Thank you so much for your kind words and for the thoughtful and thought provoking comments and questions. The reviewers’ comments have been incredibly helpful to us as we refine our idea. In addition to refining the idea and helping us shape our project, we have some responses to each of the questions which we hope will be helpful. 1) This is an excellent question. As a matter of principle Hesperian resources take into account and serve people with disabilities. During the app writing phase: we researched possible medicine interactions for women with disabilities (there are none); body positions used for abortions and accommodations for women with mobility issues (included). We suggest that all women bring someone for support to the procedure (if they want), particularly important for women with disabilities. During the app building phase: technical accessibility is built into the app to support deaf, blind, and other users. We’re still enabling other accessibility tools that will further enable the user control via the accessibility settings for their phone. This comment has highlighted that we need to be aware of documenting our processes for app iteration, particularly with regards to inclusivity.
2) This is something we intend to learn more about through piloting the project. Our organization has a tremendous amount of experience with helping people examine and clarify their values around abortion, specifically through the use of Values Clarification and Attitudes Transformation (VCAT). VCAT is a crucial and constant part of our training programs: During the orientation process for health care workers in the training programs, we assess their readiness and willingness to implement safe abortion.
We would like to include a mix of health workers from the host communities as well as Rohingya women in the project and will carefully consider our cadre of end-users during recruitment. At this point, inclusion of Rohingya women health workers depends in part on the situational context and policies around having the refugees participate as workers, something that is in flux, particularly during an acute phase of an emergency.
3) Another excellent point. We hope to learn more about health workers, who will be end-users of the app, and women in need of reproductive health care, who will be the ultimate beneficiaries of information from the app. We intend to use multi-level, mixed-methods evaluation to explore the experiences and levels of satisfaction of health workers and beneficiaries related to using the app. We also want to explore this in a broader context of their experiences: For example, what have their previous experiences with abortion been, if any, and what did they do in the absence of this app? How did they learn about the app? What might they do currently if the app did not exist? 4) The app will be provided to health workers who have mobile devices capable of running the app. We will also supply a small number of devices (tablets and Android phones) through the project in cases where health workers do not have a device with this capability. MVA and misoprostol are common through UNFPA RH kits, which are available in the project area. Misoprostol in general is widely available and relatively inexpensive in Bangladesh, though we expect that mifepristone will not be widely available in the area. Through a partnership with UNFPA, Ipas has already begun training trainers and clinicians in the project area in the use of MVA and MA for menstrual regulation. We are also prepared to provide a seed stock of these commodities through community pharmacies and thorough the humanitarian infrastructure in the project area.