Across the world, 222 million women would like to delay or prevent a pregnancy, but have no access to contraception. This unmet need for family planning contributes to a third of maternal deaths and leads to 47 000 deaths from unsafe abortion every year. These deaths are preventable if women have access to the means to control their fertility, and to safe services should they choose an abortion. So what can be done, and what are the barriers to addressing this issue?
Family planning services prevent needless deaths
Family planning is a low-tech, yet high-impact area of health care. With access to quality services, particularly to highly effective long-acting reversible contraception, women can choose whether or not to have children, when, and how many. Quality family planning services improve not only the health of the woman, but also prevent maternal deaths from unsafe abortion. Yet many health-care providers around the world are not trained in family planning or safe abortion services, and those who are trained often feel unacknowledged and unsupported.
Addressing unmet need
The Royal College of Obstetricians and Gynaecologists' (RCOG) Leading Safe Choices initiative is a 3-year donor-funded pilot programme that aims to address this unmet need and raise the professional standing of health-care providers working in women's health care. The initiative will focus on postpartum family planning and safe abortion care, and increasing skills and improving quality of care. We aim to support and mentor professionals and increase recognition of their efforts. As a result, we hope to raise the professional standing of the care provided in women's health.
We will work at all levels of the health system, from the Ministry of Health, obstetricians and gynaecologists, nurses and midwives, and professional societies and councils. With this joint working, we hope to lead change as an internationally recognised leader of clinical practice and education in obstetrics and gynaecology.
The Leading Safe Choices initiative has already produced the Best Practice Papers Postpartum family planning, Comprehensive abortion care and Comprehensive postabortion care, and developed training programmes that are modelled on those best practices.
Recognising hard work
Judiac Ranape, a nurse in South Africa, has been working in women's health care for several years. She is dedicated to assisting women who need family planning and abortion services, but she says that more trained professionals are needed to provide this essential and often life-saving care. These professionals also need to feel supported and recognised in the often difficult environments in which they work.
The Leading Safe Choices programme is being piloted in Tanzania (Dar es Salaam and Kilimanjaro regions) and in South Africa (Western Cape province)—two countries which will be the focus of our 3-year pilot to develop a training faculty. The programme is directed by Professor Lesley Regan, President-elect of the RCOG, and Professor Alison Fiander, fellow of the RCOG, acts as clinical lead; the team will work within the Ministry of Health systems, where we will be monitoring and evaluating our impact.
Midwives believe that many of the problems that women face are due to lack of access to services at the right time, particularly to long-term postpartum family planning. Women are typically offered pills or injections but struggle to return every month or 3 months, as required by short-term methods. By training midwives, we hope to see a demonstrable effect on the quality of care provided in women's health, and an acknowledgement of the need for this care and the incredible work that is already being undertaken by these health workers and others around the world.