Project Dates: March 2013-December 2014
In 2012, as part of an effort to reduce maternal mortality, particularly deaths due to unsafe abortion, Rwanda revised their penal code, increasing the legal exemptions for abortion and thereby expanding the circumstances under which women qualify for a safe abortion. Until the recent legal reforms, abortion was illegal except to save the woman’s health or life.
While abortion in Rwanda remains highly restrictive, women who previously could not access legal services are now eligible for safe abortions based on maternal and fetal conditions as well as non-medical criteria pertaining to pregnancies resulting from the crimes of rape, incest, or forced marriage. However, translating legal provisions into service provision, including raising awareness among relevant stakeholders (providers, potential clients, their families and communities) and training providers, can be challenging, particularly for highly stigmatized matters. This potential gap between the law and practice gave rise to concern that access to safe abortion service under the revised penal code would remain effectively unchanged without deliberate and concerted effort. In 2014, in collaboration with the Rwandan MOH, the international women’s health NGO and Bixby partner, Venture Strategies Innovations (VSI), launched the “Operationalization of the Exemptions for Abortion in the Penal Code of 2012” program. It was funded by the David and Lucile Packard Foundation.
Project implementation included the following:
Pilot project findings were based on both retrospective data gathered from hospitals, their affiliated gender-based violence (GBV) centers, and district courts at eight sites from the two years immediately following the change in the law and prospective data collected from the same sites during the last five months of 2014. Retrospective data collection relied on record review while prospective data was gathered as part of an intervention focused on building capacity, raising awareness, and generating evidence.
Data collection process:
In February 2015, the results of this pilot research were disseminated at a meeting of stakeholders with the goal of discussing the implications of expansion in the provision of high quality, safe abortion services for women and girls in Rwanda. Based on stakeholder collaboration and further analysis of program/implementation data and experience, the project team outlined key recommendations. The Bixby Center is committed to pursuing these during the scale up and through further expansion of project activities.
This project was the culmination of years of VSI’s work in Rwanda starting with the introduction of misoprostol for prevention of maternal mortality due to postpartum hemorrhage during in home birth and then for post-abortion cares (PAC). Before regrettably closing their doors in March 2015, VSI passed the baton to the Bixby Center to take the international NGO lead in continuing data collection in the initial sites and beginning scale up efforts by expanding implementation to 6 new sites designated by the Rwandan MOH.
More information on this pilot study and our work in Rwanda available upon request.