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2020 in review: What we learnt from a year like no other

Tuesday 02 March 2021 MSI Reproductive Choices Contraception, Safe abortion and post abortion care

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2020 forced us to think differently – here’s what we learnt from a year like no other 

2020 was a year of suffering and hardship on a global scale, with women disproportionately affected and reproductive healthcare access and rights restricted. But challenging times can also be a catalyst for innovation, and never has that more apparent than last year, as the world collectively mounted the largest public health effort in history.  

As we look to the future, this moment also presents a chance to undertake visionary, transformative improvements.  

Here are some of the lessons that we at MSI have learnt in 2020 that could contribute to more resilient and equitable health systems and accelerate access to safe abortion and contraception in 2021 and beyond. 

Adapting to meet women’s needs 

As the numbers of COVID-19 infections spiralled last April, MSI estimated that the crisis could result in an 80% reduction in our service delivery, with up to 9.5 million women and girls losing access to our services. However, thanks to the resilience, action and innovation demonstrated by our programmes and providers, the impact while significant, was nowhere near as grave. By the end of 2020 our teams had served 12.8 million people - 35,000 every day - with high-quality sexual and reproductive health services.


To safeguard access during national lockdowns, MSI's teams pivoted to get services directly into the hands of women. From Uganda, where in partnership with UNFPA, we delivered contraception using a ride-hailing app similar to Uber, to Madagascar, where we obtained government permits to deliver services by bus and transport women safely to their local health facility. This kind of convenient, client-centred provision of information and services will continue to be needed beyond the pandemic and reflects our ongoing commitment to delivering services in ways that meet the needs of all our clients and ensuring that no one is left behind.


Keeping our clients safe 

The pandemic also drove innovations in how we uphold the quality of our services. With travel bans making face-to-face audits impossible, we are rolling out new remote quality assurance systems across 35 country programmes, using audio and video streaming and recordings to conduct clinical audits. In addition to saving time and money and reducing our carbon footprint, the MSI Audio Video Assessments (AVA) will allow us to evaluate the findings alongside other data systems, such as the competency of our clinical providers, and continually improve the quality of the assessments themselves. 

Digital innovation 

The need to self-isolate during the crisis has also motivated long-overdue digital innovations that have revolutionised the delivery of services.

To protect access to timely abortion care and reduce the risk of transmitting the virus, MSI's UK and South Africa programmes rapidly implemented telemedicine, enabling women to have consultations over phone or video and self-administer medical abortion drugs in the privacy of their own homes. If made permanent this could have profound implications that go far beyond the pandemic, expanding and improving access, reducing waiting times and gestations, and allowing women greater control in the process. MSI is already sharing learnings from our UK and South Africa programmes to roll out similar telemedicine models in Nepal, India and Ghana, with the aim of delivering contraception via telemedicine too.

MSI's contact centres have also played a pivotal role: providing clients with guidance, support, directions and follow-up care. In fact, despite significant disruptions to their working arrangements, they have supported more clients than ever before, with 2.4 million interactions in 2020 compared with 2.2 million in 2019. Interestingly, while the number of calls over this period has stayed relatively flat, interactions via social messaging platforms, such as WhatsApp, increased 87% between February and August 2020. This reflects both the increased need to access information and support confidentially, particularly for young people living at home and those at risk of domestic abuse, as well as a more general shift in the way people prefer to communicate. At the end of 2020, MSI launched chat platforms in 10 countries, including the DRC, Nepal and Yemen, enabling our agents to manage WhatsApp and Facebook messaging seamlessly and expanding our ability to maintain access to advice during lockdowns, bringing us another step closer to our vision of a world where no woman is more than one contact away from a safe service. The increase in social messaging has also had the advantage of being able to more easily direct clients to our websites, with traffic across our sites doubling between January and September 2020. This trend will improve women's access to reliable information, improving client experience, safety and health outcomes.



COVID-19 continues to devastate lives and in many countries, the worst effects could be yet to come. Mitigating its impact can only be achieved with strong partnerships and collaboration. From the very start of the crisis, MSI has worked closely with partners and governments to classify sexual and reproductive health (SRH) services as essential, as well as collaborating with professional health associations like the UK's Royal College of Obstetricians and Gynaecologists (RCOG) to advocate for telemedicine. In Zimbabwe outreach teams co-located their service delivery with World Food Programme supported nutrition activities thereby ensuring that clients could access key (health and nutrition) services without having to visit health facilities. In Nigeria, MSI's programme partnered with the Ministry of Health to keep public health posts open. When sexual and reproductive healthcare services were defined as essential, the Ministry granted MSI's team members free movement between states, ensuring contraception and post-abortion care were not side-lined by the COVID-19 response. In collaboration with the public sector, this enabled MSI Nigeria to reach over 2.4 million clients with family planning services, protecting access in rural regions when needed most. Over the next decade, we will continue to take our collaboration with governments forward, working across several programmes to strengthen reproductive healthcare provision in the public sector, so that ultimately, services are nationally owned and available for the long run. 

The pandemic has also illustrated the importance of partnering with other organisations rather than trying to reinvent the wheel, such as our collaboration with the Girl Effect in South Africa. Adolescents can be embarrassed to ask for advice on sexual health, but the Girl Effect 'Big Sis' chatbot provides MSI with a platform to answer questions and provide accurate information in a confidential space. Instead of focusing on what MSI can deliver alone, we have been able to tap into a tool that girls and young women already use, making it easier for them to find the information they need. Today, one in four girls in Malawi who drop out of school do so following a pregnancy and a girl in South Sudan is more likely to die in childbirth than finish secondary school, so as the largest generation of young people in history approach their reproductive years, this sort of collaboration will only become more vital. 

Looking forward to a brighter future

The next decade presents the global community with daunting challenges from gender inequality to the climate crisis, but 2020 has shown that we can break out of our siloes, support each other in adversity and work together for the greater good. 

The world probably won't ever go back to 'normal' but maybe that's for the best. As we rebuild post-pandemic, we need to avoid reproducing the fragile models of the past and instead embrace new partnerships and capture opportunities for change to create a healthier, more resilient and more equal future for all. 



Invest in women's futures

Our estimates show that it costs less than 2 pence/3 cents per day to provide a young woman with a contraceptive method of her choice. It is a cost-effective investment that produces a lasting and sustainable impact. By enabling girls to stay in school, supporting women to forge their careers, and better equipping communities to be resilient in the face of global challenges, from COVID-19 to the climate crisis, reproductive choice is foundational to building a more equal and sustainable world for all.

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By 2030, no abortion will be unsafe and everyone who wants access to contraception will have it.