Providing technical assistance to the World Health Organization
CRHC is leading a multi-country study for the WHO 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, and may also include Cameroon and Iraq in the future.
Developing sustainable supply chains of mifepristone
As part of the Grand Challenges Canada program, and in coordination with the University of Ottawa, CRHC is working with program partners in Jordan, Niger, and Bangladesh to develop sustainable supply chains for mifepristone using a new UNFPA Reproductive Health Kits system.
Envisioning feminist 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.
Evaluating the community-based distribution of misoprostol for early induced abortion
In 2017, we 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 the Democratic Republic of the Congo, Nigeria, and Pakistan.
2018. “It is just like having a period with back pain”: Exploring women’s experiences with community-based distribution of misoprostol for early abortion on the Thailand-Burma border. Contraception. (Open access article)
2017. Community-based distribution of misoprostol for early abortion: Evaluation of a program along the Thailand-Burma border. Contraception. (October 2017 Atlas Award Nominee: https://www.elsevier.com/connect/atlas/nominations) (Open access article)
Providing online information about medication abortion
In 2003, Ibis Reproductive Health launched medicationabortion.com, 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 women 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 a Polish version of the medication abortion website in the future.
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. Our study aimed to fill this gap. Through this multi-methods study, we 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 and Ibis Reproductive Health.
Documenting the experiences of Yazidi women abducted by ISIS
We recently 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
We 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. After evaluating the impact of this effort we are now focusing on publishing the results.
Preventing and responding to early marriage in Jordan
With a number of local partners in several areas of the country, we are 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.
Establishing and evaluating safe abortion referral programs in conflict-affected settings
In 2017, we completed our 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 replicating our previous work in Jordan and seeking funding to replicate the project in Malaysia, Lebanon and DRC.
2017. To be, or not to be, referred: A qualitative study of women from Burma’s access to legal abortion care in Thailand. PLoS ONE. (Open access article)
2017. “Without this program, women can lose their lives”: Migrant women’s experiences with the Safe Abortion Referral Program in Chiang Mai, Thailand. Reproductive Health Matters. (Open access article)
2016. Establishing a referral system for safe and legal abortion care: A pilot project on the Thailand-Burma border. International Perspectives on Sexual & Reproductive Health. (Request article)
Studying women and pregnant people’s experiences with medication abortion
CRHC is conducting 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. CRHC has expanded this project to include anyone who had an abortion (using any medication or via procedure) in the US in the COVID-19 era. The aim of this project is to give voice to people’s lived experience with medication abortion, in general and in different states, and to access abortion care generally in the COVID-19 period.
Exploring 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). We are continuing ongoing projects to expand legal research, and to conduct education and outreach to reproductive justice groups around very early interventions using uterine evacuation medicines to ensure a state of non-pregnancy when menses are late and pregnancy is a possibility.
Providing technical and fundraising assistance to expand access to safe abortion in Missouri
CRHC is providing 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 are also developing a reproductive justice text service that will help pregnant teens access legal abortion, non-coercive adoption services, or advocacy if they choose to carry their pregnancies to term.
Consulting on 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 fifty states. CRHC analyzed the research to provide strategies to our client to help guide expansion of telemedicine abortion in the US.
Creating a white paper on misoprostol-alone in the US
In late 2018 CRHC completed a white paper examining both legal and practice barriers to increasing access to misoprostol-alone in the United States. 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.
2018. Strategies for protecting and expanding access to misoprostol in the United States. (Full report)
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 aimed to document women’s experiences obtaining abortion care while in service under these restrictions and identify ways in which reproductive health services could be improved.
2015. No Exceptions: Documenting the Abortion Experiences of US Peace Corps Volunteers. The American Journal of Public Health. (Request article)
Assessing the reproductive health needs of Rohingya refugees in Kuala Lumpur, Malaysia
This multi-methods needs assessment documented the availability and accessibility of reproductive health services for Rohingya women and girls residing in Kuala Lumpur, Malaysia. We have 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
Conflict in Myanmar has been ongoing for over 50 years and has led to massive population displacement, service disruptions, and shortages of trained health care workers. Reproductive health outcomes have subsequently suffered. Though the political landscape of the country has recently changed, many people fleeing volatile regions of the country have congregated in the slum settlements surrounding Yangon, Myanmar’s largest city. Little data exists on the health of women in this rapidly evolving area. This multi-methods needs assessment aimed 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.
2016. Dynamics Shaping Access to Reproductive Health Services in Peri-urban Yangon, Myanmar: A Multi-Methods Study. Global Journal of Health Science. (Open access article)
2016. "She Learned it from her Mother and Grandmother": Women's Experiences with Delivery and Post-Partum Practices in Peri-urban Yangon, Myanmar. Maternal and Child Health Journal. (Request article)
2015. “We can lose our life for the abortion": exploring the dynamics shaping abortion care in peri-urban Yangon, Myanmar. Contraception. (Request article)
2015. Near the City but Hard to Reach: A Reproductive Health Needs Assessment in Peri-Urban Yangon, Myanmar (Full report)
Expanding access to long-acting reversible contraceptive methods on the Thailand-Burma border
The risk of unintended pregnancy and subsequent unsafe abortion among women in Eastern Burma and refugees and migrants in Thailand is considerable. Identifying avenues for reducing unplanned pregnancy within this especially vulnerable population has been widely recognized as a public health, service delivery, and research priority. The Mae Tao Clinic (MTC) in Mae Sot, Thailand operates one of the largest and most comprehensive health facilities along the Thailand-Burma border. This project aimed to understand better the factors that influence uptake of long-acting reversible contraception in this setting, including health worker biases and patient misinformation.
2015. Assessing the experiences of intra-uterine device users in a long-term conflict setting: a qualitative study on the Thailand-Burma Border. Conflict and Health. (Open access article)
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.
2016. Snakes, Ladders, and Information about Sexually Transmitted Infections: Evaluation of a Peer Educator Training on the Thailand-Burma Border. Global Journal of Health Science. (Open access article)