Think | BIG: Shared View

Behavior Profile: USAID MCGL - Policymakers Establish Clear PAC Policies

	Health Goal	Health Goal: Reduce repeated unintended pregnancy
	Behavior	Policymakers establish clear national policies and guidelines that promote and support comprehensive postabortion care Existence of/number of policies and guidelines that promote access to comprehensive PAC

Behavior Analysis			Strategy
BEHAVIOR AND STEPS What steps are needed to practice this behavior? Behavior Policymakers establish clear national policies and guidelines that promote and support comprehensive PAC Steps Review sample/exemplar PAC policies Assess current PAC policy Review other laws, policies, and guidelines (e.g., FP service delivery, law enforcement) that potentially impact access to, use of, or delivery of PAC Draft or revise policies and guidelines as appropriate Establish indicators for measuring policy implementation and quality of care Follow the required approval processes for establishing policies and guidelines Disseminate the new/updated policies and guidelines at all health system levels and to the public Monitor implementation of the new/updated policies and guidelines	FACTORS What factors may prevent or support practice of this behavior? Structural Accessibility: Policymakers are more likely to establish PAC policies and guidelines when there is sufficient funding and health system capacity to implement them Service Experience: Policymakers can more easily establish clear policies and guidelines when the need and urgency for them are (broadly) felt in the national and policymaking arena Social Norms: Policymakers sometimes establish PAC policies because they know that they will have to present their country's progress in front of their peers from other countries Norms: Policymakers do not establish policies and guidelines that promote comprehensive PAC because of socio-cultural norms and religious and moral beliefs that reject PAC because of its association with abortion (A MOST CRITICAL FACTOR TO OVERCOME) Internal Attitudes and Beliefs: Policymakers do not establish clear policies and guidelines that promote PAC because of abortion-related stigma (A MOST CRITICAL FACTOR TO OVERCOME) Attitudes and Beliefs: Policymakers are guided by political considerations (such as opposition to contraception and abortion) rather than by evidence of what works to reduce maternal mortality (A MOST CRITICAL FACTOR TO OVERCOME) Attitudes and Beliefs: Policymakers do not establish clear policies and guidelines because they perceive the issue as relatively less urgent or important than other issues Self-Efficacy: Policymakers do not establish clear policies and guidelines because they lack confidence in their ability to drive a big policy push in this area Knowledge: Policymakers establish clear policies and guidelines because of evidence that postabortion care can be feasibly and safely provided at lower-level facilities by midlevel providers Knowledge: Policymakers do not establish clear policies and guidelines because they themselves are not clear about current laws and policies about or that impact PAC	SUPPORTING ACTORS AND ACTIONS Who must support the practice of this behavior, and what actions must they take? Institutional Managers: Advocate for clear policies and guidelines and their implementation through district health offices Development Partners: Provide funding and technical assistance for PAC policy and guideline review, revision, implementation, and monitoring Development Partners: Convene action-oriented fora for countries to share PAC progress and learning, including as it pertains to adolescents Development Partners: Advocate/support advocacy for adequate funding and policy/guideline development capacity and for close monitoring of policy implementation NGOs: Speak with communities about the critical need for PAC Medical, Nursing, and Pharmacy Associations: Participate in analysis of relevant policies, laws, and guidance and how they impact PAC, including adolescent access to quality, affordable care Medical, Nursing, and Pharmacy Associations: Organize members to meet with policymakers and opinion leaders about the ethical imperative of providing quality PAC to women and adolescents, challenges faced, effective solutions (e.g. task-shifting), and policymakers' role in enabling such solutions Medical, Nursing, and Pharmacy Associations: Actively disseminate PAC policies and guidelines to members and non-members, engaging them in discussions, problem-solving, identification of training and advocacy needed, etc. about the policies and guidelines and their implementation and monitoring Medical, Nursing, and Pharmacy Associations: Generate broad support among members for policy advocacy and community-level support Community Community Leaders: Advocate strongly for clear PAC guidelines and policies, full funding of PAC at all service levels, and accountability through regular monitoring and reporting Religious Leaders: Share with congregants information about the role of PAC in saving lives and reducing demand for abortion	POSSIBLE PROGRAM STRATEGIES What strategies will best focus our efforts based on this analysis? Strategy requires Communication Support Enabling Environment Financing: Provide financial and technical support for policy, guideline, and indicator development, review, revision, and introduction Partnerships and Networks: Foster collaboration between policymakers and health professional associations (national and international) on the design, shepherding through the policy process, and implementation of PAC-promoting policies and guidelines Partnerships and Networks: Create alliances with powerful groups such as unions and professional associations based on shared values or interests Partnerships and Networks: Partner with groups advocating for gender equity and youth engagement in politics to include supportive PAC policy and increased access to quality PAC in their policy and advocacy agendas Policies and Governance: Conduct a review of all laws, policies, and guidelines that impact PAC, especially for adolescents Policies and Governance: Organize regional fora where Ministers of Health and others discuss and commit to developing, implementing, monitoring, and continuously improving PAC policies, guidelines, and programs as an essential part of achieving SDG 3â€”reducing maternal mortality Norm Shifting: Undertake efforts to make comprehensive PAC a routine part of maternal and reproductive health care and seen by communities, providers, and policymakers as such Demand and Use Advocacy: Provide financial and technical support to professional association and local/national NGO advocacy efforts on the urgent need for PAC policy, guidelines (task-shifting, provider performance guidelines, monitoring, etc.), and legal reform needed to promote provision and use of quality PAC Advocacy: Identify policy champions (from within and outside the health sector) and messages to position PAC as a cost-effective, compassionate, ethical, life-saving response to women and adolescents in difficult circumstances and an essential part of reducing maternal mortality Advocacy: Focus PAC advocacy at local or regional levels as possible and necessary to avoid polarization by party elites and other powerful influencers Communication: Bring together partners who are committed to increasing access to quality PAC through the design and testing of new interventions that carefully research and prioritize key actors, including policymakers, community and religious leaders, communities, and others in order to influence social norms Communication: Use events and mass media to build empathy for and destigmatize PAC for women and adolescents, for example by highlighting the experiences of women and adolescents who did not have access to quality PAC Communication: Draft sample policies and guidelines that include the evidence base for private-sector PAC through pharmacies and private clinics Communication: Create fora (online- and in-person) for south-to-south policymaker sharing of progress and problem-solving around stigma reduction, policy design, task-shifting, quality improvement, adolescent-friendly care, financing, agenda-setting, and other key PAC topics (or include such discussions in existing fora) Collective Engagement: Implement the WHO Strategic Approach to strengthening sexual and reproductive health policies and programmes to develop consensus and take action on improving PAC policy (see https://tinyurl.com/hnh26pth) Collective Engagement: Support local NGOs to organize community engagement around the need to demand quality PAC for all who need it, including adolescents Skills Building: Provide PAC advocacy training to Ministers of Health and other potential champions within ministries of health, finance, women, youth, and justice Research: Provide the evidence base for comprehensive PAC for women and adolescents (e.g., through data analysis, demonstration programs)

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