You are currently using an unsupported browser which could affect the appearance and functionality of this website. Please consider upgrading to the latest version or using alternatives such as Mozilla Firefox, Google Chrome or Microsoft Edge.

Leading Safe Choices

Goal: To strengthen the competence and raise the standing of family planning and abortion care professionals in South Africa and Tanzania

Duration: 3 years (with 1 year extension)

Partners: The Health Foundation South Africa, The Department of Health: Western Cape, Management and Development for Health Tanzania, Ministry of Health Community Development Gender Elderly and Children of Tanzania

Funder: Large anonymous donor

Over 1000 healthcare professionals trained in postpartum family planning and postpartum family planning counselling.

20 new termination of pregnancy clinics have opened in the Western Cape.

Women going home with a contraceptive method of their choice has increased from 1% to 57% across 10 facilities in Tanzania.


214 million women worldwide wish to prevent or delay pregnancy but have an unmet need for modern contraception. Meeting the need for contraception would allow women to control their own fertility and reduce maternal deaths by one third, averting deaths from obstetric complications and early pregnancy loss, particularly unsafe abortion.

The immediate postpartum period offers a golden opportunity to provide contraception to women motivated to avoid another pregnancy too soon; however this window of opportunity is frequently missed or neglected.

The availability of modern contraception can reduce but never eliminate the need for abortion. Every year, an estimated 25 million unsafe abortions take place. Between 5% and 13% of maternal deaths are attributed to induced abortion, mostly all unsafe procedures, with an annual death toll up to 44,000 women and girls.

Increasing access to contraceptive choice and improving access to safe abortion services dramatically improves the health of women and their children.


Through a three-year grant the RCOG Leading Safe Choices programme aimed to address the unmet need in postpartum family planning (PPFP) in health facilities in South Africa and Tanzania, and sought to improve comprehensive abortion care (CAC) services in South Africa, and comprehensive postabortion care (CPAC) in Tanzania, where abortion is heavily restricted by law.

The programme was designed to upskill the existing health workforce and raise the priority of PPFP and C(P)AC amongst patients, providers, managers, leaders and policy makers. Underpinning the LSC programme was the need to address attitudes towards reproductive healthcare amongst policy and decision makers, managers and individual health care providers.

The core components of the programme were:

  1. Development of evidence-based guidelines for health care providers
  2. Development of training materials and training health care providers in best practice
  3. Assessment and certification of competency in the clinical setting

Development of evidence-based guidelines for health care providers

The LSC Best Practice Papers set out the essential elements for high-quality evidence based clinical practice in postpartum family planning, comprehensive abortion care and comprehensive postabortion care. Fully peer reviewed, the papers are easy-to-use tools designed for front-line health care providers of varying cadres, responsible for providing routine services, including in under resourced settings.

Development of training materials and training health care providers in best practice

The programme trained mid-level health care providers (nurses and midwives) in postpartum family planning, and comprehensive abortion care in South Africa and comprehensive postabortion care in Tanzania. This included training in postabortion family planning, as when a woman seeks healthcare for abortion care, she is ideally placed for her contraceptive needs to be assessed and met.

Assessment and certification of competency in the clinical setting

The programme adopted a Training the Trainers approach to establish and embed training and support systems in South Africa and Tanzania, and facilitated mentorship for health care providers to ensure modern methods of contraception and C(P)AC became a routine part of reproductive healthcare services.