1. Documenting our success &challenges

2. DOCUMENTATION OF OUTREACH AND WORD OF MOUTH CAMPAIGN By Jedidah Maina Trust for Indigenous Culture and Health (TICAH)

3.  We believe that our reach is more than our measures can capture  This is because our reach is inside out  We are always asking questions, and always learning new ways to capture and document our reach.  Information about where unsafe abortion services are provided within the communities is passed on from one person to another through word of mouth

4.  Hence information about where to get a safe abortion can be spread in this same kind of way  Information shared is comprehensive SRH to avoid victimization or stigmatization of the information  Abortion in Kenya is restricted (allowed  Ironically the Govt allows for post abortion care

5. Process..  TICAH was first trained in use of misoprostol by Women on Waves in 2010. The first training reached 25 participants  To date TICAH has directly trained over 150 participants (TOTs)  Training happens in two tiers  In the first tier training participants are trained to be trainers and are expected to advocate with pharmacies and train at least 15 participants within their communities or organization. And at least 5 pharmacists  These 150 trainers have in turn trained over 1000 participants in the second tier

6.  In each of the second tier training (1000) participants are trained to pass the info on miso to at least 5 people each.  Each participant is expected to talk to at least 5 people on use of miso for TOP and PPH  Everyone trained is given at least 5 stickers to stick in public places  Every participant is asked to fill in an action plan. This serves as a personal commitment to what one willing and able to do with the information received and which will be used to evaluate their reach as well as document it.

8.  TICAH conducts follow ups through emails and phone conversations  After an agreed period of time each individual is asked to forward their action plan and a matrix report is prepared with the compilation of the different action plans collected

10. Stories..  “First person who came to me asking for information about having a TOP after attending the Women on Waves workshop was a friend of mine. She wanted to have a TOP through a surgical procedure, but I asked her to consider using miso. I explained to her the process and asked her to think about it some more before she can make her decision. I also gave her the hand out to carefully read through and understand the process. Two days later she came to me, asking me to help her through it. We agreed that she would spend the night at my house and since there are several health care centers near by incase of an emergency. After the first 4 tablets she started experiencing abdominal cramps, at first she wanted to take something for the pain but I advised her not to since the contractions allow the TOP to be effective. Bleeding followed soon after, even before taking the next four tablets. Although I insisted that she had to take all the tablets for the procedure to be fully complete.” D. O Nairobi

11.  “This is such timely information. We find the community around us so eager for this information. Immediately after the training we got a lady needing those drugs. We had all gotten three tablets. We had to do a harambee from the other participants t get the tablets to 12.” A.R Mombasa

12.  “Some of the women we reached with miso information live in rural areas with no access to miso as there are no pharmacies there. They live in such deplorable state that they would not afford miso even if they knew where they are sold. The only SRH services they can access are Govt services which are themselves insufficient”. Night Nurse Nairobi  “There was a negative reception about the information on miso for TOP from my colleagues, my organisation is not pro choice due to some of our donors and their policies”. SWOP Nairobi 

13. Successes..  150 participants trained in the first tier trainings  Over 1000 trained in the second tier of trainings  An estimated over 5000 people reached with info about miso

14. Challenges..  There still exist huge gaps in documentation. There is difficulty in documenting people reached as some people want to remain anonymous, while some trainees are not very good in documentation. Most of safe abortions are disguised/reported as post abortion care  Reliance on self-reporting, ie we rely on the word given by the trainees on how many people they have reached. This sometimes lack in accuracy  Abortion is restricted in Kenya, as such there is need for care when sharing the information

15. Challenges cont..  Kenya is largely a religious country and TOP is at times seen as anti-religion  Some of the trainees are met with cold reception when they share info about miso  Many people still do not know that there is a possibility of having a safe abortion  Difficulty in accessing misoprostol pills. Need for prescription  Misinformation existing sometimes even by the pharmacists  Resistance even from the medical professionals and some members of RHA on the thought that women can do this by themselves  Security threats

16. Recommendations..  Coupon system to capture no of people who access services after referral  Get a network of service providers who we can refer women/ girls to for further counseling and services  Reproductive Health Alliance

17. opportunities  Its not all gloomy.. There is hope  The new constitution in Kenya  Govt with the help of development partners is training service providers on post abortion care and safe abortion to the extent of the law  RHA  Legal reforms and advocacy

18. Thank you