{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:55:09Z","timestamp":1776387309650,"version":"3.51.2"},"reference-count":26,"publisher":"Guttmacher Institute","issue":"1","license":[{"start":{"date-parts":[[2022,10,23]],"date-time":"2022-10-23T00:00:00Z","timestamp":1666483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Perspect Sexual Reproductive"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>Despite instituting a policy in 2004, M\u00e9decins Sans Fronti\u00e8res (MSF) continuously struggled to routinely provide safe abortion care (SAC). In 2016, the organization launched an initiative aimed at increasing availability of SAC in MSF projects and increasing understanding of abortion\u2010related dynamics in humanitarian settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>From March 2017 to April 2018, MSF staff conducted support visits to 10 projects in a country in sub\u2010Saharan Africa. Each visit followed a systematic approach with six key components and related tools that were later shared with teams worldwide. Data regarding women seeking abortion services and related outcomes were collected and analyzed retrospectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From Q1 2017 through Q4 2019, SAC provision increased significantly in all 10 projects, rising from three to 759 safe abortions per quarter. Teams received 3831 patients seeking SAC and provided 3640 first and second trimester abortions, over 99% via medication methods. The overall complication rate was 4.29% and 0.3% for severe, life\u2010threatening complications. No major security incidents were reported. MSF provision of SAC worldwide increased from 781 in 2016 (the year before this initiative began) to 21,546 in 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Implementation of SAC in humanitarian settings\u2014even those with significant legal restrictions\u2014is possible and necessary. Both first and second trimester medication abortion can be safely and effectively provided through both home\u2010 and facility\u2010based models of care. Programmatic data provide valuable insights into abortion\u2010related dynamics which must shape operational decision\u2010making. Addressing internal barriers and providing direct field support were key to stimulating organizational cultural change.<\/jats:p><\/jats:sec>","DOI":"10.1363\/psrh.12209","type":"journal-article","created":{"date-parts":[[2022,10,23]],"date-time":"2022-10-23T19:18:40Z","timestamp":1666552720000},"page":"60-71","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Catalyst for change: Lessons learned from overcoming barriers to providing safe abortion care in M\u00e9decins Sans Fronti\u00e8res projects"],"prefix":"10.1363","volume":"56","author":[{"given":"Manisha","family":"Kumar","sequence":"first","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Operational Centre Amsterdam  Amsterdam Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catrin","family":"Schulte\u2010Hillen","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res International Office  Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"De Plecker","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Operational Centre Brussels  Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann","family":"Van Haver","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Operational Centre Brussels  Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia Guinovart","family":"Marques","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Operational Centre Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maura","family":"Daly","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Operational Centre Amsterdam  Amsterdam Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hilde","family":"Vochten","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Operational Centre Brussels  Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Merzaghi","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Operational Centre Geneva  Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brice","family":"de le Vingne","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Operational Centre Brussels  Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Fran\u00e7ois","family":"Saint\u2010Sauveur","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Operational Centre Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"259","published-online":{"date-parts":[[2022,10,23]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"UNFPA World Health Organization UNICEF et al.Trends in Maternal Mortality: 2000\u20132017. 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