Publications

Source: http://www.ippf.org

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• Document type: Report
• Author: Department of Health
• Published date: 7 May 2008
• Product number: 287487
• Gateway reference: Not required
• Pages: 132
• Copyright holder: Crown

This Evaluation report was commissioned by the Department of Health to assess the safety, effectiveness and acceptability of early medical abortions (EMAs) in non-traditional settings, and to help establish a protocol to cover the elements and processes required for the delivery of a safe EMA service in non-traditional settings.

• Download Evaluation of Early Medical Abortion (EMA) Pilot Sites - fnal report (PDF, 2898K)

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Source: http://www.ippf.org

IPPF strives to ensure access to safe, legal abortion services worldwide. In line with this vision, these guidelines and protocols are intended to support service providers to offer high quality, client-centred abortion and abortion-related services. The document is grounded in the values and principles laid down in IPPF’s Charter on Sexual and Reproductive Rights; the clinical procedures are based on the Quality of Care Framework developed and implemented across all aspects of service provision throughout IPPF.

This document integrates protocols, guidelines and standards in a broad framework to ensure that no aspect of care is overlooked when providing comprehensive abortion care in the first trimester of pregnancy. The intended audience is staff involved in abortion services – whether as direct providers of abortion care or as counsellors or educators.

“First trimester abortion guidelines and protocols: surgical and medical procedures”

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This presentation package, created by Family Care International and Ipas, aims to foster understanding of this issue, enhance public discussion, promote partnerships, and encourage the provision of safe abortion services to the extent allowed by law. It is based primarily on the World Health Organization’s 2003 publication: Safe Abortion: Technical and Policy Guidance for Health Systems. The CD-ROM includes everything you need to learn about unsafe abortion and make presentations on this topic.

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Source: http://www.gynuity.org/

Gynuity Health Projects and Reproductive Health Technologies Project convened expert meetings looking at the use of misoprostol for two specific women's health indications: abortion induction and treatment of incomplete abortion and miscarriage. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of misoprostol based on the best current information. The results can be found in a series of documents called “Instructions for Use." The information in these documents may serve as a basis for the development of clinical practice guidelines and patient and provider education materials. These documents will be periodically reviewed and updated with new information and research developments.

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Source: http://www.ipas.org

The Medical Abortion Study Guide is the first part of the Ipas Medical Abortion (MA) Training Program, which is intended to help train clinicians on the use of first-trimester MA, particularly in limited-resource settings. The MA Study Guide is to be used for self-directed study prior to attending an in-person workshop and clinical practicum, as well as a resource document for future reference.

Please see the following link: http://www.ipas.org/Publications/Medical_Abortion_Study_Guide.aspx

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Source: http://www.ipas.org

The Ipas Medical Abortion (MA) Training Program is intended to help train clinicians on the use of first trimester MA, particularly in limited-resource settings. It has three major components: self-directed study, in-person workshop and clincal practicum. This blended learning approach combines learning essential information through self-guided study with skills development in a workshop setting to then apply to work situations through the practicum.

Medical abortion training guide: Using medicines for first-trimester pregnancy termination

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Source: http://www.gynuity.org

 2004           Gynuity recently produced a new tool for providers and policy makers who are interested in introduction of medical methods for safe termination of early pregnancy. Providing Medical Abortion in Developing Countries: An Introductory Guidebook is now available in Arabic, English, French, Portuguese, Romanian, Russian, Spanish, and in Vietnamese in PDF format.  Please contact Gynuity to obtain copies of the guidebook in English and Spanish.

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September, 2004               Clinical guidelines have been defined as systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions. The aim of this guideline is to ensure that all women considering induced abortion have access to a service of uniformly high quality.
The guideline may also be of interest to other professional groups who share in caring for women considering abortion: primary care teams, family planning clinic staff, gynaecology nurses, staff participating in non-NHS assessment centres and clinics, and all those professionals providing abortion counselling. Those with responsibilities for planning abortion services, for example directors of public health, NHS trust managers and managers of primary care groups, may also find the guideline helpful.

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Rossi B, Creinin MD, Meyn LA.

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee Womens Research Institute, 300 Halket Street, Pittsburgh, PA 15213-3180, USA.

We performed this analysis to evaluate the ability of both women and their clinicians to predict pregnancy expulsion after using mifepristone and misoprostol for medical abortion up to 63 days gestation. Women who participated in a multicenter, randomized trial comparing misoprostol 6-8 h vs. 23-25 h after mifepristone attended a follow-up visit approximately 7 days after mifepristone treatment. Each subject was asked if she felt she had expelled the gestational sac. Clinicians also assessed if the sac had been expelled based on the woman's history. Vaginal ultrasonography was then performed to assess the uterine cavity. Of the 1080 women enrolled in the multicenter study, 931 (86.2%) who attended the first follow-up visit by study day 12 and did not have a uterine suction aspiration prior to this visit were included in this analysis. Vaginal ultrasonography at the first follow-up visit demonstrated expulsion in 915 [98.3%, 95% confidence interval (CI): 97.2-99.0] women. Overall, sensitivity, specificity, and positive and negative predictive values for subjects were 96.5%, 31.3%, 98.8% and 13.5%, respectively. When both the clinician and patient felt that the gestational sac had passed (n = 880 [94.5%, 95% CI: 92.9-95.9]), expulsion was confirmed by sonography in 99.1% (95% CI: 98.2-99.6) of cases. Women and clinicians are very accurate at determining expulsion of gestational sac during medical abortion with mifepristone and misoprostol without ultrasonography or a physical examination. Copyright 2004 Elsevier Inc.

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Fetters, T., S. Vonthanak C. Picardo T. Rathavy (2008). "Abortion-related complications in Cambodia". British Journal of Obstetrics and Gynaecology. 115: 957-968.

Abstract:

Introduction:  Although termination of pregnancy has been legal in the Kingdom of Cambodia since 1997, a number of barriers to safe termination services persist and many women continue to induce their own terminations or seek unsafe services that result in complications requiring 'post-abortion' care.

Objective: To describe the complications of miscarriage and failed terminations and document the magnitude of the resulting morbidity in the Cambodian public sector.

Design: Cross-sectional descriptive study. Setting: Public sector hospitals and health centres. Sample: Stratified multistage sampling design included all hospitals (n = 71), 14% of eligible high-level health centres (n = 58) and 22% of eligible low-level health centres (n = 57).

Methods:  Data collectors used a standardised questionnaire to record information on diagnosis, reproductive history and treatment from 629 women seeking care for termination or miscarriage-related complications in study facilities over a 3-week period.

Main outcome measures:  Annual estimate of cases, clinical symptoms, severity distribution of morbidity, ratio of complications to live births and incidence of abortion complications for Cambodian public health facilities.

Results:  In 2005, an estimated 31 579 women with complications of miscarriage or terminations were treated in Cambodian government facilities; 80% of these women sought care at a health centre. Forty percent of all women seeking care for complications either reported or showed strong clinical evidence of prior attempted terminations. Nearly 17% of these women were in the second trimester of pregnancy and 42% of them presented with high severity complications. The annual incidence of termination and miscarriage complications (abortion complications) was 867 per 100 000 women of reproductive age. The projected ratio of complications was 93 per 1000 live births.

Conclusions: To re duce maternal morbidity in , women must be encouraged to seek safe termination services or seek post-abortion care without delay. Additionally, providers need further training, and facilities greater commitment, to provide safe terminations and care for complications of unsafe terminations and miscarriage.

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  Source: http://www.ncbi.nlm.nih.gov       

Hedley A, Ellertson C, Trussell J, Turner AN, Aubény E, Coyaji K, Ngoc NT, Winikoff B.

Office of Population Research, Princeton University, Princeton, NJ, USA.

Abstract

Objective:   Previously published analyses have ignored the temporal nature of medical abortion and calculated effectiveness as the proportion of abortions that succeed. By using life tables, we incorporate the important element of time to produce unbiased efficacy rates as well as afford insight into the medical abortion process.

Study design:   Using data on 6568 women from 6 previously published mifepristone-misoprostol medical abortion studies, we generated multidecrement life table efficacy curves and evaluated the cumulative probability of successful medical abortion.

Result:   Efficacy rates calculated using proportions are biased because of loss to follow-up. Compliance with the medical abortion regimen was high. More than 80% of abortions were complete within a week of receiving mifepristone. Success continued to improve thereafter. Most surgical interventions were unnecessary.

Conclusion:   Follow-up visits can be scheduled within a week of receiving mifepristone; however, aspirations should not be performed routinely if the abortion is not complete.

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International Journal of Gynecology and Obstetrics (2007) 96, 212–218

N.L. Moreno-Ruiz a, L. Borgatta a, S. Yanow b, N. Kapp a, E.R. Wiebe c, B. Winikoff d a Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston MA, USA

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The authors concluded that alternatives to routine in-person follow-up visits after medication abortion are accurate at diagnosing ongoing pregnancy. From Contraception.

The authors note that requiring a follow-up visit with ultrasound evaluation to confirm completion after medication abortion can be a barrier to providing the service.

The PubMed (including MEDLINE), Cochrane Central Register of Controlled Trials and POPLINE databases were systematically searched in October and November 2009 for studies related to alternative follow-up modalities after first-trimester medication abortion to diagnose ongoing pregnancy or retained gestational sac. The authors calculated the sensitivity, specificity, positive predictive value and negative predictive value compared with ultrasound or clinician’s exam. We also calculated the proportion of cases in each study with a positive screening test.

The search identified eight articles. The most promising modalities included serum human chorionic gonadotropin measurements, standardized assessment of women’s symptoms combined with low-sensitivity urine pregnancy testing and telephone consultation. These follow-up modalities had sensitivities ≥90%, negative predictive values ≥99% and proportions of “screen-positives” ≤33%.

The authors concluded that alternatives to routine in-person follow-up visits after medication abortion are accurate at diagnosing ongoing pregnancy. Additional research is needed to demonstrate the accuracy, acceptability and feasibility of alternative follow-up modalities in practice, particularly of home-based urine testing combined with self-assessment and/or clinician-assisted assessment.

Ibis Reproductive Health, Oakland, CA 94612, USA. dgrossman@ibisreproductivehealth.org

Alternatives to ultrasound for follow-up after medication abortion: a systematic review. Grossman D, Grindlay K. Contraception. 2011 Jun;83(6):504-10. Epub 2010 Oct 8.

Source: http://www.abortionreview.org

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Source: http://humrep.oxfordjournals.org

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Source: http://linkinghub.elsevier.com

Assessing the global availability of misoprostol
International Journal of Gynecology & Obstetrics, Volume 105, Issue 2, Pages 180-186
M. Fernandez, F. Coeytaux, R. Gomez Ponce de León, D. Harrison

Abstract

Objectives   To assess the worldwide availability of misoprostol. Documenting the extent of misoprostol use in obstetrics-gynecology is difficult because the drug typically is unregistered for such indications.

Methods   Data for 2002–2007 on annual sales (measured in weight) to hospitals and retail pharmacies, plus manufacturer prices per 200-µg misoprostol, were analyzed for medications containing misoprostol alone or combined with a nonsteroidal anti-inflammatory drug (NSAID); regional and country-specific trends were identified. Consumer prices per pill are documented for all formulations of registered medications.

Results  Of the misoprostol sold worldwide, 70% was misoprostol-NSAID-combination drugs; of this, 91% was sold in North America and Western Europe. Asia sold the most misoprostol-only drugs; sales increased dramatically in Bangladesh (by 128%) and India (646%), where various low-price brands are sold. Misoprostol sales decreased in Latin America but increased in the Middle East-North Africa and Sub-Saharan Africa; these regions generally had low amounts sold per population.

Conclusion   Availability is improving in some low-income regions where misoprostol could significantly reduce maternal deaths due to postpartum hemorrhage and unsafe abortion.

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A survey of provider experience with misoprostol to facilitate intrauterine device insertion in nulliparous women

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Source: http://linkinghub.elsevier.com

Contraception, Volume 81, Issue 2, Pages 161-164
H. Panchal, E. Godfrey, A. Patel

Abstract

Background
Cervical priming prior to uterine suction evacuation softens the cervix and lessens the force needed for dilation, thereby potentially reducing the probability of procedural complications. The use of buccal misoprostol has been shown to be an adequate cervical primer in second trimester surgical procedures, but its use in first trimester aspiration procedures is not well documented. Our objective was to assess the necessity of manual dilation of the cervix when buccal misoprostol is used for cervical priming prior to first trimester uterine aspiration procedures.

Study Design
Retrospective case review of 685 patients who underwent a first trimester aspiration abortion with buccal misoprostol cervical priming from August 24, 2006, to February 23, 2007. All procedures were performed by three experienced physicians.

Results
Adequate dilatation of the cervix was achieved in 44.2% patients. The proportion of patients with adequate dilation decreased with increasing gestational age. Patients requiring additional mechanical dilatation differed significantly between those who were parous (51.0%) and those who were nulliparous (72.4%) (p<.001).

Conclusion
Buccal misoprostol appeared to decrease our need for manual dilation prior to first trimester aspiration abortion. Earlier gestations and parous patients showed less need for manual dilitation than later gestations or nulliparous women. A larger study with a control group is needed to confirm the benefit of the use of buccal misoprostol in first trimester aspiration abortion.

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Source: http://medicine.journalfeeds.com

Int J Gynaecol Obstet. 2010 Nov 25;

Authors: Mittal S, Sehgal R, Aggarwal S, Aruna J, Bahadur A, Kumar G

OBJECTIVE: To compare the efficacy of manual vacuum aspiration (MVA) with electric vacuum aspiration (EVA) and to evaluate whether cervical priming with misoprostol facilitates cervical dilation and reduces complications associated with first-trimester medical abortion performed up to 10weeks of pregnancy.

METHODS: A total of 600 women who requested termination of pregnancy were randomized into 4 groups (150 women in each group). Group I and II received a vaginal placebo 3hours before MVA or EVA, respectively. Group III and IV received 400μg of vaginal misoprostol 3hours before MVA or EVA, respectively.

RESULTS: Complete abortion rates after MVA and EVA were both 97.9%; after cervical priming with misoprostol complete abortion rates were 98.6% versus 97.3% after cervical priming with placebo (P>0.05). Administration of misoprostol into the vagina before MVA resulted in 99.3% complete abortions (P=0.40), and the least operative blood loss, operating time, and need for cervical dilation (P<0.05). Overall complications and adverse effects were similar in all groups (P>0.05).

CONCLUSION: For surgical evacuation, EVA and MVA did not differ in efficacy. Cervical priming 3hours before MVA for termination of pregnancy significantly reduced the need for cervical dilation and the operative time, and improved the efficacy of the procedure. Pretreatment with vaginal misoprostol before MVA is a safe and effective method for terminating pregnancies of up to 10weeks of gestation. Clinical Trials Registry: CTRI/2009/091/000008.

PMID: 21112054 [PubMed - as supplied by publisher]

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Social Science & Medicine
Volume 71, Issue 1, July 2010, Pages 62-70

Choosing early pregnancy termination methods in Urban Mozambique

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Source: http://www.ncbi.nlm.nih.gov

Acta Obstet Gynecol Scand. 2010 Dec;89(12):1552-6.

Joensuu-Manninen H, Kuvaja P, Talvensaari-Mattila A.

Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.

PMID: 21080899 [PubMed - in process]

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Source: http://onlinelibrary.wiley.com

Kelly T, Suddes J, Howel D, Hewison J, Robson S.

Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, UK.

Abstract
OBJECTIVE: To compare the psychological impact, acceptability and clinical effectiveness of medical versus surgical termination of pregnancy (TOP) at 13-20 weeks of gestation.

DESIGN: Randomised trial.

SETTING: Large UK tertiary centre.

SAMPLE: Women accepted for TOP at 13-20 weeks of gestation.

METHODS: Medical TOP (MTOP) using mifepristone and misoprostol or surgical TOP (STOP) by vacuum aspiration at <15 weeks of gestation, and by dilatation and evacuation at 15 or more weeks of gestation.

MAIN OUTCOME MEASURES: Distress 2 weeks after TOP, measured by the impact of events scale (IES), and acceptability, measured by the proportion of women who would opt for the same procedure again.

RESULTS: One hundred and twenty two women were randomised: 60 to the MTOP group and 62 to the STOP group. Twelve women opted to continue their pregnancy. Follow-up rates were low (n=66/110; 60%). At 2 weeks post-procedure there was no difference in total IES score between groups. However, compared with women undergoing STOP, women undergoing MTOP had a higher score on the IES intrusion subscale (mean difference 6.6; 95% CI 1.4-11.8), and a higher score on the general health questionnaire (GHQ) (P=0.033). Women found STOP more acceptable: compared with MTOP, more women would opt for the same procedure again (100% versus 53%, P≤0.001), and fewer women found the experience to be worse than expected (0% versus 53%, P=0.001). Women who had MTOP experienced more bleeding (P=0.003), more pain on the day of the procedure (P=0.008), and more days of pain (P=0.020). Of the 107 women who declined to participate, 58 (67%) preferred a STOP.

CONCLUSIONS: Randomised trials of women requesting midtrimester TOP are challenging. Women found STOP less painful and more acceptable than MTOP.

© 2010 The Authors Journal compilation © RCOG 2010 BJOG An
International Journal of Obstetrics and Gynaecology.

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Source: Obstetrics & Gynecology Volume 99, Issue 5, Part 1

Ellen Wiebe MD, Sheila Dunn MD, Edith Guilbert MD, Francis Jacot MD and Lisa Lugtig MD

Abstract

Objectives:   To compare the effectiveness, side effects, and acceptability of medical abortions induced by methotrexate and misoprostol with abortions induced by mifepristone and misoprostol.

Methods:   This was a multicenter, randomized, nonblinded, controlled trial comparing 50 mg/m2 of methotrexate followed 4–6 days later by 800 μg of vaginal misoprostol with 600 mg of oral mifepristone followed 36–48 hours by 400 μg of oral misoprostol.

Results:   There were 518 women in the methotrexate group and 524 women in the mifepristone group. In the methotrexate group, 21 women required suction curretage, two for continuing pregnancy, eight because of physician request (usually for excessive bleeding), and 11 because of patient request. In the mifepristone group, 22 women needed surgical termination, 17 because of physician request, and five because of patient request. By day 8, only 386 (74.5%) in the methotrexate group had completed the abortion compared with 474 (90.5%) in the mifepristone group, and the mean number of days from beginning to completion was 7.1 for methotrexate and 3.3 for mifepristone (P ≤ .001). There were no differences in complications, and side effects were similar. Acceptance was slightly higher with mifepristone (88.0%) than with methotrexate (83.2%).

Conclusion:   Abortions induced with mifepristone completed faster than those induced with methotrexate, but the overall success rates, side effects, and complications were similar. Acceptance rates were slightly higher with mifepristone than methotrexate (P = .03)

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Source: http://www3.interscience.wiley.com

ASR Souza,  MMR Amorim,  FEL Feitosa

Absract

Background: The induction of full-term labour in women with a live fetus remains a major challenge in modern obstetrics.

Objectives    To determine, using the best level of evidence available, the efficacy and safety of sublingual administration of misoprostol compared with vaginal misoprostol in the third trimester of pregnancy for the induction of labour, according to initial doses, in women with a live, full-term fetus and an unripe cervix.

Search strategy    Pubmed/Medline, Lilacs and Scielo databases were consulted, as well as clinical trials registered in the Cochrane Register from January 1996 to February 2008, using the keywords 'misoprostol', 'labour, obstetric', 'delivery, obstetric', 'induced labour' and 'parturition' with the search limits of 'clinical trials' and 'randomised clinical trials'.

Selection criteria    This review contains randomised clinical trials in which the sublingual and vaginal routes of administration of misoprostol were compared. Participants were pregnant women with an indication for induction of labour and a live fetus more than 37 weeks of gestational age.

Data collection and analysis    The primary analysis compared sublingual and vaginal routes of administration of misoprostol. Secondary analyses compared different routes and initial doses of misoprostol. Statistical analysis included odds ratios and their respective 95% CI. To evaluate the heterogeneity of the studies, the I-squared test was used, studies being considered heterogeneous when I2 was greater than 50%.

Main results    Five good quality clinical trials involving a total of 740 women were eligible, and all were included. No statistically significant difference was found between the sublingual and the vaginal misoprostol groups with respect to the rate of vaginal delivery not achieved within 24 hours (OR 1.27, 95% CI 0.87–1.84), uterine hyperstimulation syndrome (OR 1.20, 95% CI 0.61–2.33) or caesarean section (OR 1.33, 95% CI 0.96–1.85). An increased risk of uterine tachysystole was found in the sublingual misoprostol group (OR 1.70, 95% CI 1.02–2.83). When the studies were grouped according to the initial dose of misoprostol, no significant difference was found between sublingual or vaginal groups.

Author's conclusions    The sublingual route of administration is as effective as the vaginal route in inducing labour in full-term pregnancies with live fetuses. However, the safety, adverse effects, optimal dose and perinatal outcome related to this route of administration remain to be established, and it cannot be recommended for routine use in obstetric practice.

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Reprod Health. 2008; 5: 2. Published online 2008 June 23. doi: 10.1186/1742-4755-5-2.

Helena von Hertzen, Gilda Piaggio, and Lena Marions

Abstract

Background:   It is not known whether a 400 μg dose of misoprostol has a similar efficacy as an 800 μg dose when administered sublingually or vaginally 24 hours after 200 mg mifepristone.

Methods:   It is proposed to undertake a placebo-controlled, randomized, non-inferiority trial (3% margin of equivalence) of the two misoprostol doses when administered sublingually or vaginally using factorial design. A total of 3008 pregnant women (< 63 days of gestational age) who request legal termination of pregnancy will be recruited for the trial at 16 clinics in ten countries providing abortion services. Eligible women willing to join the study will be allocated randomly to one of the four treatment groups within each centre. Women in all treatment groups will first receive 200 mg mifepristone, followed 24 hours later by either 400 μg or 800 μg misoprostol, administered either sublingually or vaginally. The dose and route of administration of misoprostol will be blinded to women, each woman receiving four tablets vaginally and four tablets sublingually, two or four of which are 200 μg tablets of misoprostol and the rest are placebo tablets.

The four treatment regimens will be compared in terms of: (i) their efficacy to induce complete abortion; (ii) induction-to-abortion interval when possible; (iii) the frequency of side effects; and (iv) women's perceptions. The initial judgment of the outcome of treatment is made at the follow-up visit on day 15 of the study and the final assessment four weeks later. It is estimated that the clinical phase will require 12–14 months for data collection.

To compare the two routes and two doses, relative risks (RR) of failure to achieve a complete abortion and failure to terminate pregnancy and the two-sided 95% CIs will be calculated by standard methods, as well as risk differences and two-sided 95% CIs. The latter will be used to test the non-inferiority hypotheses (at 2.5% level of significance) for achieving complete abortion. The factorial structure will be taken into account in the analysis after testing the interaction.

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Delphine Hu (1), Daniel Grossman (2), Carol Levin (3), Kelly Blanchard (4), Richard Adanu (5), Sue J. Goldie (1)

1 Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA;
2 Ibis Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA;
3 Program for Appropriate Technology in Health (PATH), 1455 NW Leary Way, Seattle, WA 98107, USA;
4 Ibis Reproductive Health, 17 Dunster Street, Suite 201, Cambridge, MA 02138, USA;
5 Department of Obstetrics and Gynaecology, University of Ghana Medical School, Ghana.

*For Correspondence: Delphine Hu. E-mail: freeflap@gmail.com.

ABSTRACT

To explore the policy implications of increasing access to safe abortion in Nigeria and Ghana, we developed a computer-based decision analytic model which simulates induced abortion and its potential complications in a cohort of women, and comparatively assessed the cost-effectiveness of unsafe abortion and three first-trimester abortion modalities: hospital-based dilatation and curettage, hospital- and clinic-based manual vacuum aspiration (MVA), and medical abortion using misoprostol (MA). Assuming all modalities are equally available, clinic-based MVA is the most cost-effective option in Nigeria. If clinic-based MVA is not available, MA is the next best strategy. Conversely, in Ghana, MA is the most cost-effective strategy, followed by clinic-based MVA if MA is not available. From a real world policy perspective, increasing access to safe abortion in favor over unsafe abortion is the single most important factor in saving lives and societal costs, and is more influential than the actual choice of safe abortion modality (Afr. J. Reprod. Health 2010; 14[2]: 85-103).

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Rashid, S., H. Standing, M. Mohiuddin, and F. Ahmed (2011)

Abstract

This article describes and analyses a research based engagement by a university school of public health in Bangladesh aimed at raising public debate on sexuality and rights and making issues such as discrimination more visible to policy makers and other key stakeholders in a challenging context. The impetus for this work came from participation in an international research programme with a particular interest in bridging international and local understandings of sexual and reproductive rights. The research team worked to create a platform to broaden discussions on sexuality and rights by building on a number of research activities on rural and urban men’s and women’s sexual health concerns, and on changing concepts of sexuality and understandings of sexual rights among specific population groups in Dhaka city, including sexual minorities. Linked to this on-going process of improving the evidence base, there has been a series of learning and capacity building activities over the last four years consisting of training workshops, meetings, conferences and dialogues. These brought together different configurations of stakeholders – members of sexual minorities, academics, service providers, advocacy organisations, media and policy makers. This process contributed to developing more effective advocacy strategies through challenging representations of sexuality and rights in the public domain. Gradually, these efforts brought visibility to hidden or stigmatised sexuality and rights issues through interim outcomes that have created important steps towards changing attitudes and policies. These included creating safe spaces for sexual minorities to meet and strategise, development of learning materials for university students and engagement with legal rights groups on sexual rights. Through this process, it was found to be possible to create a public space and dialogue on sexuality and rights in a conservative and challenging environment like Bangladesh by bringing together a diverse group of stakeholders to successfully challenge representations of sexuality in the public arena. A further challenge for BRAC University has been to assess its role as a teaching and research organisation, and find a balance between the two roles of research and activism in doing work on sexuality issues in a very sensitive political context.

Source: http://www.futurehealthsystems.org

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Source: www.prochoice.org

2002

Provides a detailed overview of the published literature on medical abortion through September 2002 by Mitchell D. Creinin, MD, and includes NAF's protocol recommendations for medical abortion with mifepristone and misoprostol and methotrexate/misoprostol.

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Source: http://www.ncbi.nlm.nih.gov

de Costa CM, Russell DB, de Costa NR, Carrette M, McNamee HM.

Mifepristone (RU486), which is used for early medical abortion, can only be obtained in Australia under the Authorised Prescriber legislation (Section 19[5] of the Therapeutic Goods Act 1989 [Cwlth]); two of the authors have permission to obtain, prescribe and administer this drug in Cairns, Queensland. From July 2006 to April 2007, 10 women who fulfilled the Therapeutic Goods Administration (TGA) criteria of "life-threatening or otherwise serious" indications underwent medical abortion with mifepristone/misoprostol, and 12 women conforming with abortion requirements of Queensland law, but not TGA legislation for mifepristone administration, had medical abortions with the less preferable methotrexate/misoprostol combination. Although it is now more than a year since the cross-party vote in federal Parliament in February 2006 confirmed wide support for the right of Australian women to a medical abortion, we believe we are at present the only medical practitioners in Australia with permission to use mifepristone. Obtaining Authorised Prescriber status from the TGA is of necessity a complex and protracted process, involving ethics committee approval and auditing, and regular reporting to the TGA. Because of the current restrictions, we believe that women seeking medical abortion in Australia face barriers not experienced by women in other comparable countries, and that drug manufacturing and distributing companies may be discouraged from seeking to market mifepristone in Australia.

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Source: http://www.contraceptionjournal.org/

26 July 2007

Abstract

Purpose   This double-blind, placebo-controlled study was conducted to evaluate the molecular mechanism of mifepristone controlling breakthrough bleeding (BTB) in new depot-medroxyprogesterone acetate (DMPA) users.

Method   A total of 50 regularly cycling women who were new starters of DMPA were randomized to receive 50 mg of mifepristone or placebo once every 14 days for six cycles. Endometrial biopsies were obtained on each patient before, during and after treatment. Endometrial matrix metalloproteinase 1 (MMP-1) and MMP-9 protein and mRNA were determined by immunohistochemistry and real-time PCR, respectively. The number of T lymphocytes (CD3-positive) and mast cells (mast tryptase-positive) was evaluated by immunohistochemistry.

Results   MMP-1, MMP-9, CD3-positive and mast tryptase-positive cells increased following the DMPA treatment. Addition of mifepristone to DMPA-exposed endometrium for 1 week significantly decreased stromal MMP-9 expression and numbers of CD3-positive and mast tryptase-positive cells.

Conclusion   The decreased rates of BTB in new users of DMPA by mifepristone are associated with decreased MMP-1 and MMP-9 expression and fewer mast and T cells.

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Source: http://www.ncbi.nlm.nih.gov

Vlassoff M, Walker D, Shearer J, Newlands D, Singh S.

Guttmacher Institute, New York, USA. mvlassoff@guttmacher.org

CONTEXT: Each year, 19 million unsafe abortions occur in developing countries, and an estimated five million women are treated for the resulting serious medical complications. Meanwhile, the economic impact of postabortion care on health care systems in Africa and Latin America is poorly understood (data for Asia are lacking).

METHODS: Two main approaches were used to estimate the cost of postabortion care: calculating the average cost of care per patient, as represented in 20 empirical studies, and analyzing treatment costs using the WHO Mother-Baby Package model, which enumerates the costs of specific components of treatment related to postabortion complications. The average cost estimates from each approach were multiplied by the annual number of cases of hospitalization for postabortion care to generate regional cost estimates. Three methods (low severity, weighted severity, and inclusion of overhead and capital costs) were used to generate a range of per-patient and regional cost estimates.

RESULTS: The average per-patient cost of postabortion care ranged from $83 in Africa to $94 in Latin America (2006 US$); estimates based on the WHO Mother-Baby Package model were between $57 and $109 per case. The health system costs of postabortion care in the two regions combined ranged from $159 million to $333 million per year. The average estimates from the two approaches were similar: $280 million and $274 million, respectively.

CONCLUSIONS: The costs of treating medical complications from unsafe abortion constitute a significant financial burden on public health care systems in the developing world, and postabortion complications are a significant cause of maternal morbidity.

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Source: http://english.vista.gov.vn

Evaluating the efficacy of medical abortion up to gestational age of 49 days with Mifestad 200 and Alsoben 

Classification (rubrics): 76.29.48

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Source: http://heapol.oxfordjournals.org

Exploring the determinants of unsafe abortion: improving the evidence base in Mexico

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This study assessed the feasibility of using telephone calls combined with high-sensitivity urine pregnancy testing for follow-up of women after medical abortion, with the aim of removing the need to return to the clinic for examination, unless signs of pregnancy were still present. 139 women in Pittsburgh, US, seeking an abortion up to nine weeks of pregnancy were enrolled to receive mifepristone 200 mg orally and misoprostol 800 mcg vaginally or buccally, as per their choice. They were initially contacted by phone one week after mifepristone administration and interviewed using a standardised questionnaire. If the woman or the clinician thought the pregnancy might be ongoing, she was asked to return for a scan. Otherwise, the woman did a home urine pregnancy test 30 days after taking the mifepristone pill and was phoned within three days of the test. Those with positive pregnancy tests were also asked to return for a scan. Those with negative tests required no further follow-up. Six women presented before the initial phone call was due with concerns about ongoing pregnancy. The other 133 women were all contacted initially by phone one week after taking the pills. Eight of these were asked to return for evaluation and all did so. Of the remaining 125 women, eight  presented for an interim visit prior to the 30-days call. Of the 117 women phoned a second time after the pregnancy test, 116 were reached. Of these, 27 had a positive pregnancy test and two had inconclusive results, and all 29 were asked to return for follow-up. Three of the 29 did not return for follow-up; of the 26 who did, none had a gestational sac or a continuing pregnancy. Complete follow-up was achieved with 135 of the 139  women (97.1%), of whom 87 (63%) had no need to return to the clinic and three were lost to follow-up. This method seems to be a feasible alternative to requiring routine return to the clinic for follow-up after medical abortion. [1]

Feasibility of telephone follow-up after medical abortion

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Jan 31, 2011 10 Steinberg JR and Finer LB, Examining the association of abortion history and current mental health: a reanalysis

Source: Guttmacher Institute

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Source: http://www.contraceptionjournal.org

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Senanayake H

Ceylon Medical Journal. 2004 Mar;49(1):1-4.

Abstract

Induced abortion in Sri Lanka is a problem that has been conveniently ignored for too long. In 1984, the Minister of Health said that over 500 abortions are done in Colombo daily, and that this was only the "tip of the iceberg". The proportion of women aged between 35 and 39 years undergoing an abortion in 1998 was estimated to be 0.0667 (95% CI=0.0458-0.0877). In the present day it is estimated that for every 10 babies born in Sri Lanka, seven are being aborted. About 700 induced abortions are done in Sri Lanka daily. The practice of abortion has become so widespread in Sri Lanka that over the past three decades, many researchers feel that abortion is being used as a means of fertility regulation. The total abortion rate for married women between the age of 15 and 49 years for 1998 was 1.92 (95% CI = 1.20-2.64), a figure close to the total fertility rate for the country. These induced abortion figures are surprisingly high for a country with a contraceptive prevalence rate of 70%. The two common reasons for seeking an abortion in Sri Lanka are, becoming pregnant either when the youngest child is too small, or after the completion of the family. The abortion seekers are most likely to be rural married women. Less than 10% of them are single. Since abortion is illegal in Sri Lanka, except when it is performed to save the life of the mother, there is a chance that many of these are performed under unsafe conditions. (PubHealth.info Document ID: ABOR1T 317-06)

PubHealth.info NOTE: The author(s) of this article titled, "Induced abortion in Sri Lanka.", is(are) Senanayake H. The source of this article is "Ceylon Medical Journal. 2004 Mar;49(1):1-4.". This article was published in 2004 in English language(s). (PubHealth.info® Document ID: ABOR1T 317-06. All rights reserved with PubHealth.info) PIN: 317

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Source: http://www.ncbi.nlm.nih.gov

Contraception. 2006 May;73(5):516-9. Epub 2006 Feb 23.

Goh SE, Thong KJ.

Edinburgh Fertility and Reproductive Endocrine Centre, Royal Infirmary of Edinburgh, Little France, EH16 4SA Edinburgh, UK.

DESIGN: A retrospective analysis of 386 women who underwent termination of pregnancy between 12 and 24 weeks' gestation.

METHODS: Each woman received 200 mg mifepristone orally followed by vaginal misoprostol 800 microg 36 to 48 h later. Three hours after the initial misoprostol administration, 400-microg doses of vaginal misoprostol were administered every 3 h, to a maximum of four doses in 24 h. If abortion failed, 200 mg mifepristone is given again 3 h after the last misoprostol dose, followed by 12 h of rest before vaginal misoprostol administration is repeated as per previous course of treatment.

RESULTS: Overall, 97.9% and 99.5% of the women aborted within 24 and 36 h, respectively. The median induction-to-abortion interval was 6.7 h (range: 1.4-73.8 h), and nulliparous women took significantly longer time to abort (6.0 h in multiparous women compared to 7.6 h in nulliparous women; p<.0001). One woman failed to abort within 48 h. Surgical evacuation of the uterus was performed in 5% of women for incomplete abortion or retained placenta. Multiparous women were less likely to need analgesic administration for pain relief, and to experience vomiting and diarrhea, than nulliparous women.

CONCLUSION: The combination of 200 mg mifepristone and vaginally administered misoprostol is a safe, effective and noninvasive regimen for termination of pregnancy between 12 and 20 weeks.

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Authors: Kawonga, Mary; Blanchard, Kelly; Cooper, Diane; Cullingworth, Lee; Dickson, Kim; Harrison, Teresa; von Mollendorf, Claire; Winikoff, Beverly

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Source: http://www.publish.csiro.au

Sexual Health | 23 November 2007  Volume 4(4) 2007  223–226

Caroline M. de Costa, Darren B. Russell, Naomi R. de Costa, Michael Carrette and Heather M. McNamee

Abstract

Recent changes to Federal Therapeutic Goods Administration legislation have seen the limited introduction of the drug mifepristone to Australia for the purpose of early medical abortion. At the same time it has become evident that both methotrexate and misoprostol, licenced and available for other indications, are being used safely and appropriately for early abortion by Australian medical practitioners. Early medical abortion is widely practiced overseas where its safety and effectiveness are well supported by current evidence. However, abortion law in many states is still contained within the Criminal Codes and does not reflect current evidence-based abortion practice. In other states and territories restrictions on where abortions may be performed pose potential barriers to the introduction of mifepristone for medical abortion. There is an urgent need for abortion law to be clarified and made uniform across the country so that the best possible services can be provided to Australian women.

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"Induced Abortion in Tehran, Iran: Estimated Rates and Correlates" , by Amir Erfani

Article is available on the Guttmacher Institute web site.

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“ Induced Abortion in Colombia: New Estimates and Change Between 1989 and 2008”,  by Elena Prada

Article is available on the Guttmacher Institute web site.

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Knowledge of correct dosages of misoprostol in reproductive health

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Background   The aim of the study was to assess efficacy and safety of administering 200 mg of mifepristone between 36 and 48 h before the insertion of 800 mcg of vaginal misoprostol to induce late second-trimester abortion between 19.1 and 25.6 weeks gestation.

Study design   A consecutive series of 428 women who requested a termination of their pregnancy between 19.1 and 25.6 weeks of gestation were analyzed.

Methods   Each woman received 200 mg of mifepristone orally between 36 and 48 h before the vaginal administration of 800 mcg of misoprostol and the insertion of two Dilapan intracervical tents if the gynecologist deemed necessary. Four hours after misoprostol, amniorrhexis was performed and intravenous oxytocin infusion started. The variables for assessing efficacy were the number of complete abortion without dilation and evacuation (D&E) and the time elapsed since misoprostol administration until the abortion.

Results   Complete abortion without surgery occurred in 387/428 (90.4%) subjects, and the mean time for misoprostol to abortion was 6.9±3.1 (SD) h. In 32/428 (7.5%) patients, it was necessary to administer a second 600-mcg misoprostol dose. The mean total oxytocin used was 9.7±7.9 (SD) IU. In 41/428 (9.6%) women, the abortion process was completed by D&E. A uterine rupture occurred in one woman with a previous cesarean section.

Conclusion   The method of abortion that combined mifepristone, misoprostol and oxytocin was effective for interrupting pregnancies between 19.1 and 25.6 weeks of gestation. It is advisable to be well trained in D&E technique in case of possible failures and/or abortion inductions that are excessively prolonged.

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Source: http://content.nejm.org

Jasveer Virk, M.S., M.P.H., Jun Zhang, Ph.D., M.D., and Jørn Olsen, M.D., Ph.D.

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Contraception , Volume 78 , Issue 4 , Pages 332 - 335 

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Source: http://www.medscape.com

Qian-Xi Zhu; Er-Sheng Gao; Ai-Min Chen; Lin Luo; Yi-Min Cheng; Wei Yuan

Abstract

Background: The aim of the study was to explore the effect of first-trimester mifepristone-induced abortion (MA) on placental complications in subsequent pregnancy.

Methods: Two cohorts of nulliparous pregnant women were recruited in China during early pregnancy, one with a history of one MA and the other with no abortion (NA). Women were followed up until delivery.

Results: The incidence proportions of abruptio placenta, placenta previa, placenta accreta and retained placenta in the MA group (4673) and NA group (4690) were, respectively, 0.5 and 0.3, 0.8 and 0.9, 0.5 and 0.5, and 0.7 and 0.8% (all differences non-significant). After adjustment for center, age, education, occupation, residence, income, BMI and type of delivery, the incidence rates of placenta previa, accreta and retained placenta in the MA and NA groups showed no significant differences. The risk of abruptio placenta in women with a MA was nearly double that of women with no abortion, although this apparent increased risk was not statistically significant. Furthermore, this increased risk of abruptio placenta was found only in those with a gestational age >6 weeks at abortion (aOR: 2.46; 95% CI: 1.00-6.04), a curettage after abortion (aOR: 3.00; 95% CI: 1.25-7.20) or a longer inter-pregnancy interval (P-value for trend: 0.022).

Conclusions: Mifepristone-induced abortion itself is not associated with placental complications in subsequent pregnancy, but other factors related to medical abortion -- such as a gestational age >6 weeks at abortion, a curettage after abortion, and a longer interpregnancy interval -- may increase the risk of abruptio placenta.

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Source: http://linkinghub.elsevier.com

Contraception, Volume 81, Issue 2, Pages 97-101
O. Gómez, A. Borrás, A. Rabanal, M. Palacio, A. Carceller, O. Coll, E. Gratacós

Abstract

Background
This study was conducted to explore the effect of gestational age (GA) on the induction-to-abortion interval of mifepristone–misoprostol midtrimester termination of pregnancy (TOP) regimen.

Study Design
This study involved a consecutive series of 270 pregnancies between 12.0 and 22.6 weeks that have undergone legal TOP from April 2006 to June 2009. All women received a single oral dose of 200 mg mifepristone and, 36–48 h later, a course of misoprostol (an initial vaginal dose of 800 mcg plus four oral doses of 400 mcg at 3-hourly intervals). Treatment was considered to be a failure if abortion did not occur within 24 h. The impact of GA, parity and maternal age on the induction-to-abortion interval was assessed by means of Cox regression.

Results
Overall, the mean GA at TOP was 18.0 weeks. The mean induction-to-abortion interval was 9.8 h (SD=8.2 h; range=1–50 h), and 246 women (91%) aborted successfully within 24 h. GA at TOP and parity were the only two variables independently associated with the induction-to-abortion interval. The mean induction-to-abortion interval was increased by about 50% in patients undergoing TOP between 20.0 and 22.6 weeks (12.9 h, SD=8.9), as compared with those at 16.0–19.6 weeks (7.8 h, SD=5.9) and 12.0–15.6 weeks (8.2 h, SD=8.3) (p<.001). The effect of parity on the induction-to-abortion interval was more modest, with a 20% increase in induction-to-abortion interval in nulliparous (10.1 h, SD=9.1), as compared with women with a previous live birth (8.1 h, SD=6.7).

Conclusions
The mean induction-to-abortion interval increases by 4 h after 20 weeks GA. This information may be relevant for counseling and planning of the procedure.

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International Journal of Gynecology & Obstetrics , Volume 99 , Pages S156 - S159

A . Weeks , A . Faúndes

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International Journal of Gynecology & Obstetrics, Volume 76, Issue 1, January 2002, Pages 65-74
S. Clark, J. Blum, K. Blanchard, L. Galvão, H. Fletcher, B. Winikoff

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J. Sherrisa, A. Binghama,  M.A. Burnsa, S. Girvinb,  E. Westleyb, and P.I. Gomezb, 

aPATH, Seattle, WA, USA bEngenderHealth, New York, NY, USA

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Source: http://www.rhmjournal.org

Alejandro Velazco Boza, Rodolfo Gómez Ponce de León, Luis Salas Castillo, Dania Rebeca Yi Mariño, Ellen MH Mitchell

Reproductive Health Matters
May 2008 (Vol. 16, Issue 31, Pages 189-195)

Abstract

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This toolkit is designed to help district or national-level clinicians, facility managers or program managers initiate the use of misoprostol as a medical treatment for incomplete abortion or integrate misoprostol into existing postabortion care services.

Misoprostol use in postabortion care: A Service Delivery Toolkit

Source: http://ipas.org

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Source: Acta Obstet Gynecol Scand. 2007;86(9):1117-21.

Nilas L, Glavind-Kristensen M, Vejborg T, Knudsen UB.

Department of Obstetrics and Gynecology, Hvidovre Hospital, Denmark. lisbeth.nilas@hh.hosp.dk

METHODS: A retrospective 2-year cohort study of 127 women, with gestation between 13 and 24 weeks and a live fetus, seeking induced abortion. The aim was to compare the effect of a 1-day and a 2-day interval between oral mifepristone (200 mg) and vaginal misoprostol (400 microg) every 3 h. RESULTS: The time to fetal expulsion was longer (9.8 versus 7.5 h; p<0.01) in the 1-day than in the 2-day group, but the median number of applications were identical and abortion occurred in 98% within 24 h in both groups The time to abortion was longer in women with a gestation of 17-22 weeks compared to women with lower gestation (10.2 versus 6.8 h; p<0.001), and longer in nulliparae than in parous women (10.0 versus 6.7 h; p<0.001).

CONCLUSION: The combined regimen of mifepristone and misoprostol is effective in the second trimester, and the interval between the drugs can be reduced allowing individualised patient care.

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One- and two-day mifepristone–misoprostol intervals for second trimester termination of pregnancy between 13 and 16 weeks of gestation

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An interagency statement OHCHR, UNFPA, UNICEF, UN Women and WHO

Authors:
World Health Organization, Department of Reproductive Health and Research

• See statement

This OHCHR, UNFPA, UNICEF, UN Women and WHO joint interagency statement reaffirms the commitment of United Nations agencies to encourage and support efforts by States, international and national organizations, civil society and communities to uphold the rights of girls and women and to address the multiple manifestations of gender discrimination including the problem of imbalanced sex ratios caused by sex selection. It thus seeks to highlight the public health and human rights dimensions and implications of the problem and to provide recommendations on how best to take effective action.

Source: http://www.who.int

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Foster AM, Wynn L, Rouhana A, Diaz-Olavarrieta C, Schaffer K, Trussell J.

Abstract

Objectives: This study analyzes the use patterns of , an English-, Spanish-, Arabic- and French-language web site dedicated to three methods of early pregnancy termination: mifepristone/misoprostol, methotrexate/misoprostol and misoprostol alone.

Methods: This study examines both the overall and language-specific use patterns of the web site from October 1, 2004 , through September 30, 2005 . Data were recorded using Wusage 8.0, a web site statistics program.

Results: Over the 12-month study period, received more than 78,000 visits and nearly 240,000 page requests. The English version is the most popular version of the web site (accessed in 46.1% of all visits), followed by the Spanish (35.0%), Arabic (10.4%) and French (8.8%) versions. Spanish-language visits are nearly three times as likely to access the misoprostol-only section of the web site when compared with the other language versions (p<.001).

Conclusion: This study confirms that multilingual, medically accurate online resources have the potential to expand information about medication abortion to both providers and women considering the option of abortion in diverse communities. Analysis of the language-specific use patterns highlights the different priorities of various types of web site visitors and suggests future priorities for educational outreach, collaboration and research.

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Source: www.ncbi.nlm.nih.gov

Bixby Center for Reproductive Health Research and Policy, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.

Over 99% of deaths due to abortion occur in developing countries. Maternal deaths due to abortion are preventable. Increasing the use of misoprostol for elective abortion could have a notable impact on maternal mortality due to abortion. As a test of this hypothesis, this study estimated the reduction in maternal deaths due to abortion in Africa, Asia and Latin America. The estimates were adjusted to changes in assumptions, yielding different possible scenarios of low and high estimates. This simple modeling exercise demonstrated that increased use of misoprostol, an option for pregnancy termination already available to many women in developing countries, could significantly reduce mortality due to abortion. Empirical testing of the hypothesis with data collected from developing countries could help to inform and improve the use of misoprostol in those settings.

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Source: http://linkinghub.elsevier.com

Saxena P, Salhan S, Sarda N.
Department of Obstetrics and Gynecology, Vardhman Mahavir Medical
College and Safdarjung Hospital, New Delhi 110029, India.
pikeesaxena@hotmail.com

Abstract

This is a prospective randomized clinical trial evaluating, for the first time, the effectiveness of sublingual route of misoprostol for cervical priming prior to vacuum aspiration (VA). The trial included 100 women seeking first trimester abortion who were sequentially randomized into two groups of 50 each. Patients of study group received 400 μg sublingual misoprostol 3 h prior to VA while those of the control group did not receive any premedication for cervical ripening. For all periods of gestation between 6 and 12 weeks, misoprostol significantly reduced pain score, blood loss, time duration and rate of complications without increasing the side effects. Sublingual misoprostol is an effective alternative to mechanical cervical dilatation. It can be self-administered and has a good patient-acceptability rate. As no study has evaluated the role of sublingual route of misoprostol for cervical priming before VA, wider studies should be done to advocate its routine use.

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Reproductive Health Matters, Volume 17, Issue 33, Pages 70-79
L. Patel, T. Bennett, C. Halpern, H. Johnston, C. Suchindran

Abstract

Medical abortion has the potential to increase the number, cadre and geographic distribution of providers offering safe abortion services in India. This study reports on a sample of family planning providers (263 mid-level providers, 54 obstetrician-gynaecologists and 88 general physicians) from a 2004 survey of health facilities and their staff in Bihar and Jharkhand, India. It identified factors associated with mid-level provider interest in training for early medical abortion provision, and examined whether obstetrician-gynaecologists and general physicians supported non-physicians being trained to provide early medical abortion and what factors influenced their attitudes. Findings demonstrate high levels of mid-level provider interest and reasonable physician support. Among mid-level providers, being male, having a more permissive attitude towards abortion and current provision of abortion using any pharmacological drugs were associated with greater interest in attending training. Mid-level providers based in private health facilities were less likely to show interest. More permissive attitude towards abortion and current medical abortion provision using mifepristone-misoprostol were inversely associated with obstetrician-gynaecologists' support for non-physician provision of medical abortion. General physicians based in private/other health facilities were less supportive than those in public facilities. Study findings strengthen the case for policymakers to expand the pool of cadres that can legally provide safe abortion care in India.

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Source: http://www.esog.org.et

Ethiopian Journal of Reproductive Health

Tekle-Ab Mekbib1, Yirgu G/Hiwot 2, Misganaw Fantahun3

1Population Council, Addis Ababa, Ethiopia; 2Department of Ob/Gyn, Faculty of Medicine, Addis Ababa University; 3 Department of Community Health, Faculty of Medicine, Addis Ababa University

Abstract

In order to fill the gap in evidence based information, and help in programming for the reduction of maternal deaths due to unsafe abortion, a nationwide hospital based survey in 9 of the 11 administrative regions of Ethiopia was conducted from June to December 2000.

A total of 1075 women presenting with abortion to the 15 hospitals during the study period were consecutively enrolled . About 58 percent of the cases were in the age range of 20-29 years, 26.5 percent were illiterate, and 27.5 percent were with secondary education. Three-fourth of patients had spontaneous abortion and one fourth (25.6 percent) of them had induced abortion. The majority of women (87 percent) were aware of contraceptive methods, but only about half of them ever used a family planning method. Of those pregnancies that ended in abortion 60 percent were unplanned and 50 percent were unwanted. Method non-use was responsible for 78 percent of pregnancies that occurred. Among those with induced abortion, the most common reason for termination of pregnancy was contraceptive need. Rape accounted only for 3 percent of all pregnancies that ended in abortion (i.e. 2.5 percent of all reasons for termination of pregnancies).   Fifty eight percent of women who induced abortion terminated the current pregnancy either by seeking the help of untrained personnel or by themselves with no assistance. The most frequent reason for hospital visit was vaginal bleeding and abdominal pain. Evacuation and curettage (E & C) was the commonest method (83.6 percent) of evacuating the contents of the uterus. The major categories of complications identified were infection (28 percent), genital tract injuries (12 percent), foreign bodies in the genital tract (1.6 percent) and organ failure (13.1 percent). There were 13 deaths, which made an overall procedure related deaths of 1,209 per 100,000 abortions. Using a modified Delphi technique, and taking the six months study period, it was found out that the total cost to treat incomplete abortion by health facilities under this survey was Birr 332,259.9. In conclusion, there is a need for a strong family planning program for the country, to prevent unwanted and unplanned pregnancies. There is a also an urgent need for improvement of providers knowledge and skills, provision of safe abortion services, and liberalization of the abortion law.

*Corresponding author: email address: mekbibt@ethionet.et

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Source: http://www.sciencedirect.com

Yimin Cheng, Xiao Xu, Juncai Xu, Françoise Wuillaume, Jinliang Zhu, Diana Gibson and Marleen Temmerman

Abstract

Objective:   To assess the need for integrating postabortion care with family planning services in China.

Method:   We collected data from a clinic-based study of 24 abortion clinics in 3 large cities in China.

Results:   There was a total of 287 (10.3%) high-risk abortions among the 2780 respondents, 974 (35%) of whom had had repeated abortions and 48.4% had had 2 abortions within 1 year; 63.7% of the current pregnancies resulted from not using contraceptives; 28.8% and 19.8% of these new pregnancies, respectively, were due to the failure of the rhythm or the withdrawal method; only 9.7% of the respondents consistently used condoms; and only 9.1% could identify the correct time of their first ovulation following an abortion.

Conclusion:   Contraceptive neglect and the high rates of repeated and high-risk abortions call for the integration of postabortion care with family planning services in China.

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Source: http://www.ncbi.nlm.nih.gov

1: Curr Opin Obstet Gynecol. 2006 Dec;18(6):581-6.

Tang OS, Ho PC.

Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong SAR, China. ostang@graduate.hku.hk

PURPOSE OF REVIEW: This paper reviews the current management of early pregnancy failure with particular emphasis on the use of misoprostol.

RECENT FINDINGS: Medical management using misoprostol is effective for the management of miscarriages. The success rate ranged from 84 to 93% depending on the regimen of misoprostol, the duration of waiting period and the types of miscarriage.

SUMMARY: Miscarriages occur in 10 to 20% of all pregnancies. Surgical evacuation has been used to empty the uterus. Recently, medical treatment using misoprostol has been studied for the management of miscarriage. It avoids surgery and its associated complications. Compared to expectant management, the success rate is higher. Nonsurgical management takes a longer period to reach the endpoint and medical management is associated with side effect of medication. Studies have shown that medical management is safe and acceptable to women. The optimal regimen of medical management, however, is yet to be determined.

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FialaC, Safar P, Bygdeman M, Gemzell-Danielsson K. Eur J Obstet Gynecol Reprod Biol. 2003; 109(2): 190-5.

Abstract

Objectives:   The combination of mifepristone and misoprostol is an established method for termination of pregnancy. However, there is no general agreement about how best to evaluate the treatment outcome.

Study design:   In 217 women with an unwanted pregnancy below 49 days of amenorrhoea, ultrasound examination and serum hCG test were performed before treatment and at follow-up.

Results:   Treatment was successful in 98.2%. At follow-up their hCG dropped to a mean of 3% (S.D. 3) of initial levels and the endometrium measured a mean of 10mm (S.D. 4). Interpretation of endometrium was difficult in some cases because of inhomogeneous structure. Using hCG was reliable in 98.5% of successful abortions. For ultrasound the corresponding figure was 89.8% for the cases with a confirmed intrauterine pregnancy before treatment but only 66% if all pregnancies were included.

Conclusion:   Measuring serum hCG before treatment and at follow-up is more effective than ultrasound to confirm a successful medically induced abortion in early pregnancy.

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Uterine rupture associated with misoprostol labor induction in women with previous cesarean delivery

European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 113, Issue 1, Pages 45-48

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Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality

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World Abortion Policies 2007 provides the most up-to-date, accurate and objective information available on the legal status of induced abortion for the 195 Member and non-Member States of the United Nations. To complement this information, data on abortion rates, contraceptive prevalence, total fertility and maternal mortality are also provided.

 
Wall Chart (pdf)
Table (Excel)

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Christina Zampas* and Jaime M. Gher**

* Senior Regional Manager Legal Adviser for Europe, Center for Reproductive Rights–International Legal Program, 120 Wall Street, 14th Floor, New York, New York 10005.
** Attorney–Consultant, Center for Reproductive Rights–International Legal Program, 120 Wall Street, 14th Floor, New York, New York 10005.

This article focuses on the striking expansion of international and regional human rights standards and jurisprudence that support women's human right to abortion. It summarises pertinent developments within the United Nations, European, Inter-American and African human rights systems regarding abortion, as they relate to women's rights to life and health, in situations of rape, incest or foetal impairment, and for abortion based on social and economic reasons and on request. In doing so, the article touches on charged issues such as maternal mortality, prohibitions of therapeutic abortion as infringing on the right to be free from cruel, inhuman and degrading treatment, and state procedural obligations to ensure women's right to access legal abortion. Finally, the article addresses the growing recognition by international human rights bodies that criminalisation of abortion leads women to obtain unsafe abortions, threatening their lives and health, and recent national-level developments in the field.

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REBECCA J. COOK , University of Toronto - Faculty of Law
JOANNA ERDMAN , University of Toronto - Faculty of Law
BERNARD DICKENS,  University of Toronto - Faculty of Law   

Abstract:     

National and international courts and tribunals are increasingly ruling that although states may aim to deter unlawful abortion by criminal penalties, they bear a parallel duty to inform physicians and patients of when abortion is lawful. The fear is that women are unjustly denied safe medical procedures to which they are legally entitled, because without such information physicians are deterred from involvement. With particular attention to the European Court of Human Rights, the UN Human Rights Committee, the Constitutional Court of Colombia, the Northern Ireland Court of Appeal, and the US Supreme Court, decisions are explained that show the responsibility of states to make rights to legal abortion transparent. Litigants are persuading judges to apply rights to reproductive health and human rights to require states' explanations of when abortion is lawful, and governments are increasingly inspired to publicize regulations or guidelines on when abortion will attract neither police nor prosecutors' scrutiny.

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Source: http://www.asap-asia.org

Asia Safe Abortion Partnership (ASAP) had completed a study: “A Study of Knowledge, Attitudes and Understanding of Legal Professionals about Safe Abortion as a Women’s Right” .

This study was conducted in 7countries: 

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Source: http://www.hst.org.za

Author:                    Roberts, Jaine

Publisher:              Health Systems Trust

Publication Date: 9/2007ISBN:                      1-919839-61-5

Summary  Unsafe abortions are recognised as a global health problem. It is estimated that, worldwide and annually, twenty (20) million abortions are induced by untrained people under medically unsafe conditions. It is further estimated that, worldwide and annually, eighty thousand (80 000) women die as a result of unsafe abortions while another five (5) million women suffer non-fatal health problems (UNDP) as a consequence of unsafe abortions.

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Source: http://reproductiverights.org

Download Bringing Rights to Bear: Abortion and Human Rights (PDF, 0.1 MB)

01.14.09 - The Center has completed updating one of its signature publications, Bringing Rights to Bear. Initially published in 2002, Bringing Rights to Bear takes a long, hard look at the thousands of comments, statements, and recommendations produced by UN treaty-monitoring bodies, analyzing their potential for advancing reproductive rights. Our 2008 update, produced as a series of standalone briefing papers on specific issues, reflects the growing recognition among these UN bodies that reproductive rights are firmly grounded in international human rights treaties. The redesigned layout allows audiences with more tailored thematic interests to receive only the information they need. On November 5, we formally launched the publication in Geneva with presentations to the UN Committee on the Elimination of Discrimination against Women and the UN Committee on Economic, Social, and Cultural Rights.

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Source: http://popdev.hampshire.edu

Villa Torres, Laura

2008

Full text

DifferenTakes, no. 49. Amherst, MA, Population and Development Program, Hampshire College.

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Source: http://papers.ssrn.com

Rebecca J. Cook
University of Toronto - Faculty of Law

Bernard Dickens
University of Toronto - Faculty of Law

International Journal of Gynecology and Obstetrics 106 (2009) 106–109

Abstract:
Since the 1994 Cairo Conference on Population and Development, the human rights movement has embraced the concept of reproductive rights. These are often pursued, however, by means to which objection is taken. Some conservative political and religious forces continue to resist implementation of several means of protecting and advancing reproductive rights. Individuals' rights to grant and to deny consent to medical procedures affecting their reproductive health and confidentiality have been progressively advanced. However, access to contraceptive services, while not necessarily opposed, is unjustifiably obstructed in some settings. Rights to lawful abortion have been considerably liberalized by legislative and judicial decisions, although resistance remains. Courts are increasingly requiring that lawful services be accommodated under transparent conditions of access and of legal protection. The conflict between rights of resort to lawful reproductive health services and to conscientious objection to participation is resolved by legal duties to refer patients to non-objecting providers.

Keywords: Abortion rights, conscientious objection, contraception, Developments legal, reproductive health

JEL Classifications: K10, J13, I18, I10

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Source: http://hrw.org

In Peru abortion is legal in order to save the life of the woman or to avoid serious and permanent damage to her health. In practice, accessing lawful abortions is next to impossible.
My Rights, andMy Right to Know: Access to Therapeutic Abortion in Peru examines the obstacles to accessing therapeutic abortion in Peru’s public health system. Obstacles include ambiguities in Peru’s criminal law, the absence of a national protocol on therapeutic abortion, dysfunctional approval and referral procedures, fear of prosecution, cost, and widespread beliefs that such abortions are illegal.
For many women and girls, the decision to undergo a therapeutic abortion is not an easy one tomake. Policymakers and medical authorities who complicate and impede access to legal abortion services and information do not reduce the number of abortions – they simply drive them underground.
Women and girls confronting crisis pregnancies that could kill them or permanently harm their health need urgent access to safe, dignified, affordable abortions. Yet Human Rights Watch documented cases where women and girls clearly eligible for legal abortions were refused or unable to access the service, with terrible consequences to their physical and mental health.
Peru has an obligation under international human rights law to ensure that access to therapeutic abortion in the public health system is a reality.
Human Rights Watch calls on Peru to act immediately to: adopt a nationwide protocol on therapeutic abortion; inform women, health practitioners, and the general public that therapeutic abortions are permitted by law; and investigate instances in which healthcare providers deny therapeutic abortion to eligible women and girls, and discipline them appropriately.

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Also available in: Spanish

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Source: www.awid.org

It draws on the results of a global survey of over 1,600 women’s rights activists, in-depth interviews with over 50 key experts, as well as supplementary research and consultations. This brief report presents the highlights of the research to date.

Read the brief report in following languages:

En , Es , Fr

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Bonnie Scott Jones, JD; Simon Heller, JD

As early medical abortion becomes more widely used and available in the United States, providers of women's health care are questioning whether, and in what way, existing abortion restrictions apply to medical abortion. Many of these laws, virtually all of which were written before early medical abortion was widely used in this country, make little sense in the context of medical abortion. Nonetheless, most abortion restrictions are broadly written and could be interpreted by state officials to apply to providers of medical abortion. This paper identifies and briefly describes common types of abortion restrictions, including physician-only laws, targeted regulation of abortion providers, fetal tissue examination and disposal laws, parental involvement requirements, and mandatory waiting periods, and explains the extent to which these types of requirements may be enforced against providers of medical abortion. In addition, because some abortion restrictions are irrational or impose significant and unwarranted burdens on women's access when applied to medical abortion, they may be vulnerable to legal challenge. We also review possible legal efforts to invalidate these laws, as well as legislative or regulatory changes that can be sought in order to make medical abortion truly accessible to women in this country.

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Source: www.awid.org

This publication draws on the survey responses of more than 1,600 women’s rights activists and interviews with 51 key experts. It seeks to build a deeper and more shared understanding among women’s rights activists and their allies of the way fundamentalist projects work to undermine women’s rights, human rights and development.

Read the complete publication in following languages:

En , Es , Fr

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Source: http://reproductiverights.org

Download the Russian edition of Reproductive Rights are Human Rights .

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Source: http://www.ijgo.org

Anibal Faúndesa,  Kamini Raob, Leonel Briozzoc

published online 19 June 2009.

Abstract

The International Congress on Population and Development (ICPD) Programme of Action urged governments and intergovernmental and nongovernmental organizations to reduce women's recourse to abortion through improved family planning services; reliable information and counseling should be readily accessible to women who have unwanted pregnancies; where abortion is legal, it should be safe; and in all cases, quality services for management of abortion complications should be accessible. Review of the extent to which these recommendations have been implemented over the last 15 years shows that, with few exceptions, little attention has been given to this serious problem. Because of its political and religious implications, abortion is mostly ignored. Those with the power to promote change have an obligation to raise the issue of abortion from the darkness in which it is currently hidden, and bring it into the public light as a human drama and a health problem that is not difficult to solve if the ICPD recommendations are taken seriously.

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Whether and in what circumstances abortion should be legal is highly debated in many parts of the world, with arguments based on religious, moral, political, human rights and public health grounds. Given the emotionality of the debate, it is crucial to shed light on why, how many and under what conditions women around the world have abortions. With the best available information, individual countries and the international community can engage in a balanced discussion of how to both reduce the levels of unintended pregnancy that lead to abortion and deal with the sometimes deadly consequences of unsafe abortion for women in many of the world’s poorest countries.

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Source: www.awid.org

By grappling with these questions, this publication aims to understand how women’s rights activists from different parts of the world experience and define the complex phenomenon of religious fundamentalisms. Based on the responses of more than 1,600 individuals to AWID’s survey in September 2007, and 51 in-depth interviews conducted by the AWID research team, this publication aims to explore how women’s rights activists characterize religious fundamentalisms and to reach a better understanding of their views and experiences of the issue in various parts of the world.

Read the complete publication in following languages:

En , Es , Fr

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Cardozo Journal of Law and Gender, spring 2007, vol. 13, no 2, pp. 273-303.

Abortion is one of the subjects that have been discussed extensively in both  academic and popular literature. Nevertheless, such discussions do not consider abortion as a constitutional, legal issue.

Consequently, the public opinion on abortion in Croatia expresses irreconcilable, contradictory judgments. Croatians accept the right on abortion and at the same time consider it to be killing, a deprivation of life.  It is reasonable, therefore, to try to present the outcome of abortion dilemma emerged in the Republic of Croatia by comparative legal analysis.  Comparing the experiences of the highest judicial bodies in the Federal Republic of Germany and USA, the author of the article tries to present the abortion issue as a battle of compelling state interests, rights of a mother and rights of the unborn.  The outcome of such analysis confirms the right of abortion as one of the basic rights originated in right to privacy, right to self-determination and even freedom of religion.  

The special attention has been given to CEDAW Convention. To grasp a current and truthful public standing on abortion issue, the article presents research results on students' attitudes towards the abortion. The results have been compared with results obtained in two previous public opinion researches on abortion in Croatia.  

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Source: www.awid.org

Together, these women’s rights activists represent a diverse group: ranging in age from under 16 to over 65 years of age; working on different issues and affected by different religious fundamentalisms; working at local, national, regional or international levels in various regions, and in organizations that range from non-governmental organizations (NGOs) and community-based organizations (CBOs) to government and multilateral agencies. They include academics, human rights defenders, youth and development workers, as well as members of religious
organizations.

Despite this diversity, we found many myths in common: myths we hold about religious fundamentalisms, as well as myths that religious fundamentalists would like us to believe. Our research reveals that the behaviours and impacts of religious fundamentalisms are clearly more negative than they would like to admit or take responsibility for. But it also reveals that religious fundamentalisms are not as simple to analyze as we sometimes believe. In other words, some major myths, promoted both from the inside looking out and from the outside looking in, were exposed by our findings.

This publication is about the top ten myths common to all regions and religions covered in AWID’s research. They can be countered by holding religious fundamentalists accountable for what they say and do, and by ensuring that our analysis most closely matches the lived experiences of women’s rights activists. By exposing these myths, we hope that we can contribute to strengthening resistance and challenges to religious fundamentalisms.

Read the complete publication in following languages:

En , Es , Fr

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La Mesa por la Vida y la Salud de las Mujeres (Colombia) and la Alianza por el Derecho a Decidir (Mexico) announce the publication of a new document on the Health Exception for Termination of Pregnancy.

Executive summary

The health exception is one of the components of legal permission for the termination of a pregnancy guaranteed by the majority of Latin American and Caribbean countries. This exception refers to the possibility of terminating a pregnancy when the pregnancy puts the woman’s health at risk. However, its practical implementation has been accompanied by a combination of obstacles that have resulted in many women not accessing safe and timely abortion services, even when legally permitted.

One of the most recent debates on the topic of Lawful Termination of Pregnancy/LTP has been precisely on the definition of the scope of the health exception, given that its interpretation by health care professionals defines, blocks or favors opportune access to services. Very significant legal decisions have made an important contribution to this debate, in addition to a collection of international commitments that oblige these professionals to interpret the concept of health in a broad and integrated manner. This broad interpretation of health naturally influences the scope of the cause of permission for terminating a pregnancy based precisely on the risk to health. It is increasing clear, for example, that the interpretations of the scope of the exception should comply with the broad framework of the protection of women’s human and constitutional rights that are connected with and recognized by the countries in the region.

This document provides an extensive and in-depth assessment of various ideas related to the interpretation of the health exception, and presents arguments for the most appropriate interpretations for implementing the health exception as an effective protection of women’s human rights. In order to do this, the analyzed material and the interpretive proposals are organized according to the following chapters:

• The health exception within the human rights framework and other related concepts;
• Dimensions of the right to health;
• Principles to be considered when implementing the health exception;
• Ethical considerations;
• Criteria for interpreting the health exception;
• Criteria for resolving conflict.

The Health Exception: Lawful termination of pregnancy, ethics and human rights‏

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Source: http://papers.ssrn.com

Rebecca J. Cook , University of Toronto - Faculty of Law
Simone A. Cusack , affiliation not provided to SSRN
Bernard Dickens , University of Toronto - Faculty of Law

International Journal of Gynecology and Obstetrics, Vol. 109, pp. 255-258, 2010

Abstract:

Stereotypes are generalized preconceptions defining individuals by group categories into which they are placed. Women have become stereotyped as homemakers and mothers, with the negative effect of precluding them from other roles and functions. Legislation and judicial constructions show a history, and often a continuing practice, of confining women to these stereotypical functions. In access to reproductive and sexual health care, for instance, women's requests have been professionally subject to approval of their husbands, fathers or comparable males. Choice of abortion is particularly significant, because it embeds moral values. Women's capacity to act as responsible moral agents is denied by stereotypical attitudes shown by legislators, judges, heads of religious denominations, and healthcare providers who consider women incapable of exercising responsible moral choice. These attitudes violate ethical requirements of treating patients with respect and equal justice. They can also result in violations of human rights laws that prohibit discrimination against women.

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Source: http://www.reproductiverights.org

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Abortion and Women's Lives

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Source: http://www.familycareintl.org

The Health Impact of Unsafe Abortion is a report of a regional meeting held in September 2003 in Kuala Lumpur, Malaysia and organized by the Safe Motherhood Inter-Agency Group. Bringing together decision-makers and planners from selected countries in the Asia region, the meeting aimed to promote discussion and dialogue on the health impact of unsafe abortion within the context of safe motherhood, and to exchange information, experiences, and strategies. English (2005)

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www.rhmjournal.org

  “Second-Trimester Abortion: Women’s Health and Public Policy” is a  supplement to Reproductive Health Matters 2008; 16 (31). The publication stemmed from the International Conference on Second Trimester Abortion which was organized by International Consortium for Medical Abortion   (ICMA) in London on 29-31 March 2007.

Who is excluded when abortion access is restricted to twelve weeks? Evidence from Maputo, Mozambique
Available in Ar,  En , Es,  Fr , Hi,  Pt , Ru
Momade Bay Ustá, Ellen MH Mitchell, Hailemichael Gebreselassie, Eunice Brookman-Amissah, Amata Kwizera

Reasons for second trimester abortions in England and Wales
Available in Ar,  En , Es,  Fr , Hi,  Pt , Ru
Roger Ingham, Ellie Lee, Steve Joanne Clements, Nicole Stone

Factors influencing the percentage of second trimester abortions in the Netherlands
Available in Ar,  En , Es,  Fr , Hi,  Pt , Ru
Olga Loeber, Cecile Wijsen

Second trimester abortions in India
Available in Ar,  En , Es,  Fr , Hi,  Pt , Ru
Suchitra S Dalvie

Termination of pregnancy for fetal abnormality: the perspective of a parent support organisation
Available in Ar,  En , Es, Fr , Hi,  Pt , Ru
Jane Fisher

A week in the life of an abortion doctor, Western Cape Province, South Africa
Available in Ar,  En , Es, Fr , Hi,  Pt , Ru
Marijke Alblas

Second trimester abortion provision: breaking the silence and changing the discourse
Available in Ar,  En , Es, Fr , Hi,  Pt , Ru
Lisa H Harris

Decision-making after ultrasound diagnosis of fetal abnormality
Available in Ar,  En , Es,  Fr , Hi,  Pt , Ru
Hilmar H Bijma, Agnes van der Heide, Hajo IJ Wildschut

Maintaining access to safe abortion and reducing sex ratio imbalances in Asia
Available in Ar,  En , Es, Fr , Hi,  Pt , Ru
Bela Ganatra

Implications of the federal abortion ban for women’s health in the United States
Available in Ar,  En , Es, Fr , Hi,  Pt , Ru
Tracy A Weitz, Susan Yanow

Clarifying values and transforming attitudes to improve access to second trimester abortion
Available in Ar,  En , Es,  Fr , Hi,  Pt , Ru
Katherine L Turner, Alyson G Hyman, Mosotho C Gabriel

Fetal pain: do we know enough to do the right thing?
Available in Ar,  En , Es, Fr , Hi,  Pt , Ru
Stuart WG Derbyshire

Applying the WHO Strategic Approach to strengthen first and second trimester abortion services in Mongolia
Available in Ar,  En , Es,  Fr , Hi,  Pt , Ru
Bazarragchaa Tsogt, Khishgee Seded, Brooke R Johnson, and the Strategic Assessment Team

Establishing second trimester abortion services: experiences in Nepal, Viet Nam and South Africa
Available in Ar,  En , Es, Fr , Hi,   Pt, Ru
Alyson G Hyman, Traci L Baird, Indira Basnett

Second trimester abortion in Viet Nam: changing to recommended methods and improving service delivery
Available in Ar,  En , Es,  Fr ,  Hi,   Pt , Ru
Tuyet Hoang TD,Thuy Phan,Trang Huynh NK

Surgical abortion in the second trimester
Available in Ar,  En , Es,  Fr ,  Hi,   Pt, Ru
Patricia A Lohr

Second trimester medical abortion with mifepristone–misoprostol and misoprostol alone: a review of methods and management
Available in Ar,  En , Es, Fr , Hi,   Pt, Ru
Kristina Gemzell-Danielsson, Sujata Lalitkumar

Complications after second trimester surgical and medical abortion
Available in Ar,  En , Es,  Fr , Hi,   Pt, Ru
Daniel Grossman, Kelly Blanchard, Paul Blumenthal

The choice of second trimester abortion method: evolution, evidence and ethics
Available in Ar,  En , Es,  Fr , Hi,   Pt, Ru
David A Grimes

Misoprostol preferable to ethacridine lactate for abortions at 13−20 weeks of pregnancy: Cuban experience
Available in Ar,  En , Es, Fr , Hi,  Pt, Ru
Alejandro Velazco Boza, Rodolfo Gómez Ponce de León, Luis Salas Castillo, Dania Rebeca Yi Mariño, Ellen MH Mitchell

An historical overview of second trimester abortion methods
Available in Ar,  En , Es,  Fr , Hi,   Pt , Ru
Marc Bygdeman, Kristina Gemzell-Danielsson

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Source: http://www.pathfind.org

2000
This report presents a review of Pathfinder's efforts to address the consequences of unsafe abortion around the world. It provides a broad picture of the range of programs undertaken, how they evolved, what their effects have been, and what has been learned from them.

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Source:  http://www.ipas.org 

07.10.2007     This study examines how prepared Ghanaian public health facilities are to provide essential and life-saving reproductive health care, such as safe abortion services, postabortion care and contraception. This assessment documents the availability of treatment for incomplete abortion and health facilities’ postabortion care caseloads. It also measures knowledge about Ghana’s progressive abortion law among health-care workers and factors that influence provider attitudes about the provision of safe abortion care.

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Source: http://www.pathfind.org

This tool is designed to help assessment teams, project managers, supervisors, and providers collect detailed information on the quality of Postabortion Care (PAC) services provided to adolescents at a given facility in order to make services more youth-friendly.

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Source: http://www.popcouncil.org

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Source: http://www.popcouncil.org

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Source: http://www.worldaidscampaign.org

30.10.2009     Women living with HIV/AIDS have unwanted pregnancies for the same reasons as women with unknown or HIV-negative status, but may also have HIV-specific reasons for wanting to terminate an unintended pregnancy: fears about their own or the baby’s health, fears of leaving behind orphaned children, or a wish to postpone childbearing until they have undetectable viral loads.

Despite this, safe abortion as a means for women living with HIV to deal with unwanted pregnancies has remained the most neglected area of reproductive health within HIV/AIDS-related policies and programming.

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Source: http://www.ids.ac.uk

Institute of Development Studies at the University of Sussex Brighton BN1 9RE UK
IDS RESEARCH REPORT 59
Economic Impact of Unsafe Abortion-Related Morbidity and Mortality: Evidence and Estimation Challenges
Michael Vlassoff, Jessica Shearer, Damian Walker and Henry Lucas
IDS Research Report 59
First published by the Institute of Development Studies in December 2008
© Institute of Development Studies 2008
ISBN 978 1 85864 539 5

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Source: http://www.pathfind.org

Increasing Access to Safe, Comprehensive Abortion Care Services in Northern and Upper East Regions of Ghana: The Pathfinder International Community Approach, 2009

Pathfinder/Ghana's safe abortion project increases access to services through community advocacy, provider training, and facility upgrades. The project's successes and challenges are described in this paper.

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Source: http://www.pathfind.org

Between June 2003 and June 2006, Pathfinder International undertook the Improved Access to Safe Abortion Care project (IASAC), in Karnataka, India, an innovative program designed to improve the quality of abortion training for medical students, and improve the skills of a significant number of current abortion providers at the community level. Over the course of the project, 21 faculty/master trainers were trained. They, in turn, trained a total of 318 providers—two practitioners in each of 49 towns in 7 districts. Pathfinder has now trained 17 percent of the best-known abortion providers in the districts covered, who currently perform 60 percent of all abortions in these districts.

Full text, 2007

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Source: http://www.pathfind.org

Improving Abortion and Postabortion Care Services Using Community Survey Data in Ghana, 2009

This paper discusses the results of a community servey conducted to assess the knowledge, attitudes, and practices of men and women of reproductive age toward abortion in six districts of northern Ghana.

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Source: http://www.pathfind.org

Pathfinder commissioned a baseline study prior to the implementation of the Improved Access to Safe Abortion Care project (IASAC) and a midterm assessment after about a year of implementation.  The study sought to understand the extent to which medical providers offer abortion services and follow standard protocols for abortion services and the extent of community knowledge regarding abortion.

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Authors: Kawonga, Mary; Blanchard, Kelly; Cooper, Diane; Cullingworth, Lee; Dickson, Kim; Harrison, Teresa; von Mollendorf, Claire; Winikoff, Beverly

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Source: http://www.wiley.com

Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care

Maureen Paul (Editor), Steve Lichtenberg (Editor), Lynn Borgatta (Editor), David Grimes (Editor), Philip Stubblefield (Editor), Mitchell Creinin (Editor)

ISBN: 978-1-4051-7696-5

May 2009, Wiley-Blackwell

More on >>

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Source: http://www.crehpa.org.np/

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This 18-page report documents how this ban on abortion has made women afraid to seek even legal health services. Fearing prosecution under the new law, doctors are unwilling to provide necessary care. The report is based on interviews with officials, doctors from the public and private health systems, women in need of health services, and family members of women who died as a result of the ban.
HRW Index No.: B1902
October 2, 2007    Report

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Source: http://www.pathfind.org

A report on Pathfinder's Youth-Friendly Postabortion Care project in eight African countries. The project was implemented June 2007 to May 2008 with the goal of increasing access to PAC services that are responsive to adolescents' special needs.

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The Postabortion Care flipchart provides the materials and information needed for conducting counseling and community education related to unsafe abortion in English- and French-speaking Africa. The flipchart outlines different procedures to reduce the risk of post-abortion complications, self-care instructions for after receiving post-abortion treatment, warning signs for identifying complications, as well as a guide for assessing the patient’s medical condition. The flipchart also discusses some reasons for unplanned pregnancy and the risks involved with unsafe abortions, and an explanation of how a woman becomes pregnant and contraception options prevent pregnancy.

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Source: http://www.ijgo.org

Anibal Faúndesa,  Kamini Raob, Leonel Briozzoc

published online 19 June 2009.

Abstract

The International Congress on Population and Development (ICPD) Programme of Action urged governments and intergovernmental and nongovernmental organizations to reduce women's recourse to abortion through improved family planning services; reliable information and counseling should be readily accessible to women who have unwanted pregnancies; where abortion is legal, it should be safe; and in all cases, quality services for management of abortion complications should be accessible. Review of the extent to which these recommendations have been implemented over the last 15 years shows that, with few exceptions, little attention has been given to this serious problem. Because of its political and religious implications, abortion is mostly ignored. Those with the power to promote change have an obligation to raise the issue of abortion from the darkness in which it is currently hidden, and bring it into the public light as a human drama and a health problem that is not difficult to solve if the ICPD recommendations are taken seriously.

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Source: http://www.pathfind.org

Summarizing Pathfinder's recent experience implementing the Youth-Friendly Postabortion Care (YFPAC) Project in eight African countries, this report contains program descriptions, an overview of the process of making PAC services youth-friendly, key results, challenges, lessons learned, and recommendations.

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Source: http://www.familycareintl.org

The Health Impact of Unsafe Abortion is a report of a regional meeting held in September 2003 in Kuala Lumpur, Malaysia and organized by the Safe Motherhood Inter-Agency Group. Bringing together decision-makers and planners from selected countries in the Asia region, the meeting aimed to promote discussion and dialogue on the health impact of unsafe abortion within the context of safe motherhood, and to exchange information, experiences, and strategies. English (2005)

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Source: http://www.popcouncil.org

 Full text

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Source: http://www.popcouncil.org

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Source: http://www.pac-consortium.org

The State of Postabortion Care Worldwide with an Eye to the Future: 

• English
• Spanish
• French
• Portuguese
• Arabic (available soon)

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Source: http://www.sciencedirect.com

Yimin Cheng, Xiao Xu, Juncai Xu, Françoise Wuillaume, Jinliang Zhu, Diana Gibson and Marleen Temmerman

Abstract

Objective:   To assess the need for integrating postabortion care with family planning services in China.

Method:   We collected data from a clinic-based study of 24 abortion clinics in 3 large cities in China.

Results:   There was a total of 287 (10.3%) high-risk abortions among the 2780 respondents, 974 (35%) of whom had had repeated abortions and 48.4% had had 2 abortions within 1 year; 63.7% of the current pregnancies resulted from not using contraceptives; 28.8% and 19.8% of these new pregnancies, respectively, were due to the failure of the rhythm or the withdrawal method; only 9.7% of the respondents consistently used condoms; and only 9.1% could identify the correct time of their first ovulation following an abortion.

Conclusion:   Contraceptive neglect and the high rates of repeated and high-risk abortions call for the integration of postabortion care with family planning services in China.

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Source: http://www.crehpa.org.np

Unsafe Abortion
Nepal Country Profile 2006

Year of publication: July 2006
Language: English
Pages: 84
Size: 5.23 MB

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Source: http://heapol.oxfordjournals.org

P H David , L Reichenbach  I  Savelieva , N Vartapetova 

It has been well documented that abortion is a common means of controlling fertility in Russia. Women undergo repeat abortions throughout their reproductive lives, but recent studies of abortion trends in the Russian Federation suggest that abortion rates are on the decline, use of modern contraceptives is increasing, and women dislike abortion as a method of fertility control. Using data collected during 1999–2003 in women's health facilities in three Russian cities, this paper reports the results of an evaluation of interventions to improve post-abortion care, which show an impressive increase in post-abortion contraceptive counselling but no reduction in the rate at which women present at clinics for repeat abortions. The findings indicate a discrepancy between women's stated preferences for modern medical contraceptive methods and their abortion-seeking behaviour. Further exploration of these data suggests that certain women resort to abortion with greater frequency than others, and points to the need for a more focused investigation of these women. These results indicate the complexities associated with changing what has been a relatively common and long-standing practice, and have implications for improving reproductive health services. Meeting the reproductive health needs of Russian women requires not only improved provider and client knowledge but may also demand a more focused delivery of client-centred care than may be the case in other settings.

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2007      This six-page brochure discusses the growth and successes of comprehensive abortion care (CAC) services in Vietnam. The 18 CAC sites in Vietnam have substantially improved access to safe abortion while reducing barriers to care and providing related services such as counseling and contraception.

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Source: http://www.ipas.org 

2003     This publication puts a human face on the issue to which Ipas has dedicated 30 years: the need to ensure access to safe abortion services for all women, no matter how rich or poor, no matter where they live. Through fictionalized stories- several based on real life - set in India, Kenya, Nicaragua, Russia and the United States, it illuminates the personal contexts that lead women to seek abortions and the obstacles they too often encounter in exercising their sexual and reproductive rights.

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Source:http://www.ipas.org

June 1,1999

Katie Early McLaurin

This publication discusses actions that can be taken to bring about improvements in women's health related to unsafe abortion.

(PDF)  370 Kb

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Source: http://www.ipas.org

June 15, 2004

Ellen M.H. Mitchell; Kelvin Mwaba; M. Sophie Makaola; Karen Trueman

Although much effort has been dedicated to identifying and overcoming the obstacles that limit reproductive freedom for all South Africans, Limpopo Province has received comparatively little attention. This study offers a comprehensive review of the status of health facilities in Limpopo Province designated to provide termination of pregnancy (TOP) and a series of recommendations for the expansion and improvement of services.

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Source: http://www.stats.govt.nz

Statistics on the number of abortions performed in New Zealand.
The latest releases contain tables on:

• Number of abortions by: number of previous abortions, age of woman, number of previous children, duration of pregnancy and ethnicity.
• International comparisons.

Source: Abortion Supervisory Committee
Frequency: Annual
Available from: 1997
Geographic Coverage:National

• Abortions: Year ended December 2006
• Abortions: Year ended December 2005
• Abortions: Year ended December 2004
• Abortions: Year ended December 2003
• Abortions: Year ended December 2002
• Abortions: Year ended December 2001
• Abortions: Year ended December 2000
• Abortions: Year ended December 1999
• Abortion Statistics (1998 Annual)
• Abortion Statistics (1997)

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Source: http://www.informaworld.com

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Fetters, T., S. Vonthanak C. Picardo T. Rathavy (2008). "Abortion-related complications in Cambodia". British Journal of Obstetrics and Gynaecology. 115: 957-968.

Abstract:

Introduction:  Although termination of pregnancy has been legal in the Kingdom of Cambodia since 1997, a number of barriers to safe termination services persist and many women continue to induce their own terminations or seek unsafe services that result in complications requiring 'post-abortion' care.

Objective: To describe the complications of miscarriage and failed terminations and document the magnitude of the resulting morbidity in the Cambodian public sector.

Design: Cross-sectional descriptive study. Setting: Public sector hospitals and health centres. Sample: Stratified multistage sampling design included all hospitals (n = 71), 14% of eligible high-level health centres (n = 58) and 22% of eligible low-level health centres (n = 57).

Methods:  Data collectors used a standardised questionnaire to record information on diagnosis, reproductive history and treatment from 629 women seeking care for termination or miscarriage-related complications in study facilities over a 3-week period.

Main outcome measures:  Annual estimate of cases, clinical symptoms, severity distribution of morbidity, ratio of complications to live births and incidence of abortion complications for Cambodian public health facilities.

Results:  In 2005, an estimated 31 579 women with complications of miscarriage or terminations were treated in Cambodian government facilities; 80% of these women sought care at a health centre. Forty percent of all women seeking care for complications either reported or showed strong clinical evidence of prior attempted terminations. Nearly 17% of these women were in the second trimester of pregnancy and 42% of them presented with high severity complications. The annual incidence of termination and miscarriage complications (abortion complications) was 867 per 100 000 women of reproductive age. The projected ratio of complications was 93 per 1000 live births.

Conclusions: To re duce maternal morbidity in , women must be encouraged to seek safe termination services or seek post-abortion care without delay. Additionally, providers need further training, and facilities greater commitment, to provide safe terminations and care for complications of unsafe terminations and miscarriage.

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Source:  http://www.ipas.org 

07.10.2007     This study examines how prepared Ghanaian public health facilities are to provide essential and life-saving reproductive health care, such as safe abortion services, postabortion care and contraception. This assessment documents the availability of treatment for incomplete abortion and health facilities’ postabortion care caseloads. It also measures knowledge about Ghana’s progressive abortion law among health-care workers and factors that influence provider attitudes about the provision of safe abortion care.

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Source: http://www.popcouncil.org

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Source: http://www.popcouncil.org

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Source: http://www.pathfind.org

2002     In Peru, where induced abortion has long been penalized by the government, clandestine abortion is a widespread public health concern. This document details a study undertaken by Pathfinder to generate information about the incidence of clandestine abortion in order to promote sexual and reproductive rights and inform the development of pertinent government policies.

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Source: http://www.ncbi.nlm.nih.gov

de Costa CM, Russell DB, de Costa NR, Carrette M, McNamee HM.

Mifepristone (RU486), which is used for early medical abortion, can only be obtained in Australia under the Authorised Prescriber legislation (Section 19[5] of the Therapeutic Goods Act 1989 [Cwlth]); two of the authors have permission to obtain, prescribe and administer this drug in Cairns, Queensland. From July 2006 to April 2007, 10 women who fulfilled the Therapeutic Goods Administration (TGA) criteria of "life-threatening or otherwise serious" indications underwent medical abortion with mifepristone/misoprostol, and 12 women conforming with abortion requirements of Queensland law, but not TGA legislation for mifepristone administration, had medical abortions with the less preferable methotrexate/misoprostol combination. Although it is now more than a year since the cross-party vote in federal Parliament in February 2006 confirmed wide support for the right of Australian women to a medical abortion, we believe we are at present the only medical practitioners in Australia with permission to use mifepristone. Obtaining Authorised Prescriber status from the TGA is of necessity a complex and protracted process, involving ethics committee approval and auditing, and regular reporting to the TGA. Because of the current restrictions, we believe that women seeking medical abortion in Australia face barriers not experienced by women in other comparable countries, and that drug manufacturing and distributing companies may be discouraged from seeking to market mifepristone in Australia.

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Bhandari, A., Nang, Mo Hom, Rashid, Sabina, Theobald, Sally (2008). "Experiences of abortion in and menstrual regulation in Bangladesh: a Gender Analysis". Gender and Development 16: 257-272.

Abstract:
The extent to which abortion and menstrual regulation services are safe, legal, and women-friendly is a strong proxy of gender equity. This article draws on women's voices from Nepal and Bangladesh to illustrate that even where services are provided legally, women can still face multiple barriers to access to services, and problematic quality of care. This is exacerbated by the stigma which surrounds these services. Stigma is directly related to gender inequality, and is constructed at both the community and provider level. It is imperative to overcome these barriers by promoting gender equality across the board, in all services and all contexts.

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Source: http://www.pathfind.org

Between June 2003 and June 2006, Pathfinder International undertook the Improved Access to Safe Abortion Care project (IASAC), in Karnataka, India, an innovative program designed to improve the quality of abortion training for medical students, and improve the skills of a significant number of current abortion providers at the community level. Over the course of the project, 21 faculty/master trainers were trained. They, in turn, trained a total of 318 providers—two practitioners in each of 49 towns in 7 districts. Pathfinder has now trained 17 percent of the best-known abortion providers in the districts covered, who currently perform 60 percent of all abortions in these districts.

Full text, 2007

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Source: http://www.pathfind.org

Pathfinder commissioned a baseline study prior to the implementation of the Improved Access to Safe Abortion Care project (IASAC) and a midterm assessment after about a year of implementation.  The study sought to understand the extent to which medical providers offer abortion services and follow standard protocols for abortion services and the extent of community knowledge regarding abortion.

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Source: http://www.pathfind.org

Improving Abortion and Postabortion Care Services Using Community Survey Data in Ghana, 2009

This paper discusses the results of a community servey conducted to assess the knowledge, attitudes, and practices of men and women of reproductive age toward abortion in six districts of northern Ghana.

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This paper summarizes the barriers to abortion in the United States, including the determination of viability, cost and insurance coverage, waiting periods and parental consent laws, restrictions on medical abortion, provider unavailability, harassment, targeted regulation of abortion providers laws, refusal clauses, antichoice laws, and the fetal legal rights movement. Federally subsidized abstinence-only sex education, which has not been shown to decrease the rate of unintended pregnancy (and may increase it), has expanded and access to a full range of contraceptive options has been limited. The policies of the current and past administrations have strengthened barriers to abortion both at home and abroad. Preserving women’s right to choose will require improved public and professional education, legislative and legal efforts, and advocacy by physicians and other health care professionals.

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Source: http://www.publish.csiro.au

Sexual Health | 23 November 2007  Volume 4(4) 2007  223–226

Caroline M. de Costa, Darren B. Russell, Naomi R. de Costa, Michael Carrette and Heather M. McNamee

Abstract

Recent changes to Federal Therapeutic Goods Administration legislation have seen the limited introduction of the drug mifepristone to Australia for the purpose of early medical abortion. At the same time it has become evident that both methotrexate and misoprostol, licenced and available for other indications, are being used safely and appropriately for early abortion by Australian medical practitioners. Early medical abortion is widely practiced overseas where its safety and effectiveness are well supported by current evidence. However, abortion law in many states is still contained within the Criminal Codes and does not reflect current evidence-based abortion practice. In other states and territories restrictions on where abortions may be performed pose potential barriers to the introduction of mifepristone for medical abortion. There is an urgent need for abortion law to be clarified and made uniform across the country so that the best possible services can be provided to Australian women.

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Source: http://www.pathfind.org

Increasing Access to Safe, Comprehensive Abortion Care Services in Northern and Upper East Regions of Ghana: The Pathfinder International Community Approach, 2009

Pathfinder/Ghana's safe abortion project increases access to services through community advocacy, provider training, and facility upgrades. The project's successes and challenges are described in this paper.

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Senanayake H

Ceylon Medical Journal. 2004 Mar;49(1):1-4.

Abstract

Induced abortion in Sri Lanka is a problem that has been conveniently ignored for too long. In 1984, the Minister of Health said that over 500 abortions are done in Colombo daily, and that this was only the "tip of the iceberg". The proportion of women aged between 35 and 39 years undergoing an abortion in 1998 was estimated to be 0.0667 (95% CI=0.0458-0.0877). In the present day it is estimated that for every 10 babies born in Sri Lanka, seven are being aborted. About 700 induced abortions are done in Sri Lanka daily. The practice of abortion has become so widespread in Sri Lanka that over the past three decades, many researchers feel that abortion is being used as a means of fertility regulation. The total abortion rate for married women between the age of 15 and 49 years for 1998 was 1.92 (95% CI = 1.20-2.64), a figure close to the total fertility rate for the country. These induced abortion figures are surprisingly high for a country with a contraceptive prevalence rate of 70%. The two common reasons for seeking an abortion in Sri Lanka are, becoming pregnant either when the youngest child is too small, or after the completion of the family. The abortion seekers are most likely to be rural married women. Less than 10% of them are single. Since abortion is illegal in Sri Lanka, except when it is performed to save the life of the mother, there is a chance that many of these are performed under unsafe conditions. (PubHealth.info Document ID: ABOR1T 317-06)

PubHealth.info NOTE: The author(s) of this article titled, "Induced abortion in Sri Lanka.", is(are) Senanayake H. The source of this article is "Ceylon Medical Journal. 2004 Mar;49(1):1-4.". This article was published in 2004 in English language(s). (PubHealth.info® Document ID: ABOR1T 317-06. All rights reserved with PubHealth.info) PIN: 317

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Source: http://www.contraceptionjournal.org

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Authors: Kawonga, Mary; Blanchard, Kelly; Cooper, Diane; Cullingworth, Lee; Dickson, Kim; Harrison, Teresa; von Mollendorf, Claire; Winikoff, Beverly

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Joanna N. Erdman, JD, LLM, Amy Grenon, JD and Leigh Harrison-Wilson, JD

At the time of the study, the authors were with the Health Equity and Law Clinic, Faculty of Law, University of Toronto, Ontario.

Correspondence: Requests for reprints should be sent to Joanna N. Erdman, JD, LLM, Faculty of Law, University of Toronto, 78 Queen's Park, Toronto, Ontario, M5S 2C5, Canada (e-mail:joanna.erdman@utoronto.ca ).

The right to health under the International Covenant on Economic, Social, and Cultural Rights, to which Canada is a signatory, entitles women to available, accessible, and acceptable abortion care. Abortion care in Canada currently fails this standard. Medication abortion (the use of drugs to terminate a pregnancy) could improve abortion care in Canada, but its potential remains unrealized.

This is in part attributable to the unavailability of mifepristone, the safest and most effective pharmaceutical for medication abortion. Given that it could improve abortion care, we investigated why mifepristone remains unapproved in Canada, whether its unavailability is attributable to government inaction, and whether Canada is therefore failing to fulfill its obligations under the right to health.

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Source: http://www.mariestopes.org

Boler T, Marston C, Corby N and Gardiner E.

Medical Abortion in India: A model for the rest of the world?

London: Marie Stopes International, 2009
© Marie Stopes International 2009

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Source: http://www.rhmjournal.org

Alejandro Velazco Boza, Rodolfo Gómez Ponce de León, Luis Salas Castillo, Dania Rebeca Yi Mariño, Ellen MH Mitchell

Reproductive Health Matters
May 2008 (Vol. 16, Issue 31, Pages 189-195)

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International Journal of Gynecology & Obstetrics, Volume 76, Issue 1, January 2002, Pages 65-74
S. Clark, J. Blum, K. Blanchard, L. Galvão, H. Fletcher, B. Winikoff

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Source: http://hrw.org

In Peru abortion is legal in order to save the life of the woman or to avoid serious and permanent damage to her health. In practice, accessing lawful abortions is next to impossible.
My Rights, andMy Right to Know: Access to Therapeutic Abortion in Peru examines the obstacles to accessing therapeutic abortion in Peru’s public health system. Obstacles include ambiguities in Peru’s criminal law, the absence of a national protocol on therapeutic abortion, dysfunctional approval and referral procedures, fear of prosecution, cost, and widespread beliefs that such abortions are illegal.
For many women and girls, the decision to undergo a therapeutic abortion is not an easy one tomake. Policymakers and medical authorities who complicate and impede access to legal abortion services and information do not reduce the number of abortions – they simply drive them underground.
Women and girls confronting crisis pregnancies that could kill them or permanently harm their health need urgent access to safe, dignified, affordable abortions. Yet Human Rights Watch documented cases where women and girls clearly eligible for legal abortions were refused or unable to access the service, with terrible consequences to their physical and mental health.
Peru has an obligation under international human rights law to ensure that access to therapeutic abortion in the public health system is a reality.
Human Rights Watch calls on Peru to act immediately to: adopt a nationwide protocol on therapeutic abortion; inform women, health practitioners, and the general public that therapeutic abortions are permitted by law; and investigate instances in which healthcare providers deny therapeutic abortion to eligible women and girls, and discipline them appropriately.

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Also available in: Spanish

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Source: http://www.crehpa.org.np/

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