Global Comprehensive Abortion Care Initiative

Global Comprehensive Abortion Care Initiative (GCACI) is being implemented in FPA India clinics since 2008 to increase access to the provision of comprehensive, safe and legal abortion care and abortion related services with special focus on reaching poor, young, marginalized, rural and displaced groups. Currently the initiative is in its fifth phase starting from year 2019 till year 2021.

Phase-wise strategies of GCACI

After 10 years of implementation experience of a dedicated, safe abortion service delivery project, a few factors that emerge as the critical ones responsible for successful implementation of women-centric, safe abortion care in the given set-up are:

• Non-stigmatising behaviour of staff: All staff in FPAI clinics are sensitized to respect the clients’ rights.The reason why clients prefer to come to FPAI clinics is that they feel that their choice is valued by the doctors. Counsellors and doctors don’t preach clients on what should be done but give factual information which helps clients to take a decision and their decision is respected.
• Accompanied referral: Five Link workers are appointed in each clinic who work in the designated operational area. They conduct door to door visits to inform women about family planning and safe abortion services available in FPAI clinics. Apart from this, they offer to accompany clients to the clinic. This feature of their work seems to have worked well since many abortion clients don’t come to clinics simply out of fear of stigmatization by the staff. Link workers becomes their confidante’ and assures them of high quality nonjudgmental treatment by the staff, personally accompanies them and offers all kind of help.
• No refusal policy: FPAI is committed to provide all SRH services to all and as a policy, no client is to be refused on basis of age, sex, caste, religion, marital status, reason for the service seeking, finance or HIV status or any other discriminatory reasons. Those clients who cannot be given services in the clinic for medical reasons are referred to an appropriate place so that the client receives right kind of service. All FPAI clinics have a board of No refusal policy displayed in local language.
• Tailormade counseling: Counselling is the most crucial component in the safe abortion care. Terminating an unwanted pregnancy may be a choice made by a client herself, but it is an carries its emotional burden. Counseling offers considerable support to bear it. Couple counseling is offered if clients wishes for it especially for acceptance of post abortion contraception. Sometimes other family members like mother in law are also involved in process of counseling. If the counselor feels that clients is unwilling for abortion but is under pressure from family, situation is created to help client confide this and the help is offered to find a solution in a consensual manner. This approach helps to build trust among clients.
• Privacy and confidentiality of clients: MTP law mandates privacy and confidentiality of the clients through record keeping which is strictly followed in the clinics. Going beyond that, the clinic infrastructure is made in such a way that maximum audio-visual privacy is offered to client so that no other person knows the reason for visit and details of the decision made by clients. This approach attracts many young and unmarried/ single clients for safe abortion. Many clients who have self-attempted abortion by MMA and landed up in complication also feel comfortable coming to clinic as they are confident that their information will be kept a secret.