Delivering transformative, rights-based family planning
Project Name: Supporting Access to Family Planning and Post-Abortion Care (SAFPAC)
Partner(s): Columbia University (evaluation)
Program start date: 2011 (ongoing)
Locations: Chad, DR Congo, Mali (also have responded to acute emergencies in other countries)
Objectives: 1) To prevent unintended pregnancies and deaths from unsafe abortion by ensuring access to family planning services, with a focus on long-acting reversible contraception and post-abortion care in fragile and crisis-affected settings. 2) To build CARE’s institutional capacity to ensure access to essential SRH services in emergency responses.
Crisis exacerbates maternal mortality and other sexual and reproductive health outcomes. Among 50 countries currently ranking lowest on global indicators of mothers’ and children’s well-being, such as infant mortality and contraceptive use, 30 have recently experienced armed conflict or host substantial refugee populations.
The reality is that sex, conception, and pregnancy continue to happen in emergencies. Through SAFPAC, CARE works to ensure access to family planning services (including long-acting reversible contraception), post-abortion care, and safe abortion (where legal and possible), which are needs often overlooked by other actors.
As a member of the Interagency Working Group for Reproductive Health in Emergencies (IAWG) steering committee, CARE provides technical leadership and guidance on IAWG strategy and program direction. The Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations, developed by IAWG, is the gold standard for addressing women’s SRH needs in the acute phase of emergencies. The MISP offers guidelines to address: coordination among the multiple-sectors related to women’s health and safety, access to safe delivery services, prevention of STI/HIV transmission (in high prevalence settings), protection from sexual violence, and provision of comprehensive family planning as soon as feasible after the onset of the emergency.
SAFPAC is focused on three “core countries” with protracted/ongoing crises – Mali, Chad, and DR Congo (and previously Djibouti and Pakistan) – but also responds to acute crises when they arise. SAFPAC currently also works in Nigeria – Borno state, Bangladesh – Myanmar refugee crisis response, northern Syria, DRC – Kasai Orientale, Uganda, South Sudan, and Cameroon.
CARE’s work in the core countries is focused on building the capacity of local health workers and systems to deliver family planning and post-abortion care. Because these settings are not acute emergencies, the work is similar to traditional development programming but in fragile environments where the government has very little reach or capacity. Program participants include many local residents as well as internally displaced people, refugees, returnees, etc. In areas with acute crisis, SAFPAC works to ensure delivery of the MISP (with a focus on family planning and post-abortion care). This work tends to be of shorter duration (a few months to a year) and is often located outside of CARE’s pre-existing operational areas.
Our experience in delivering proven and cost-effective emergency and development programs has shown that success depends on a combination of efforts at the family, community and health systems level. SAFPAC’s approach has resulted in a highly effective and sustainable program that ensures access to high quality sexual and reproductive health services for women in some of the most challenging environments in the world.
From June 2011 to December 2017, SAFPAC has reached hundreds of thousands of women and girls. In the original five core countries (Chad, Djibouti, DRC, Mali, and Pakistan), the project has seen:
Over 280,000 new family planning users, and 58% of them chose a long-acting reversible contraceptive method (implant or IUD)
Over 14,000 post-abortion care clients, 61% of them chose a modern family planning method at their visit (65% of those who did chose a long-acting reversible method)
For more detailed results and evaluation details, see publications below.
Articles in peer-reviewed journals
Delivering high-quality family planning services in crisis-affected settings I: Program implementation (Curry, Rattan, Nzau, & Giri, 2015)
Delivering high-quality family planning services in crisis-affected settings II: Results (Curry, Rattan, Huang, & Noznesky, 2015)