STARS: Strengthening Abortion Research Capacity in sub-Saharan Africa
A collaborative research initiative focused on assessing and improving comprehensive abortion care and sexual and reproductive health services in Mali. The project was a partnership between the International Center for Research on Women (ICRW) and the Center for Vaccine Development-Mali (CVD-Mali).
overview
The Strengthening Abortion Research Capacity in sub-Saharan Africa (STARS) Mali project aimed at enhancing and improving reproductive healthcare in Mali.
The project addressed the significant challenges faced by public health facilities in providing comprehensive abortion care (CAC) and post-abortion care (PAC), an area often overlooked due to its sensitive nature. By fostering in-country research capacity and generating robust, nationally-driven evidence, STARS sought to improve sexual and reproductive health and rights (SRHR) for women and girls in Mali.
The partnership between CVD-Mali and ICRW ensured that the research was not only technically sound but also culturally appropriate and sustainable, with a strong emphasis on building local expertise. The project also addressed the impact of the COVID-19 pandemic on SRH services, providing valuable insights for future public health emergencies.
OBJECTIVES
The project had two primary objectives:
- To identify barriers and challenges: To understand the barriers and challenges to the provision of quality comprehensive abortion care services.
- To assess facility readiness: To investigate how equipped public health facilities in Mali are to deliver comprehensive abortion care and post-abortion care.
Details
Aim
The overarching aim of the STARS Mali project was to contribute to a critical mass of skilled abortion researchers in Africa, boosting the number and quality of abortion studies in the region. Ultimately, it sought to advance the availability of robust, nationally-generated evidence to improve SRHR and the well-being of women and girls in Mali. The project specifically sought to understand how equipped public health facilities are to deliver comprehensive abortion care in Mali and to identify the barriers and challenges to providing quality comprehensive abortion care.
Scope
The study took place in three regions of Mali: Kita (western Mali), Koutiala (southeast Mali), and Bamako (the capital city district). It involved assessing 51 public health facilities, including Community Health Centers (CSComs), Reference Health Centers (CSRefs), and Hospitals. Data collection involved both health facility assessments and in-depth interviews with various stakeholders.
Timeline
The project spanned multiple phases, from initial capacity building and situational assessments to data collection, analysis, and reporting. Key milestones included:
- February 2023: Project completion and submission of the end-of-project report.
- January – December 2020: In-country planning, assessment of abortion research team needs, and development of training materials.
- December 2020 – March 2021: Initial qualitative research activities, including NVivo software training, and transcription and translation of in-depth interviews.
- January – June 2021: Development and finalization of codebooks for NVivo analysis, and preparation for data analysis.
- July – September 2021: Completion of data analysis for the COVID-19 impact study and drafting of an academic paper. Preparatory work for the principal STARS research project (comprehensive abortion care assessment) also progressed.
- December 2021 – February 2022: Contextual analysis, including research risks and optimization of interview techniques, and a desk review of West African abortion research.
- October – December 2022: Completion of health facility data collection.
- February 2023: Project completion and submission of the end-of-project report.
Implementation
The implementation of the STARS project involved a mixed-methods approach. Health facility assessments were conducted using a tool based on the Ministry of Health and Social Affairs’ national health center evaluation tool. In-depth interviews were conducted with SRHR providers, including nurses, midwives, doctors, pharmacists, and community health workers, as well as facility-based supervisors and, where possible, clients of these services. Extensive training was provided throughout the project. The emphasis on maintaining strict confidentiality and anonymity for all participants and facilities was paramount and respected throughout all stages of the study.
Oversight
The STARS project was jointly overseen by the International Center for Research on Women (ICRW) and CVD-Mali. Regular progress and budget narrative reports were prepared and shared with donors. The project also involved key officials from the Ministry of Health and Social Affairs and regional health directorates in Mali, ensuring governmental alignment and support for the research findings and potential policy changes.
