At Jemo Health Centre on the outskirts of Addis Ababa, health worker Tewodros Tibebu says social stigma and limited awareness continue to delay access to comprehensive abortion care, despite Ethiopia legalizing broad abortion services more than two decades ago.

Tibebu, who has worked in comprehensive abortion care for four years, is among only three trained providers currently delivering the service at the facility. According to his account, many patients arrive after significant delays, often seeking help only after complications emerge from procedures carried out elsewhere.

“The biggest challenge is stigma,” Tibebu said in a feature published by the World Health Organization on May 5. “Many women are afraid someone will recognize them when they come here. Others do not even know the service exists.”Comprehensive abortion care has reportedly been available at Jemo Health Centre for nearly a decade.

However, Tibebu said access barriers remain widespread, particularly for women seeking confidential and medically supervised treatment.According to his account, many patients first visit private clinics where procedures may be carried out by practitioners lacking formal training in abortion care. By the time some women reach public facilities such as Jemo, they are already suffering from infections or sepsis that could have been prevented through earlier medical intervention.

Ethiopia expanded legal access to abortion in 2005 under revised provisions that allowed the procedure under broader circumstances than previously permitted. Despite the legal framework, health care providers and reproductive health organizations have continued to report uneven access across regions, driven by social stigma, provider shortages and gaps in public awareness.

Tibebu said the stigma surrounding abortion services affects providers as well as patients. “Some coworkers oppose the comprehensive abortion care department,” he said. “Some people in my community do not know what I do.”The social pressures attached to abortion care are a recurring issue in reproductive health systems globally, particularly in countries where legal reforms have outpaced shifts in public attitudes or health infrastructure.

Health workers often face professional isolation, ethical scrutiny and personal criticism while providing services that remain politically and culturally contested.Tibebu said professional training helped him better understand both the clinical and ethical dimensions of abortion care. “Before, it was difficult,” he said.

“After I received specific training, I understood the work differently and could provide the care women need.”The experiences described by Tibebu formed part of a broader announcement by the Human Reproduction Programme, known as HRP, regarding a new international training initiative on comprehensive abortion care.

The programme, launched through the WHO Academy platform, combines four separate learning modules focused on medical abortion, surgical abortion, post-abortion care and human rights integration in comprehensive abortion care. According to HRP, the courses are designed to provide modular and interactive learning environments that simulate real clinical decision-making scenarios encountered by frontline health workers.

WHO said the training initiative is intended to strengthen evidence-based care and improve consistency in abortion services across different health systems. The programme also places emphasis on privacy, non-discrimination and accountability within clinical practice.

The human rights integration component links medical treatment with broader principles related to patient dignity and access to care, according to WHO. Together, the courses are intended to establish a standardized framework for providers working in comprehensive abortion care settings.The launch reflects continuing international efforts by global health organizations to reduce preventable maternal complications associated with unsafe abortion procedures.

WHO has repeatedly stated in policy guidance that access to trained providers, accurate information and safe clinical environments are central to reducing maternal morbidity and mortality.At facilities such as Jemo Health Centre, providers say the gap between legal availability and practical access remains significant.

Tibebu noted that many patients learn about the service only through informal networks and word-of-mouth referrals rather than official health campaigns or referrals from primary care systems.That reliance on informal communication channels, he said, contributes to delays that can worsen medical outcomes.

The WHO feature also highlighted the operational pressures facing providers in facilities with limited staffing. With only three trained workers handling abortion care services at Jemo, workloads remain concentrated among a small number of clinicians.

Training programmes such as the one launched by HRP are intended in part to address those shortages by expanding provider knowledge and strengthening clinical capacity. WHO said the interactive nature of the courses allows health workers to engage with practical decision points similar to those encountered during patient care.

The organization has increasingly used digital and modular learning systems to expand access to specialized medical training, particularly in lower-resource health settings where formal clinical education opportunities may be limited.Tibebu said the training reinforced his understanding of abortion care not only as a technical medical service but also as direct patient support during periods of vulnerability and medical risk.

“People may not understand what we do,” he said. “But when you think about the woman in front of you, the decision is clear. You are helping someone.”WHO separately announced a webinar linked to the comprehensive abortion care learning programme scheduled for April 28, 2026.

The organization also published updated abortion-related fact sheets in December 2025 as part of its broader reproductive health guidance materials.The HRP programme operates jointly under the United Nations Development Programme, the United Nations Population Fund, the United Nations Children’s Fund, WHO and the World Bank, focusing on research, policy development and training in human reproduction and reproductive health services.

Women survivors of Nepal’s decade-long internal conflict are increasingly shaping the country’s transitional justice process, as advocacy efforts led by survivors push for accountability, legal reform, and recognition of conflict-related sexual violence.

The conflict between government forces and Maoist insurgents from 1996 to 2006 left at least 13,000 people dead and more than 1,300 missing, according to United Nations estimates. Women were among those most affected, facing arbitrary detention, torture, rape, forced displacement, and other violations, while also playing significant roles as combatants and political actors.

Devi Khadka, a former member of Nepal’s Constituent Assembly and a prominent women’s rights activist, is among those who have transformed personal trauma into sustained advocacy. Detained at the age of 17, she was tortured and subjected to gang rape by police who accused her of aiding her brother, a Maoist activist.

Reflecting on her experience, Khadka said a lack of understanding about trauma at the time shaped her response. “I didn’t understand why I suffered this,” she said, describing how she later joined the Maoist movement during a period marked by psychological distress and a desire to confront her circumstances.

Years later, the public disclosure of her rape by Maoist leaders compounded the trauma, exposing her to further harm and reinforcing the challenges faced by survivors in seeking dignity and privacy.The 2006 Comprehensive Peace Agreement formally ended the conflict and initiated Nepal’s transition toward democratic governance. Transitional justice mechanisms, including the Truth and Reconciliation Commission and the Commission of Investigation on Enforced Disappeared Persons, were established to investigate violations and promote reconciliation.

However, progress has been slow, and transitional justice remains one of the agreement’s unresolved commitments.Women survivors have faced systemic barriers in accessing justice, including stigma, social exclusion, and institutional limitations. Many lost family members who were primary earners, leaving them to assume economic responsibilities while also dealing with long-term psychological and physical impacts of violence.

Official data underscores the extent of underreporting. Of more than 63,000 complaints filed with the Truth and Reconciliation Commission, only 314 were classified as cases of sexual violence prior to legal reforms in 2024. Analysts attribute this gap to fear of retaliation, social stigma, and a lack of trust in institutions.

In response, Khadka and a group of survivors established Aparajit, meaning “the Undefeated,” a network aimed at supporting victims and advocating for systemic change. The organization has facilitated access to medical and legal services while promoting collective action among survivors.Khadka said the initiative initially faced resistance and accusations of undermining national reputation.

However, support from media organizations helped bring visibility to the issue, enabling the movement to expand and gain broader recognition.Advocacy efforts have contributed to tangible legal reforms. In August 2024, Nepal amended its transitional justice law to address longstanding gaps in the treatment of sexual violence cases.

The revised legislation includes provisions to classify sexual violence more comprehensively, remove statutes of limitation, and ensure that serious crimes are not subject to sentence commutation.Khadka said previous legal definitions were inadequate, narrowly interpreting rape and excluding various forms of sexual violence. “We brought up almost 75 percent of cases where the victim herself doesn’t call it sexual violence, and society doesn’t either,” she said, highlighting the need for broader recognition of such crimes.

The amended law also reopened the process for filing complaints, allowing survivors who had previously been unable or unwilling to come forward to seek redress. These changes reflect a shift toward a more inclusive and survivor-centered approach, though implementation challenges remain.At the international level, Khadka and other survivors have engaged with United Nations platforms to advocate for reforms.

Speaking at a Human Rights Council panel in Geneva in September 2025, she emphasized the importance of including survivors in designing justice mechanisms.“Especially in the case of sexual violence… it should be done with the involvement of the survivors themselves,” she said, noting that legal frameworks often fail to capture the lived realities of victims.

UN Human Rights has supported Nepal’s transitional justice process through technical assistance, policy advice, and engagement with government institutions, civil society, and victims’ groups. The organization has emphasized the need for a victim-centered approach that aligns with international legal standards and addresses root causes of conflict.

Efforts also focus on integrating gender considerations into justice mechanisms. The UN’s Women’s Rights and Gender Section has worked to highlight issues such as gender-based violence and women’s participation in post-conflict governance, aiming to ensure that survivors’ experiences inform policy decisions.Khadka said international support has been critical in advancing reforms and amplifying survivor voices.

Representing more than 3,800 individuals in her network, she noted that access to global platforms has strengthened advocacy efforts and contributed to legislative progress.For many survivors, participation in these processes carries both practical and symbolic significance. Public testimony, particularly in the presence of state authorities, can serve as a form of recognition and validation, helping to restore dignity.

Khadka described this recognition as central to recovery. “If a person’s lived experience becomes untrue… then there is no meaning to a life,” she said, underscoring the role of acknowledgment in the pursuit of justice.Nepal’s experience reflects broader challenges in post-conflict societies, where balancing accountability, reconciliation, and institutional reform requires sustained political commitment and inclusive approaches.

The increasing involvement of women survivors in shaping policy marks a shift toward more participatory models of transitional justice.As reforms continue, the emphasis on survivor-led advocacy highlights the role of lived experience in addressing systemic gaps and advancing accountability within complex post-conflict environments.