How to Transform Healthcare Providers’ Attitudes Towards Safe Abortion Using Values Clarification for Action and Transformation (VCAT)

Through our advocacy efforts, MDFC discovered that legal and policy reforms alone were not enough to ensure access to safe abortion care. While the revised legal framework created an enabling environment, implementation depended largely on healthcare providers who remained as critical gatekeepers in translating policy into practice. We found that many healthcare providers continued to face challenges including limited understanding of the legal framework, fear of legal consequences, misconceptions about abortion, and uncertainty about their role in providing safe abortion care. Beyond knowledge gaps, personal beliefs, social norms, and abortion stigma influenced providers’ attitudes and willingness to support women seeking services.

MDFC also recognized that traditional approaches focusing only on laws, policies, and clinical knowledge were insufficient to address deeply held values and perceptions around abortion. Healthcare providers needed safe spaces to reflect on their own beliefs, engage in respectful dialogue, and better understand their professional responsibilities. These lessons highlighted the need for an approach that addressed both knowledge and attitudes. This led MDFC Rwanda to adopt Values Clarification for Action and Transformation (VCAT) as a strategy to support healthcare providers in reducing stigma and strengthening commitment to respectful, rights-based abortion care.

To address these challenges, MDFC integrated Values Clarification for Action and Transformation (VCAT) into its advocacy approach to engage healthcare providers and address the underlying attitudes and beliefs affecting access to safe abortion care.

The VCAT sessions combined evidence-based learning with structured reflection and dialogue. Healthcare providers were introduced to international and national legal frameworks on abortion, the burden and consequences of unsafe abortion, and comprehensive abortion care, including post-abortion care, counseling, and family planning. These sessions helped strengthen providers’ understanding of their professional responsibilities within the existing legal framework.

Beyond knowledge sharing, VCAT created opportunities for providers to reflect on their personal values, beliefs, and assumptions through participatory exercises such as “Four Corners,” “Cross the Line,” “Why Did She Die?” and discussions on “Why do women have abortions?” These activities encouraged honest conversations, challenged misconceptions, and supported healthcare providers to examine how personal beliefs could influence the care they provide. This approach supported healthcare providers to transform their knowledge and attitudes, reduce abortion stigma, and strengthen their commitment to providing respectful, rights-based abortion-related care.

The training reached 34 healthcare providers from 17 health centres across five provinces/city areas, covering both urban and rural/peri-urban settings. Participants included 13 nurses, 12 mental health officers and 9 midwives; 27 were female and 7 were male, with an age range of 23–61 years.

Pre- and post-training assessments recorded a 13% increase in knowledge scores and a 20% increase in attitude scores. The number of providers in the positive attitude category rose from 11 before the training to 30 after the training, equivalent to a 172% increase. The results suggest that the VCAT training contributed to measurable improvements in both knowledge and attitudes, with the strongest change observed in the proportion of providers demonstrating positive attitudes.

MDFC learned that policy reform alone cannot guarantee access to safe abortion care. Before advocating for legal and policy change, advocates need to understand the different factors influencing implementation, including the knowledge, attitudes, and experiences of healthcare providers who play a key role in translating policies into practice. It is essential for advocates to recognize healthcare providers as important partners in achieving sustainable change because engaging providers requires more than sharing legal information and clinical guidelines; it requires creating safe spaces where they can openly reflect on their values, beliefs, concerns, and professional responsibilities. MDFC also learned that addressing abortion stigma requires approaches that combine evidence-based information with personal reflection and dialogue. VCAT provided an effective platform for meaningful engagement because it allowed providers to examine misconceptions, understand the realities of women seeking care, and connect their professional roles with principles of dignity and respectful healthcare. For future advocacy efforts, organizations should consider investing in strategies that address both systemic barriers and individual attitudes, while building strong partnerships with healthcare providers as champions for safe and respectful abortion care.

1. Understand the context before designing an intervention. Conduct a situational analysis to understand the legal environment, health system barriers, provider perspectives, and social factors influencing access to safe abortion care.
2. Recognize that policy change is only the beginning. Legal reforms must be accompanied by strategies that support implementation and address the attitudes and practices of key actors within the health system.
3. Engage healthcare providers as partners, not obstacles. Providers are essential allies in translating policies into quality services and should be involved through respectful dialogue and continuous engagement.
4. Go beyond knowledge sharing. Training on laws and clinical guidelines is important, but addressing stigma and personal beliefs requires approaches that encourage reflection, dialogue, and attitude transformation.
5. Create safe spaces for honest conversations. Sensitive issues such as abortion require skilled facilitation that allows participants to express concerns, challenge misconceptions, and learn from different perspectives.
6. Adapt approaches to the local context. VCAT and other advocacy strategies should be tailored to the realities, legal framework, culture, and needs of the communities and health systems where they are implemented.
7. Invest in follow-up and sustainability. Attitude transformation is a continuous process; ongoing engagement, peer support, and collaboration with health system leaders are important to maintain progress.
8. Measure both knowledge and attitudes. Changes in abortion knowledge do not always translate into changes in practice. Advocates should use pre- and post-intervention assessments to measure shifts in knowledge, attitudes, confidence, and willingness to support services.

Every country has a different legal, cultural and social context, but one lesson remains universal: creating safe spaces for honest conversation can transform how healthcare providers think about their role in supporting women seeking care.

This guide reflects MDFC’s experience in Rwanda, but we hope the principles and practical lessons can help advocates working in many different settings adapt VCAT to their own context.