions