BACKGROUND/OBJECTIVES
This presentation showcases results from a policy advocacy intervention to clarify and activate guidelines governing women's access to safe abortion in Lagos State, Nigeria. Until 2011, access to safe abortion was governed by a 95-year-old state law that only permitted abortion to save the life of the woman but was updated that year to also allow abortion to protect her physical health. Service providers were still reluctant, however, to do more than offer postabortion care. Through the intervention, stakeholders influenced the Lagos State commissioner of health to require public health facilities to provide safe abortion services to the full extent allowed by law.
MATERIALS AND METHODS
Evaluators used contribution tracing-a technique that links outcomes through a causal chain of events produced by an intervention-to evaluate the intervention, which featured a locally led organization establishing an expert task force to co-create an advocacy video and implement a dissemination strategy. Contribution tracing combines elements of process tracing and Baynesian probability updating to evaluate a well-articulated causal path.
RESULTS
Evaluators confirmed that the intervention influenced the commissioner's decision to issue an official memorandum clarifying the conditions under which medical staff could legally provide an abortion. Evidence supported each step in the articulated causal chain: the commissioner chaired the task force, participated in policy dialogue, was exposed to updated information on safe abortion and the need to educate public health facilities, all leading him to issue a memorandum for that purpose.
CONCLUSIONS
Evaluating policy change is difficult yet necessary to help advocates demonstrate the impact of their work and understand which factors influence policy change. Contribution tracing is an important tool; applying it to reproductive health interventions can generate documented policy impacts and help make the case for investing in advocacy activities to strengthen the policy environment for reproductive health.
