Erin Worden

Erin Worden (NYU Wagner)| Ipas| Nairobi, Kenya

Here’s the unlikely and welcome headline from my summer: radical feminism and humanitarianism can and should co-exist.

The Ipas, Ibis, and community-level leaders who I worked with this summer have demonstrated that, in the right hands, humanitarian aid – a space not known for its liberation thinking, programming, and practice – can indeed work toward more equitable, dignified lives for women and girls worldwide.

Working within the confines of aid-as-we-know-it, I was struck by the radical elements of our work: the harm-reduction approach, conversations centering on structural access, and the creation of partnerships enabling women and girls to support each other during abortions.

Arguably most radical of all, I am struck by the abortion-seekers in Kakuma themselves. In performing their own abortions, these women and girls reinscribe their agency; insist on the inherent political nature of their bodies and lives; and lend solidarity to the global struggle for gender-liberated communities. These refugee women and girls have rights to safer abortions and are entitled to the tenets of Reproductive Justice. It’s my hope that this summer’s work inched closer, even if incrementally, to creating an eco-system where these rights can be claimed, fulfilled, and even celebrated.

_________________

Women are builders of society. We are the ones who are going to build it. You know why? We have no choice. Either you shut up, and you are humiliated, or you do what I’m doing. You scream. – Fatema Mernissi (Moroccan sociologist, author, and radical feminist)

Erin Worden (NYU Wagner) | Ipas | Kenya

The way we talk about self-managed abortion (SMA) in the humanitarian space is changing – and for the better.

Long-standing discourses around abortion care in the humanitarian sector have historically failed to fully recognize SMA, in which pregnant people induce their abortions outside of clinical settings. These traditional discourses instead emphasized “safe” and “unsafe” abortion, centering the medicalization of abortion over the autonomy and efficacy of the pregnant person.

Thanks in large part due to the growing evidence base around the efficacy and availability of medication abortion (notably misoprostol and/or mifepristone), abortion discourses in the humanitarian world now hold more space for SMA.

Within recent years, the World Health Organization shifted to formally acknowledging self-administered abortions, often referred to as “self-care,” occurring outside of clinical healthcare spaces and published guidelines for embracing SMA in interventions.

Humanitarian INGOs, too, are gradually embracing long-standing SMA practices. Médecins Sans Frontières and International Rescue Committee, for example, recently recognized the unique potential of SMA in humanitarian settings where fragile health systems, disruptions to contraceptive access, and upticks in sexual violence heighten risks of unwanted pregnancy.

This sector-wide discursive shift – from neglecting the radical act of SMA by dubbing it “unsafe” to now acknowledging the role of self-efficacy in terminating one’s pregnancy – reflects a harm reduction approach. If pregnant folks in emergency settings have long managed their abortions, creating abortion ecosystems that maximize SMA information, minimize risks, and make effective abortion methods such as MA more accessible promises to reduce maternal mortality.

In embracing SMA both as a radical, feminist act and an enduring, everyday approach to abortion, the humanitarian sector moves closer to elevating the personal and political agency of displaced women and girls worldwide.

Erin Worden (NYU Wagner) | Ipas | Kenya

In my first humanitarian job, I came across a disheartening statistic that the majority of humanitarian publications available online – including the fan-favorite report – essentially go unread. Only a bleak fraction of the reports is ever clicked, let alone read and used meaningfully.

Thankfully, Ipas is taking a different approach to self-managed abortion research.

Enter human-centered design (HCD) – an iterative, innovative problem-solving process that starts and ends with the people we are designing for, pregnant women and girls in humanitarian settings who are performing their abortions.

Preparing for an HCD workshop this fall is the focus of my work with Ipas. I am working alongside a network of top-notch regional and community-based organizations in Kenya to create a multi-day, contextualized HCD workshop. The workshop will involve activities, visuals, and conversations that will enable community participants, from refugee women to local NGO workers, to generate an output that uniquely solves abortion information and access challenges in Kakuma.

The output, whatever it may be, will be uniquely tailored to the specific challenge abortion seekers are facing. This is the great purpose and potential of HCD in sexual and reproductive health and rights programming.

Erin Worden (NYU Wagner) | Ipas | Kakuma, Kenya

The ability to control one’s fertility is a human right – inalienable, indivisible, interrelated, and uneven in its access.

Few populations are as familiar with the barriers and opportunities of reproductive agency as pregnant people living in humanitarian settings. The United Nations (UN) estimates that 55% of maternal deaths globally and 38% of stillbirths occur in countries with active UN humanitarian response plans. Pregnant people in emergency settings are at heightened risk of death, including from unsafe abortion.

This summer, I will be partnering with Ipas, a global NGO dedicated to advancing sexual and reproductive health and rights (SRHR) by expanding access to abortion and contraception. Seeking to enable safe abortion ecosystems globally, Ipas is motivated by a commitment to Reproductive Justice – a rights-based framework created by Black women to illuminate the reproductive needs of women of color, trans people, and other marginalized pregnant people.

As a graduate student at Wagner and early-career humanitarian, I will be supporting the final months of a multi-year, a multi-partner research project exploring self-managed abortion (SMA), which involves a range of methods – from traditional herbs to medication abortion – to end pregnancy without clinical supervision. The study is being piloted in two refugee communities: Bidibidi, Uganda, and Kakuma, Kenya. No known peer-reviewed evidence on abortion incidence and experiences in humanitarian settings exists, suggesting that this study fills a crucial knowledge gap that will enable humanitarian-development practitioners to better understand and meet the abortion needs of pregnant folks in humanitarian settings.

My work will involve drawing on findings from the study to inform high-impact, low-literacy visuals that will function as inputs for a user-centered design workshop in Kakuma. These inputs will be informed by my fieldwork in Kakuma refugee settlement, one of the world’s largest refugee camps. I look forward to leveraging the rights-based focus of the Gallatin fellowship to center positionality, equity, and impact in opportunities to advance Reproductive Justice for refugee women and girls.