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5 things our clients taught us on delivering choice

Friday 24 September 2021 Anisa Berdellima Contraception, Safe abortion and post abortion care

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When designing our programmes, we speak directly with the people who use them – our clients. That’s why, every year, we conduct client exit interviews, inviting a representative sample of clients to speak with an impartial interviewer, covering topics from their background and community support system, to what they value in a service and their experience with MSI.

Our clients’ responses drive improvements across our programmes and provide unique insight into the experiences - and challenges - that people across the world face in accessing reproductive healthcare. To mark ‘Choice Week’, between World Contraception Day and International Safe Abortion Day, we’re sharing five things we learned from the 18,000 clients we spoke with in 2020, on how we can deliver reproductive choice for all, on our clients’ terms:

1. Community-based is best

MSI is built on the expertise, dedication, and hard work of our bold providers, who go the extra mile to make choice possible for women in their communities. Our client exit interviews show that in environments where contraception and abortion continue to be stigmatised, community-based providers and advocates are best placed to shift perceptions and expand access.

Across our contraceptive clients, nearly a third (30%) heard about their service from a community-based mobiliser – someone embedded in their local community to improve awareness of reproductive healthcare and rights, via community engagement activities.

Our clients also shared that our community-based providers, known as MSI Ladies, were well placed to deliver abortion and post-abortion care, as they visit clients directly in their communities, and in some cases, their homes. In one programme, 87% of clients who accessed an abortion or post-abortion care service with an MSI Lady shared that they did not know of an alternative provider for their service, showing how they can plug the gap in communities where abortion care continues to be stigmatised.

Lesson 1: Our community advocates and providers who are rooted in their local community are well placed to shift social norms, de-stigmatise healthcare and expand access to services.

2. We can drive equitable access at scale

Across sub-Saharan Africa, the poorest fifth of women are twice as likely to face an unmet demand for contraception as the wealthiest fifth, meaning fewer women in poor and rural communities have access to reproductive choice, and more women die from pregnancy-related causes.

This inequity is echoed by our client exit interviews. 57% of clients served by our rural outreach teams knew of no alternative provider for their service. Among clients served by the public health services we support, this increased to 71%. But our data also shows that we can plug the gap for these communities affordably, at scale. It only costs 2 pence / 3 cents per day for our outreach teams to provide the contraception that protects a girl or young woman from an unintended pregnancy.

In 2020, we reached 7.9 million clients with services designed to reach the most underserved women and girls. 16% were adolescents, 30% were living in extreme poverty, 5% were people living with a disability, and nearly half (48%) of clients were adopters, meaning they were using contraception for the first time, or after a lapse in use. This data proves that we can reach marginalised groups, at scale - in Nigeria, for example, we reached 2.6 million women and girls who either had no prior access or were from an underserved community.

Lesson 2: Driving equity and access at scale aren’t mutually exclusive. Our teams have shown that we can deliver access to underserved and marginalised communities, at scale, too.

3. To get communities talking, quality matters

MSI is proud to deliver client-centred services to over a million women worldwide every month. Delivering at this scale requires an organisation-wide mindset that puts clinical quality and client safety at the heart of everything we do. Our interviews show that clients value this too.

We know that in stigmatised settings, if a client feels empowered to speak about their service after their visit, it can help to build community awareness and normalise essential healthcare. Our global interviews revealed that when our clients strongly agreed that they were treated with respect, had privacy, and found it easy to ask questions during their service, they were twice as likely to recommend MSI’s services to a friend.

Lesson 3: Provision of high-quality client-centred care empowers clients to champion their experience, building awareness of stigmatised settings and challenging social norms.

4. Digital journeys can empower clients in their choices

Digital is transforming healthcare globally. From a growing number of clients accessing information and referrals via MSI’s website and chat tools, to a rise in questions for our online counsellors, clients’ phones are fast becoming a one-stop-shop for reproductive healthcare.

At MSI, we are meeting this shift through our global network of 31 contact centres, providing advice over the phone, social media, and WhatsApp. Of our abortion and post-abortion care clients who interacted with a contact centre ahead of their appointment, 78% shared that they were very likely to recommend the service to a friend – 12% higher than those who went straight for a service. They also rated higher satisfaction with service opening hours and pricing, and found it easier to ask questions, with access to non-judgemental, accurate advice before, during and after their service.

Lesson 4: Access to non-judgemental accurate advice before, during and after a service, including via digital routes, supports clients in making the reproductive choices that are right for them.

5. Women want a choice of abortion methods

We have seen promising global progress in the self-management of medical abortion and telemedicine, from a fall in maternal deaths due to greater availability of medical abortion, to studies showing that our UK telemedicine programme is just as safe and effective as in-facility care, and preferable to clients.

Yet, while self-management has progressed, it is essential we protect access to a choice of both medical and surgical abortion methods. For clients who would prefer to access face-to-face care, are seeking an abortion in their second trimester, or are facing complications from a previous unsafe abortion attempt, access to in-facility services and surgical abortion care remain vital.

Our client data echoes this, showing that across our global centres, where a choice of abortion methods is offered, 50% of clients opted for a surgical abortion method and 50% opted for a medical abortion method. With clients split evenly, it is important we protect this choice.

Lesson 5: As our global community expands access to the self-management of medical abortion, we must listen to women and ensure surgical abortion remains available.

We would like to take this opportunity to thank the 18,000 clients who shared their experiences and insights with us in 2020. Whilst every client experience is unique, these responses help us to improve our service delivery based on what our clients want and value.

With these findings, we will continue to build safe client pathways, and by sharing these insights, we hope to support other programmes and policy makers to improve and expand access to reproductive choice too, so that everyone has access to the services and choices that let them determine their futures.


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Our vision for the future is bold.

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