Trailblazing care means trusting the frontline

A dispatch from the Abortion and Reproductive Justice Conference, Nairobi

Empath Alliance members were out in force at ARJC 2026

She did not walk into our office. She ran. Six months pregnant, with a six-month-old baby tied to her back, she had been chased out of her home by a husband who beat her when she came back too tired to finish the housework. She had seen our sign from the street and run towards it because it looked like the one place she might be safe. Someone was there to meet her at the door. Someone believed her straight away. No fee, no form to prove her worth, no question about what she might have done to deserve it.

This week we are in Nairobi for the Abortion and Reproductive Justice Conference, where the theme is Trailblazing Care: a vision of care that moves beyond medical gatekeeping and state control. For those of us who work in Nigeria, that phrase is not abstract. It describes a woman running down a street with a baby on her back, hoping a stranger will help.

Who actually answers

The picture we want you to hold in your mind is of the people on the other end of the line.

Since we launched our Ms Rosy hotline in 2014, we have reached more than three million people with free, honest, non-judgemental information about their reproductive health and their choices. Since 2016, more than fourteen thousand of those calls have been about violence. During the pandemic alone we logged 2,290 cases. In the last year we have sat with around 720 women in person, in our office and out in their communities.

Behind every one of those numbers is a woman who picked up a phone. Often she is frightened. Often she is ashamed of something that was never her fault. Almost always she has already been turned away somewhere else: a police station that wanted a fee she could not pay, a clinic that looked at her and stepped back, a family that told her to be quiet. By the time she reaches us she is not expecting much.

And behind every call is the woman who answers it. Our operators are not a switchboard. They are trained counsellors who offer what we call a woman-to-woman alternative: a voice that believes you immediately, that does not judge and does not send a bill. In a country where one in three women experiences physical or sexual violence, where femicide cases rose by 240 per cent in early 2025 and where more than six in ten women still cannot make their own decisions about their own bodies, that voice is sometimes the only door that opens.

Care beyond the clinic is not care without rigour

It would be easy to mistake this for a soft alternative to "real" medicine. It is not. We were a partner in the SAFE study, published in The Lancet, which followed women in Nigeria and Argentina who managed their own medication abortions with accompaniment support. The finding was clear. For pregnancies under nine weeks, self-managed abortion with the right support was as effective as care managed by a clinician.

That is what trailblazing care actually means. Not lower standards, but care placed in the hands of the people closest to the woman who needs it, backed by evidence and held to account. The innovation is not a new device. It is the decision to trust a trained woman with a phone and to trust the woman who calls her.

Onyinye Okoye introduced Giwyn and the Empath Alliance's pathbreaking grassroots funding approach

At last week’s Abortion and Reproductive Justice Conference, the session on Clinical and Out-of-Clinic Care for Reproductive Health highlighted the critical role of trust, evidence, and community-led support in expanding access to reproductive healthcare. We discussed how such data can be used to strengthen advocacy efforts, inform programme design and demonstrate impact to funders and policymakers. Panellists noted importance of safeguarding client privacy through confidentiality, secure communication channels, informed consent, and non-judgmental support.

A recurring theme throughout the conversation was that access begins with trust. As one panellist said, “You have to build trust in order to give care. People are more likely to seek help when they feel understood, respected and supported as individuals rather than treated as cases"

What we are taking home

Trusting the frontline asks more of institutions, not less. It asks funders and policymakers to believe that a counsellor in Lagos and an activist in a hard-to-reach community hold expertise worth backing and to resource them as though that were true.

We came to Nairobi to contribute and we are leaving with our conviction sharpened. The future of access will not be handed down from the centre. It is already here, in a small office where someone keeps the door open, ready for the next woman who runs towards it.