Making Outpatient Abortion Services a Reality
Every year, an estimated 20 million unsafe abortions take place. And of all maternal deaths, unsafe abortion accounts for 13%. Imagine if we could change that. Imagine if we could make a serious dent in the deaths and morbidities that are caused from botched abortions, from unhygienic surgeries, and from unskilled providers. Now, imagine if we could change that with a few simple, low-cost pills. That’s what the drugs mifepristone and misoprostol are doing for women around the world.
At today’s panel session on “Reducing the toll of unsafe abortion using simple medical technology” at the Global Maternal Health Conference in Delhi, panelists laid out the landscape of how introducing and expanding access to medical abortions could save lives and prevent injury:
• Beverly Winikoff, of Gynuity Health Projects, talked about misoprostol as first-line treatment of incomplete abortion, and about introducing and expanding existing services and implications for training. As she said, misoprostol is low cost, and it can increase women’s choice and reduce the burden on doctors and health facilities.
• Patricio Sanhueza Smith, from the Secretariat of Health in Mexico City, talked about lessons learned from Mexico City on the potential of misoprostol alone for transitioning services. He said, “Medical abortion with misoprostol alone is not the Gold Standard, but it is a duty to widely disseminate its use, while mifepristone becomes available.”
• Selma Hajiri, of the Center for Research and Consultancy in Reproductive Health, talked about a randomized controlled trial of medical abortion with misoprostol only versus mifepristone plus misoprostol. She said that although the combination is the gold standard, misoprostol alone should be promoted where mifepristone is not accessible.
• Kelsey Lynd, of Stanford University, spoke about making outpatient services a reality. She discussed research on administering mifepristone and misoprostol at home, and a pregnancy test that could simplify medical abortion provision.
• Hillary Bracken, of Gynuity Health Projects, spoke about expanding access late in the first trimester, and the promise of outpatient mifepristone and misoprostol after 63 days.
Though I’m constantly amazed by the possibility and potential of mifepristone and misoprostol for safe abortion, I was even more amazed to hear about Kelsey Lynd’s work on making outpatient services a reality. Having an abortion is a difficult and traumatic decision, with serious health repercussions. But that decision becomes so much harder when you have to pay for a sonogram to determine gestation period; to attend a clinic to take the mifepristone; to return to the clinic two week later for a follow-up visit and second dose; and to have a second sonogram to ensure the pregnancy was terminated. It’s a time-consuming and costly decision… but every one of those steps also takes an emotional toll.
Lynd presented research that showed that it is safe for women to self-administer mifepristone and misoprostol at home. Though this is great news for time and money saving reasons, it also gives women some control and choice over when to start their abortion. Lynd also presented findings on a home pregnancy test that determine their pregnancy status after abortion.
This semi-quantitative pregnancy test is administered at the health facility while the woman is pregnant to achieve a baseline of her hCG blood level. Then, 1 to 2 weeks after the woman has been administered mifepristone and misoprostol, she can use the test to check if her hCG blood level has decreased, thus confirming termination of pregnancy.
In her findings, 98% of women felt they could use the test on their own in the future, and the tests identified ALL ongoing pregnancies. The implications for this research are mind-boggling. I think it is obvious that cutting down clinic visits and sonograms would save time (for the woman and the provider) and save money. But it is the emotional implications that jump out at me. The ability for women to feel they have some control over their bodies and their abortions is something that is severely needed.
One last note is that although these findings are encouraging in making outpatient services a reality, they must be partnered with education, information, and counseling. Home abortions are a scary thing. Bleeding for days on end is a scary thing. And women need to understand complications that need treatment, and have some emotional support. We need to guide these women with the proper education, counseling, call centers, job-aids, and more, if and when we finally make outpatient services a reality.
Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010. For more posts about the Global Maternal Health Conference, click here. For the live stream schedule, click here. Check back soon for the archived videos of today’s presentations.
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