Abortion stigma affects everyone: individuals, communities and service providers. Young women and adolescent girls bear the brunt of abortion stigma. It causes delays in people seeking abortion and stops others from accessing it, leading to unintended pregnancies. Stigma drives abortion underground, where it is more likely to be unsafe. Since 2014, the support of the David & Lucile Packard Foundation has enabled IPPF to reduce abortion stigma affecting young people around the world, working directly with Member Associations in six countries (Bénin, Burkina Faso, India, Pakistan, Ghana and Nepal). Meaningful youth participation has ensured that young people’s lived experiences were central in every aspect of this work. This project has also supported smaller ground-breaking youth-led projects in 14 different countries: Albania, Colombia, Ghana, Guinea, Kenya, Macedonia, Nepal, Nigeria, Palestine, Puerto Rico, Sierra Leone, Spain, Tanzania and Venezuela. This document highlights the achievements and learnings from the Abortion Stigma Project between 2014 and 2020, including case studies, research and evidence generated around abortion stigma, and popular resources and tools developed throughout the project, and more. We invite you to read more on this ground-breaking work in Reducing Abortion Stigma: Global Achievements since 2014

During the COVID-19 pandemic, women globally face compounded barriers to accessing safe abortion care. The de-prioritization of sexual and reproductive health services including abortion care, overwhelmed health systems, restrictions on movement and fear of visiting health facilities have all created additional challenges for women to safely end a pregnancy. However, recognizing the need to adapt to ensure women have access to the care they need, this crisis has sparked innovation among IPPF Member Associations. They developed new approaches to reach women with safe abortion information and care, while keeping women’s choice and quality of care at the centre of their work.  This document illustrates some of the innovative approaches used to ensure continued access to quality abortion care during the pandemic.  

In 2018, IPPF endorsed the WHO/UNFPA Call to Action to Attain Universal Health Coverage Through Linked Sexual and Reproductive Health and Rights and HIV Interventions.13 This IMAP statement serves as a reminder of this call to action to ensure all people have access to comprehensive SRH services, including integrated contraceptive and HIV/STI services, provided through primary healthcare.

Since the early 1990s, the evidence has been inconclusive as to whether using hormonal contraception increases women’s risk of acquiring HIV, particularly among progestogen-only injectable users. Observational studies indicated that women using progestogen-only injectable contraceptive methods may be at higher risk of acquiring human immunodeficiency virus (HIV).  The Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial finds no link between HIV acquisition and the use of DMPA-IM, progestogen implant, and non-hormonal copper IUD. For more information please see the technical brief on the ECHO trial.  Following the release of the result of the ECHO trial and the WHO latest guidance statement and revised Medical Eligibility Criteria (MEC) for contraceptive use, IPPF developed a follow-up technical brief to support IPPF MAs and frontline service providers’ work regarding the provision of the integrated contraceptive, HIV and other STI programmes to expand access and contraceptive choice. For more information, please see the attached technical brief After the ECHO trial – Expanding access and choice through integrated services, available in English and French.

The body of evidence on possible increased risk of HIV acquisition with use of progestogen‑only contraception has remained mixed since 1991, with the greatest concern of an increased risk of HIV acquisition centred on the use of intramuscular depot‑medroxyprogesterone acetate (DMPA‑IM). Data on the risk of HIV acquisition and use of other highly effective contraceptives such as norethisterone enanthate (NET‑EN), hormonal implants, and hormonal and non‑hormonal IUDs are limited.2 And there are no data on subcutaneous DMPA (DMPA‑SC) and HIV risk.  In 2016, an updated systematic review of epidemiological evidence on hormonal contraception and HIV acquisition concluded that there was a significant association between the use of DMPA and HIV acquisition and no increased HIV risk with oral contraceptive pills.3 The updated systematic review provided important data regarding DMPA users at high risk of HIV; however, confounding in these observational data could not be excluded. The historically mixed data and the need to control for confounding required further investigation into the association between use of progestogen‑only injectables and increased risk of HIV acquisition, using a more robust research design. This led to the development of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial.  

Since the early 1990s, the evidence has been inconclusive as to whether using hormonal contraception increases women’s risk of acquiring HIV, particularly among progestogen-only injectable users. Observational studies indicated that women using progestogen-only injectable contraceptive methods may be at higher risk of acquiring human immunodeficiency virus (HIV).  The ECHO trial finds no link between HIV acquisition and the use of DMPA-IM, progestogen implant, and non-hormonal copper IUD.