Expanding and Sustaining Safe Abortion Services in Ghana, Mozambique and South Africa through the Safe Abortion Action Fund

Photo by John Lazame Tindanbil

To create an environment where safe abortion services are more widely accepted, advocates lead a conversation with community members about the risks of unsafe abortion.

Photo by John Lazame Tindanbil

At a mosque in Ghana, community members discuss abortion, dispel myths, and learn the risks of delaying postabortion care.

Photo by John Lazame Tindabil

A group of midwives, trained by Pathfinder in safe abortion, gather to share their experiences. Their shirts announce their support for their work—which demonstrates their courage and the changing attitudes in their conservative communities.

With its third round of funds from the Safe Abortion Action Fund, Pathfinder built on existing efforts to expand and create sustainable safe abortion services in Ghana, Mozambique, and South Africa. The overarching goal of this project was to reduce maternal morbidity and mortality due to unsafe abortion.


In collaboration with the Ghana Health Service, Pathfinder successfully scaled-up comprehensive abortion care (CAC) services to five new districts where access to quality, safe, and postabortion care (PAC) services were previously not available. In all of these newly established facilities, close to 100 percent of the midwives and medical doctors received training and onsite coaching and are now providing high quality CAC services. The project witnessed a marked reduction in stigma as providers and managers no longer criticize young women who come for CAC services. Facilities also received equipment and financial support for CAC services. As a result of its successful work, Pathfinder was approached by managers of four remote sub-district level facilities in the Upper East Region where access to district hospitals is particularly difficult. Pathfinder supported these facilities to provide quality safe postabortion care and to institute appropriate referral systems to district and regional hospitals for cases with complications. This is the first time such services will be provided at the sub-district level in Ghana. The project also built Ghana Health Service's capacity to scale-up services in the remaining 15 northern districts where public sector CAC services are unavailable; the partnership with the Ghana Health Service has placed CAC squarely on the health agenda and the Ghana Health Service is now willing to take budgetary responsibility for these services.


In Mozambique, Pathfinder worked at both the policy and service delivery levels in order to expand access to comprehensive safe abortion care. At the policy level, Pathfinder supported the establishment of an advocacy coalition, the Coalition for the Defense of Sexual and Reproductive Rights. As a result of advocating with policymakers in Parliament and the Ministry of Health, the Coalition was invited to participate in the revision of the Mozambican penal code. The code was approved by the Governing Council in late 2011 and is expected to be passed by the Parliament this year. Other key Coalition activities included the organization of study tours of parliamentarians and Ministry of Health staff to Kenya and Ethiopia and establishment of “media champions” to ensure strong coverage of the issues being addressed by the Coalition. At the provincial level, Pathfinder collaborates with the provincial health directorates of Gaza and Inhambane, along with the Associacao Mocambicana de Obstetras e Ginecologistas, to increase the number of health facilities providing comprehensive abortion care. The project adapted a comprehensive safe abortion care training curriculum, which was then used in the training of 44 project-supported facility providers. Pathfinder also reinforced these project facilities through provision of needed equipment and supplies and through support of the implementation of the CAC/PAC guidelines, norms, and procedures.

South Africa

In South Africa, Pathfinder worked with the Eastern Cape Department of Health to build its capacity to improve access to and quality of youth-friendly comprehensive abortion care. There are significant social and structural barriers to accessing safe abortion services in South Africa, including stigma associated with abortion, misunderstanding of the legal status of abortion, few service providers, and limited supplies. Pathfinder is one of the few organizations providing youth-friendly CAC services in South Africa, and its comprehensive approach addresses the factors that prevent young people from seeking services and improves the quality of those services. The project’s successful integration of family planning was witnessed by the close to 100 percent acceptance of an FP method by clients who come for services. Apart from this, other services were also made available to clients such as HIV counseling and testing, sexually transmitted infection screening, and gender-based violence screening with appropriate referrals. The successful collaboration with the Eastern Cape Department of Health led to the adoption of Pathfinder’s facility baseline assessment tool and expanded services to four sites: Empilweni, Nontyatyambo, Idutywa, and Elliotdale.



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Related Publications

June 2013

Securing Equitable Access to Comprehensive Abortion Care in South Africa: Technical Update

This technical update discusses Pathfinder South Africa’s experience supporting youth-friendly comprehensive abortion care service delivery in public sector facilities, providing recommendations for future such efforts.

November 2012

Driving Innovation in Sexual and Reproductive Health

In 2012, Pathfinder went where the need was greatest—the places where women, men, and young people must fight every day to defend their sexual and reproductive health and rights. This annual report explores our successes during fiscal year 2012.

October 2012

Support for Scale-Up of Comprehensive Abortion Care in Northern Ghana-Technical Update

This technical update discusses Pathfinder's global CAC approach and experience in Ghana, as well as the government's recent endorsement to scale up the approach in the north.

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