Providing Safe Abortion in Rural and Low Resource Settings

This session on providing safe abortion in rural and low-resource settings explores service delivery bottlenecks and discusses ways to expand access to safe abortion by highlighting innovative success stories enabling this access.

Francis Makiya is a medical doctor currently working as the District Medical Officer for Mwanza District in Malawi. He has interests in strengthening health systems, health rights, and policy advocacy. He is a board member of the International Network for the Reduction of Abortion Discrimination and Stigma (inroads). He has been volunteering with the Coalition for the Prevention of Unsafe Abortion (COPUA) in Malawi for the past eight years advocating for change to reform restrictive abortion laws. He served as the founding chairperson for Medical Students for Choice (MSFC) – Malawi chapter.

Francis Makiya

Francis Makiya, District Medical Officer for Mwanza District, Malawi


In Malawi, abortion is legally restricted. There is only one medical school with around 700 medical doctors working in government serving 19 million people. Maternal mortality is high at 439 deaths by 100,000 live births, and abortion-related death is among the top 5 causes of maternal death. Misoprostol is available; however, accessing a prescription is a challenge and requires secret referral systems where private clinics and NGOs conceal the actual reason for the prescription.


Providing safe abortion remains a challenge in rural and low-resource settings like Sub-Saharan Africa, where less than 97% of abortions performed are unsafe. Rural and low resource settings are typically poverty-stricken and have poor health systems and weak governing institutions. Individual, community, and systemic factors often limit access to safe abortion. 


Advocacy in rural and low-resource settings requires influencing local leaders and decision-makers and building an environment conducive to enabling people to exercise their rights by changing laws and policies. Collaborating and networking with grassroots movements and local and regional organizations is crucial to accessing technology and networks. The Harm Reduction model is a valuable tool to reach underserved rural communities and reduce public health risks as seen through telemedicine examples include HowToUseAbortionPill, Women on Web, Hesperian Health Guides, Aunty Jane Hotline (0800-721530), and the Ipas Health Link