Making Outpatient Abortion Services a Reality

This is the third in a series of posts coming from the Global Maternal Health Conference in New Delhi, the first conference of its kind. According to EngenderHealth‘s Maternal Health Task Force’s website, ‘Every minute, a woman dies from complications related to childbirth or pregnancy. While most maternal deaths are preventable, poor health services and scarce resources limit women’s access to life-saving, high-quality care.’ Check out the conference’s live streaming schedule. You can follow the conference on Twitter, too: the Maternal Health Task Force and EngenderHealth are @MHTF and @EngenderHealth; the conference hashtag is #GMHC2010.

This guest post is cross-posted from the Maternal Health Task Force blog. Its author, Janna Oberdorf, is the Communications Manager at Women Deliver.

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.

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8 comments for “Making Outpatient Abortion Services a Reality

  1. September 2, 2010 at 6:52 pm

    Interesting info here. The self-administered test is particularly cool.

  2. September 2, 2010 at 8:15 pm

    “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.”

    informative and thought provoking post. the sad reality is we can change it. the powers that be need to lift the veil of controlling a woman’s body and her right to chose from their eyes and start implementing some of these practices.

  3. Miss S
    September 2, 2010 at 9:53 pm

    I suppose you would need a prescription for this? Personally I think this would benefit women from an emotional perspective. It’s often a hard enough decision, and being able to do this at home makes it far more personal and private.

    And it would cut down on cost tremendously.

  4. William
    September 2, 2010 at 10:36 pm

    And it would cut down on cost tremendously.

    Which alone makes me despair at the energy the forced birth lobby will put into fighting it. Even with all their notifications, statutory language, ultrasounds, and ridiculous definitions of person hood the greatest barriers to access are cost and location.

  5. Cat
    September 3, 2010 at 9:42 am

    This is interesting to me because when had an abortion about four years ago it was a medical abortion and l took the pills at home. I was in a very progressive part of a very progressive state and l did have to pay out of pocket but l remember that l only had to go in twice-because there was some strange “think it over” law. There may have been a followup visit that I skipped because of cost.

    It seemed a totally reasonable way to do it, to me at the time, but obviously I had an advantage already, living a short bus ride from a clinic. I don’t know what I’d do now. l don’t think there’s a Clinic any closer than two hours.

  6. Wednesday
    September 3, 2010 at 11:56 am

    This was a really informative article. I’d known that confirming the pregnancy is ended is an important part of “aftercare” – I’m excited to hear about the effective home tests. Reducing the number of trips cuts down on cost and on other barriers to abortion access (time off work, childcare, travel, hiding the trip from a judgmental neighbor or abusive partner), and puts more control of the situation in the hands of the person having the abortion.

  7. Mightydoll
    September 4, 2010 at 1:41 pm

    Honestly, I had a medical abortion a few years ago (combination type) and found it to be a terrifying experience. I am quite educated about my body and reproductive system, and have given birth naturally twice, as well as worked as a birth attendant (so I know how much pain and blood is to be expected) and it was still scary to measure the size of clots passing, weather the pain (even with T3’s) and be sure I wasn’t haemmhoraging or passing my uterus. I wouldn’t recommend it to anyone with any possibility of going to a clinic. I recognize my privilege here, (I live in a large Canadian city with plentiful and supportive free access to abortion) but having also had a clinical abortion, the latter is vastly preferable, and increasing access to and awareness of a supported option seems, to me, to be far more beneficial to women’s overall health and to reducing the trauma of abortion.

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