In order to curtail the prevailing restrictions concerning abortion, many women resort to private clinics to have an abortion or use traditional methods at home, this constitutes a severe health risk.
Unfortunately, the weakness of the governmental and non-governmental awareness programs and policies regarding unsafe abortion, coupled with limited access to FP methods, are main contributing reasons for this increasing phenomenon, especially in refugee camps. Socio-economic conditions in the camps are generally poor with a high population density, cramped living conditions and inadequate basic infrastructure. The West Bank covers 5,500 square kilometers with an estimated population of 1.8 million. Approximately, one quarter of the refugees live in nineteen recognized refugee camps and the majority live in West Bank towns and village

In Palestine availability of data on the incidence and condition under which the abortion is performed, which impacts the quality of advice and the services by who ever is willing to perform the procedure consider as main constrain in our work.

The project was implemented through the PFPPA clinics during the year 2006, on the dangerous of unsafe abortion and how to minimize the incidence, in addition to post abortion counselling about the using of different types of contraceptive in order to avoid unwanted pregnancy.

Project description (including achievements)
As a result of information collected from the field visits for our clinics in different areas in Palestine & through the community outreach sessions PFPPA identified a lack of information upon the community especially women on abortion related issues.

And due to this sensitive issue PFPPA thought of producing a video cassette in a simple way showing the cases of women who had an abortion, the physiological implications and complications linked to of unsafe abortion on having unsafe abortion. The MAs health educator, legal advisor and counselor talked about abortion from their perspective (legal and medical) and real clients were asked to talk about their experience. The medical doctor of Bethlehem clinic gave some information about what to do to make a safe abortion, then the legal counselor talked about legal issues according to the MOH & Palestinian law, and the social worker talked about supporting the clients psychosocially and try to help them in the individual counseling sessions.

PFPPA started collecting the data from the clinics about the cases coming for post abortion services for the video. At the beginning it was very difficult to convince the clients to appear on a video tape talking about their individual experience with unsafe abortion although they were told that their faces would be hidden. Finally, two clients agreed to speak about their experience. A 20 minutes video was filmed in collaboration with Bethlehem Television and the MA staff prepared the material for the video.

A client talked about her experience trying to terminate an unwanted pregnancy because of her economic status by using traditional methods (putting the gas bottle which is a heavy metal on her abdomen, letting her children jump on her abdomen which caused her bleeding and complications). Another client said that she had an unwanted pregnancy because she didn’t use family planning methods. She was scared that they could provoke infections, bleeding and reduce her fertility. She was getting pregnant almost every year and recurred to many unsafe abortions until she got sick due to bleeding. She was very weak and came to PFPPA clinic since during an awareness session she heard that the MA team talked to the community about family planning methods and emergency contraceptives. PFPPA doctor gave her appropriate counseling and convinced her to insert an IUD. She became a regular client.

At the end of the video cassette PFPPA counselor introduced the various family planning methods, emergency contraception and methods to prevent unsafe abortion.

Achievements
The video was then used in PFPPA clinics and refugee camps where the MA is working during awareness sessions. This video was also distributed to other GOs & NGOs working in the same field and will be used by the Innovation Fund team during their community awareness sessions, trainings, meeting with decision makers, and religious people to advocate for women rights related to reproductive health.

12 workshops were conducted in refugees’ camps about dangers of unsafe abortion and prevention methods by using the video followed by discussion. 265 beneficiaries assisted to the sessions (aged 17 – 50 years). Women liked this approach and they learned a lot from the cases. The project team noticed that in the north camps people need more sessions. People in villages around the camps heard about the project and the video and asked the team to have the chance to see it. MA staff arranged sessions for them. Local women said that no body in the area talked about these issues and they see it very important and every one have a case of a woman they know that had unsafe abortion.
 
In the southern camps and especially because PFPPA have access in the areas, the attendances were more familiars with the topics and they heard about SRH issues but they see the video as new style and very effective methods to spread information between the communities.

During the session the field coordinator gathered information about the attendance responses toward these sensitive issues and recorded some interviews with the participants asking them about their feelings, point view and what benefit they got from the video. PFPPA will do a video with this material and use it as an advocacy tool.

Constraints

• It was not easy to find women that wanted to talk about their experience. The subject is taboo in Palestine. However, since the women were MAs clients and knew how much the MA stresses on the importance of confidentiality they were willing to open themselves and help other women
• The sensitivity of the issue and the new situation that rose after Palestinian elections makes the NGOS hesitate to collaborate in the field of abortion

Partnership

• MA will work in partnership with other organisations to have a greater impact
• UNRWA will be a strategic partner to be able to reach women in refugee camps
• The expertise of the Bethlehem TV was instrumental in having a good quality video

Lessons learned

•  This topic is sensitive in Palestine and in order to be able to reach women is important to stress on the fact that unsafe abortion can affect women’s health
• To have a greater impact is important to establish partnerships with other organizations working in the field.

Changing lives

The following cases are samples from the interview and they represent the areas from the north to the south, the cases express their feelings toward abortion and how this video touches their inside.

1. Abeer, from a camp in the south, 33 years old: “I was fascinated by the video and the PFPPA programme in general. The information in the video was very important for me, I got married when I was 15 years old, and no body prepared me for this new life and gave me information about marriage, children, and contraceptive methods and how to avoid pregnancy. I had recurrent abortions and no body told me how to prevent this problem. I will now talk to my daughter and raise her awareness her about this issue that may put her life in danger and as women we have to believe in our rights!”
2. Nawal, 38 years old, said: “I always attended sessions related to reproductive heath, but this is the first time I attend session about unsafe abortion. The video tackled it in a very nice way and acceptable to every one. Nothing in the video is against our believes and religion, all what was presented is in the real life and we are ashamed to talk about it in public. The video talked about the problem and gave us the solution at the same time. It was the first time I heard about emergency contraception and we can use it as married women in our life especially because most of the women who aborted did it at home with traditional methods and threaten their life”
3. Rghda 29 years old , said "I liked the idea to tackle a sensitive issue by using the video in the same time the information was valuable and comprehensive and the methodology was very simple and understandable. We learned about abortion from different point of views as well as on family planning methods and the emergency contraception. This is a new methodology and it is very effective. I would like to thank the team for their efforts in explaining each point and their elaboration on size of the problem. I now realized from the discussions that the size of the problem is big but we don’t talk about it”.
4. Manal, 30 years old, living in a refugee camp in the north saw the video and found it very helpful, she had unsafe abortion in the past without knowing that it could affect her. “ I believe I am a victim of the community culture and believes. I was touched seeing the video and can see myself using traditional methods for abortion. I will never forget it and from now I will talk about this problem with every woman I know. I believed that this was only my problem and did not know that other women had the same experience. I now realize that it is a big problem among the women and it is very important to spread this valuable information within my community”.