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Assessing self-managed medication abortion in humanitarian and fragile settings

With funding from the Canadian Partnership for Women’s and Children’s Health, CRHC is working with program partners in Asia, Latin America, the Middle East, and Sub-Saharan Africa as well as with the University of Ottawa and the National Abortion Federation Canada to understand data collection practices and programmatic interventions related to self-managed abortion. 

Developing sustainable supply chains of mifepristone

In collaboration with the University of Ottawa, CRHC is working with program partners in multiple regions to develop sustainable supply chains for mifepristone using the UNFPA Reproductive Health Kits system. 

Establishing and evaluating safe abortion referral programs in conflict-affected settings 

In 2017, CRHC completed an evaluation of our initiative to develop and scale-up a referral program to link women from Burma with legal and safe abortion care in Northern Thailand. This project is now integrated into the activities of community-based organizations in Chiang Mai. We are now seeking funding to replicate the project in the DRC, Jordan, Lebanon, and Malaysia.

Evaluating the community-based distribution of misoprostol for early induced abortion 

In 2017, CRHC completed a three-year evaluation of the outcomes associated with the community-based distribution of misoprostol for early pregnancy termination. We have now published several papers about the initiative and women’s experiences using misoprostol through these Networks. We are now expanding this initiative to other countries in Asia and Sub-Saharan Africa.

Providing online information about medication abortion

In 2003, Ibis Reproductive Health launched, one of the first multi-lingual online resources dedicated to medication abortion. CRHC now partners with Ibis Reproductive Health to update and maintain the website and introduce interactive, user-friendly features to expand the reach of this global resource. The website is currently available in Arabic, Burmese, English, French, Persian, Spanish, Turkish, and Portuguese. The site provides medically accurate and evidence-based information about three different medication abortion regimens to researchers, health service providers, and abortion seekers considering the option of medication abortion for early pregnancy termination. The website receives more than one million visitors each year from more than 200 countries and territories. We have ongoing plans to launch additional language versions of the medication abortion website in the future. 

Providing technical assistance to the World Health Organization

CRHC is leading a multi-country study for the WHO on collecting sexual and reproductive health data and indicators in humanitarian settings. The overall project includes fieldwork in Afghanistan, Bangladesh, the Democratic Republic of the Congo, and Jordan.

Reimagining humanitarian assistance

In 2019, CRHC finished a white paper envisioning a feminist humanitarian aid and assistance framework, specifically from the viewpoint of bi-lateral donors, international NGOs and civil society organizations. This work included desk reviews, interviews, and collaborations with civil society organizations in Jordan and Liberia.

Understanding the efficacy of abortion medications at very, very early gestation

In 2019, CRHC conducted a scoping review to explore the efficacy and safety of medication abortion drugs at days 28-35 LMP. In addition to consulting peer-reviewed and grey literature, we analyzed a dataset from Women Help Women and interviewed key stakeholders. This project is part of a larger effort to identify strategies to demedicalize medication abortion and expand access to safe and effective technologies.


Middle East and North Africa

Assessing the availability, accessibility, and acceptability of emergency contraception in Tunisia

In 2001, Tunisia became the first country in the Arab world to register a dedicated emergency contraceptive pill (ECP). However, little research has been undertaken to systematically evaluate the service delivery and use patterns of ECPs in Tunisia. Through this multi-methods study, CRHC assessed the availability, accessibility, and acceptability of EC in Tunisia and focused on the perspectives and experiences of pharmacists and both married and unmarried women. This project was undertaken in partnership with the Tunisian Center for Public Health, Ibis Reproductive Health, and the University of Ottawa.

Documenting the experiences of Yazidi women abducted by ISIS 

In 2020, CRHC completed a qualitative exploratory study dedicated to Yazidi women’s experiences while in captivity. We were asked to conduct this study with an Iraqi community-based organization in order to help them develop and evaluate a culturally appropriate clinical and psycho-social intervention. 

Expanding access to emergency contraception among Syrian refugees in Jordan 

CRHC recently completed a series of studies dedicated to emergency contraception in Jordan. Our baseline research informed the development and implementation of trainings for the largest reproductive health service provider to Syrian refugees in Jordan and incorporation of emergency contraception into their standard of care protocols. 

Preventing and responding to early marriage in Jordan 

With a number of local partners in several areas of the country, CRHC is engaged in a multipronged initiative to prevent and respond to early marriage among both Syrian refugees and Jordanians. We are now in the process of evaluating the interventions. 

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North America

Creating a white paper on misoprostol-alone in the US 

In 2018 CRHC completed a white paper examining both legal and practice barriers to increasing access to misoprostol-alone in the US. The research identified strategies for policy makers, advocates, and clinicians to protect and expand access to misoprostol in an environment of greater restrictions on access to clinic-based, legal abortion.  

Documenting the abortion experiences of US Peace Corps Volunteers

Between 1979 and 2014, a US federal appropriations bill restricted the coverage of abortion for Peace Corps Volunteers. There were no exceptions to the coverage ban, and abortion care was not covered under any circumstance. This large-scale qualitative study documented women’s experiences obtaining abortion care while in service under these restrictions and identified ways in which reproductive health services could be improved. 

Expanding access to medication abortion in the US

The Massachusetts Medication Abortion Access Project uses an asynchronous telemedicine platform to provide medication abortion care to abortion seekers throughout the US. CRHC is leading this coalition of providers, researchers, and activists. 

Exploring women and pregnant people’s experiences with medication abortion

CRHC is leading a large-scale qualitative study on medication abortion in the US. We are recruiting participants from any state who have had an abortion using mifepristone (with or without misoprostol) since 2017. The aim of this project is to give voice to people’s lived experience with medication abortion, in general and in different states, in the evolving legal landscape.

Framing very early access to uterine evacuation medicines

CHRC is leading a multi-year qualitative research study on framing liminal interventions which ensure a state of non-pregnancy when one is suspected but not confirmed (i.e. missed period pills, menstrual regulation, or “pushing” or “bringing down” a period).

Providing technical and fundraising assistance to expand access to safe abortion in Missouri

CRHC provided fundraising and technical assistance to local advocates in Missouri, who are working to improve access to safe abortion in a state where medication abortion is no longer available at all, and where adults can be subjected to punitive legal action for helping teens leave the state to seek abortion care elsewhere. CRHC consultants also developed a reproductive justice text service that helps pregnant teens access legal abortion, non-coercive adoption services, or advocacy if they choose to carry their pregnancies to term. 

Understanding telemedicine abortion strategy and expansion

In 2019, CRHC concluded a consultancy that assessed telemedicine laws, as well as abortion provider licensing, credentialing, and reimbursement policies in all 50 states. CRHC analyzed the research to provide strategies to our client to help guide expansion of telemedicine abortion in the US. 

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Southeast Asia

Assessing the reproductive health needs of Rohingya refugees in Kuala Lumpur, Malaysia

CRHC completed a multi-methods needs assessment to document the availability and accessibility of reproductive health services for Rohingya women and girls residing in Kuala Lumpur, Malaysia. We presented the findings to local stakeholders and are in the process of publishing the findings. We are actively seeking funding to work with local partners to implement the recommendations derived from the assessment. 

Conducting a reproductive health needs assessment in peri-urban Yangon, Myanmar

CRHC conducted a multi-methods needs assessment to understand the availability and accessibility of reproductive health services in the peri-urban Yangon region, explore women’s experiences and unmet needs, and identify mechanisms by which comprehensive service delivery can be improved. Informed by Separated by Borders, United in Need, we undertook this project in partnership with researchers at the University of Ottawa and the National YWCA of Myanmar.


Expanding access to long-acting reversible contraceptive methods on the Thailand-Burma border

The Mae Tao Clinic in Mae Sot, Thailand operates one of the largest and most comprehensive health facilities along the Thailand-Burma border. CRHC led a project to understand better the factors that influence uptake of long-acting reversible contraception (LARC) in this setting, including health worker biases and patient misinformation. As a result of the findings, we worked with partners to design and implement didactic and clinical trainings on patient-centered LARC care.

Improving young women's access to reproductive health education in Yangon, Myanmar

Building on the reproductive health needs assessment conducted by researchers at the University of Ottawa, the National YWCA of Myanmar and CRHC, this project aimed to address misinformation surrounding sexual and reproductive health among young and unmarried women in peri-urban Yangon, Myanmar. Through a series of participatory peer education training sessions, this year-long project aimed to build confidence, increase knowledge of sexual and reproductive health issues, and address misinformation that hinders access to available services and care. Building on the priorities and experiences of our peer education participants, we developed a series of reproductive health education resources, including comic books, tailored to the experiences and interests of young, unmarried women in peri-urban Yangon.

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