The International Consortium for Medical Abortion (ICMA) works to promote medical abortion within the framework of support for safe abortion worldwide, focusing on the needs of women in developing countries, including those countries where abortion is unsafe or not accessible. This chapter is part of a comprehensive information package developed by the Consortium. The information package consists of five chapters. Each of the first four chapters is aimed at a specific audience: women and women’s groups, women’s health advocates, providers of sexual and reproductive health services and health managers, and policy makers. This fifth and final chapter presents a list of select resources for those interested in obtaining further information on medical abortion.
The chapter is organised into five sections. The first section lists sources of information materials for users or potential users of medical abortion. Section two contains a list of sources of technical and clinical information aimed mainly at health providers. Section three provides a list of resources on international experiences with the use of medical abortion. This includes publications on women’s perspectives on medical abortion and health system and policy issues related to medical abortion, for use by advocates and policy makers.
Most of the information materials for users of medical abortion are from the United States and UK. The eligibility criteria, regimens and clinic visit requirements mentioned in them pertain to the countries for which the materials were developed, and need to be suitably modified for other settings.
1. Ibis Reproductive Health operates the Medication Abortion (another term used for medical abortion) Website, which provides education information for women considering the option of medical abortion. The website is http://www.medicationabortion.com/
2. Ipas, which works internationally to increase women\'s ability to exercise their sexual and reproductive rights and to reduce deaths and injuries of women from unsafe abortion, has produced the following factsheets for medical abortion users:
3. Reproductive Health Matters Journal issue "The abortion pill". Volume 13 Number 26 November 2005. http://rhmjournal.org.uk/26abs.html
This issue is about medical abortion, which is the use of pills to cause a miscarriage, and why it is expending access to safe abortion and saving women\'s lives in many parts of the world.
4. The Food and Drug Administration of USA has updated its information for patients in July 2005, after the reporting of deaths from infection following medical abortion.
5. bpas is the leading provider of abortion services in the UK, with a national network of consultation centres and clinics. It has produced pamphlets for clients on medical abortion up to 20 weeks of the last menstrual period.
‘Men too !’ is a pamphlet for men partners of women considering an abortion (not specific to medical abortion)
6. The National Abortion Federation (NAF) is the professional association of abortion providers in North America. It has produced the following materials for women thinking about having a medical abortion:
Making your choice: A woman’s guide to medical abortion (Brochure).
Describes what to expect during a medical abortion and outlines the similarities and differences between medical and surgical abortion. Available in six languages: Chinese, Croatian, English, Russian, Spanish and Vietnamese.
Making Your Choice: A Woman\'s Guide To Medical Abortion (video)
This video for women considering or choosing medical abortion provides a balanced overview of early abortion options and informs women about what to expect during a medical abortion. Available in English and Spanish from
National Abortion Federation
1755 Massachusetts Avenue, NW, Suite 600
Washington, DC 20036
E-Mail:naf@prochoice.org
7. ‘How can I do an abortion? A woman’s guide to inducing an abortion using misoprostol. From “Women on waves”, a non-profit feminist organization which operates a mobile clinic on a ship that sails to countries where abortion is illegal. Women on Waves aims to prevent unsafe abortions and empower women to exercise their human rights to physical and mental autonomy, by combining free healthcare services and sexual education with advocacy.
Information is available in Dutch, English, Spanish, Portugese, Polish, French.
8. The RU486 website, RU486facts.org is designed to answer the most common questions about medical abortion simply and directly, and is meant for women thinking of using medical abortion and health providers. http://www.ru486facts.org/index.cfm?
From the Abortion Access project (AAP), a US-based organization of reproductive rights activists and women\'s health care providers dedicated to making abortion truly accessible. Available at: www.abortionaccess.org/AAP/2sidecards.htm
10. ‘Questions and answers about the safety of mifepristone’. Information for patients and advocates produced by the Abortion Access Project, addressing questions related to safety of mifepristone which were raised after the death of four women who had taken mifepristone.
11. The Planned Parenthood Federation of America Inc and its various branches have information available for users of medical abortion. For example:
Questions and answers on medical abortion, 2005, from Planned Parenthood Federation of America, Inc.
Patient information packet from Planned parenthood Delaware
12. Information for users of medical abortion is also available from the websites of several women’s health centres in the US and UK. The following are some examples
There are standards and guidelines for the provision of medical abortion for each country where medical abortion has been approved. Materials relevant to the development of standards and guidelines based have been produced by the World Health Organization, by manufacturers of mifepristone such as DANCO laboratories, and also by NGOs working on sexual and reproductive health nationally and/or internationally, such as Gynuity, bpas and Ibis. The following is a list of select standards and guidelines.
Please note that some of the guidelines have not been updated based on the most recent evidence. For example, the US FDA recommends a mifepristone dose of 600 mg whereas most others recommend a mifepristone dose of 200 mg based on subsequent research evidence. Also, guidelines developed for specific countries would need to be suitably adapted for other settings.
Clinical guidance
1.World Health Organization. Safe abortion: technical and policy guidance. Geneva: WHO, 2003.
This guidance presents strategies for improved clinical care for women undergoing procedures, and the appropriate placement of necessary services. Medical abortion is discussed as one of the procedures and guidance is provided on regimens and health system requirements. The book’s annexes present guidance to further reading, and international consensus documents on safe abortion.
2. von Hertzen H, Baird D; Bellagio Study and Conference Center. Frequently asked questions about medical abortion. Contraception. 2006 Jul;74(1):3-10. Epub 2006 May 15.
This article provides an overview of some of the frequently asked questions about medical abortion by service providers in various countries, and the answers to these as discussed in a consensus meeting of experts held in November 2004. A useful update of the information provided in WHO’s Guidance document.
3.Gynuity. Providing Medical Abortion in Developing Countries: An Introductory Guidebook. New York, Gynuity Health Projects, 2004.
A list of almost 1100 articles on medical abortion has been created by Gynuity Health
A tool for providers and policy makers who are interested in introduction of medical methods for safe termination of early pregnancy. Available in Arabic, English, French, Portuguese, Romanian, Russian, Spanish, and in Vietnamese in PDF format.
4.Consensus Statement: Instructions for use – Abortion induction with misoprostol in pregnancies up to 9 weeks LMP. Expert Meeting on misoprostol sponsored by Reproductive Health Technologies Project and Gynuity Health Projects. Washington D.C, July 28, 2003.
This document represents consensus reached by professionals with epidemiological, clinical and programmatic expertise on the appropriate use of misoprostol for abortion, in an expert meeting convened by Gynuity Health Projects and Reproductive Health Technologies Project. Available in Arabic, English, French, Portuguese, Russian and Spanish.
This is a recently updated protocol revised to reflect new data concerning the safety and efficacy of buccal administration of misoprostol, as well as evidence for an effective alternative regimen for oral misoprostol in addition to a regimen for vaginal use of misoprostol.
8. Bpas, UK has a series of pamphlets for health professionals, on abortion options at different durations of pregnancy, and includes information on medical abortion regimens. There is also a pamphlet with guidance for health providers who are opposed to abortion
10. The US Food and Drug Administration has produced information for health providers updated in November 2005.
11. AmericanCollege of Obstetricians and Gynecologists (ACOG). Medical management of abortion (available for members only) Washington (DC): AmericanCollege of Obstetricians and Gynecologists (ACOG); 2005 Oct. 12 p. (ACOG practice bulletin; no. 67).
12. RoyalCollege of Obstetricians and Gynaecologists. National clinical guidelines. The care of women requesting induced abortion. London: RCOG, 2004.
Clinical guidelines for providers of induced abortion in the United Kingdom, including medical abortion. Provides guidance on regimens and protocols for management and the evidence-base on which these are based. Summary version , Full guideline
13. Medical abortion clinical guidelines for British Columbia, India and New Zealand, respectively are available at the following websites:
14. Talluri-Rao, Sudha and Baird Traci. Information and training guide for medical-abortion counseling. Chapel Hill, Ipas, 2003. Available in English and Portugese .
15. Tabbutt-Henry J and Graff K. Client-provider communication in post-abortion care. International family planning perspectives 2003; 29(3): 126-129.
16. Akinyemi L, Laschalt B, Fiala C and Safar P. Counseling aspects of pregnancy termination with Mifegyne. Department of Obstetrics and Gynaecology, GeneralPublicHospital, Korneuburg, Vienna, 2000. Unpublished paper.
II. Updated (2005 July and later) information on safety of mifepristone
Recently, the deaths of four women who had taken mifepristone have caused concern about its safety. The following sources provide unbiased and medically sound information for clinicians.
To keep abreast with the latest technical and clinical evidence on medical abortion, refer to articles from scientific journals, using PubMed, the National Library of Medicine\'s search service that includes over 16 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s, at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed
IV. Resources for training of and self-study by health professionals
1. Ibis Reproductive Health. Medication abortion: a training module for health professionals. Power point presentation. Ibis Reproductive Health. 2003.
Arabic version of the training module – click - Arabic .
2. Paul M, Stewart FH, Weitz TA et al. Early abortion training workbook. UCSFCenter for Reproductive Health Research and Policy, San Fransisco, CA (2003)
4. NAF produces a monthly newsletter for medical professionals, NAF Early Options Health Care Professionals Updates. To receive these, write to healthcare_professionals@lyris.prochoice.org
5. NAF has produced a training and resource binder, which includes eight PowerPoint training modules, practical resources for providing medical abortion, an August 2000 NAF-sponsored American Journal of Obstetrics and Gynaecology supplement on medical abortion, and an Early Options Self-Study Guide.
Available from:
National Abortion Federation 1755 Massachusetts Avenue, NW, Suite 600 Washington, DC20036
Some of the resources in the binder are available for download from:
Berer M. Medical abortion: issues of choice and acceptability. Reproductive Health Matters. 2005 Nov;13(26):25-34.
Berer M. Why medical abortion is important for women. Reproductive Health Matters. 2005 Nov;13(26):6-10
Blum J, Hajri S, Chelli H et al. The medical abortion experiences of married and unmarried women in Tunis, Tunisia. Contraception. 2004 Jan;69(1):63-69.
Clark S, Ellertson C, Winikoff B. Is medical abortion acceptable to all American women: the impact of sociodemographic characteristics on the acceptability of mifepristone-misoprostol abortion. Journal of American Medical Women’s Association. 2000;55(3 Suppl):177-82.
Elul B, Pearlman E, Sorhaindo A et al. In-depth interviews with medical abortion clients: thoughts on the method and home administration of misoprostol. Journal of American Medical Women’s Association. 2000;55(3 Suppl):169-172.
Fiala C, Winikoff B, Helstrom L et al. Acceptability of home-use of misoprostol in medical abortion. Contraception. 2004 Nov;70(5):387-392.
Fielding SL, Edmunds E, Schaff EA. Having an abortion using mifepristone and home misoprostol: a qualitative analysis of women\'s experiences. Perspectives in Sexual and Reproductive Health. 2002 Jan-Feb;34(1):34-40
Gould H, Ellertson C, Corona G. Knowledge and attitudes about the differences between emergency contraception and medical abortion among middle-class women and men of reproductive age in Mexico City. Contraception. 2002 Dec;66(6):417-426.
Hajri S, Blum J, Gueddana N et al. Expanding medical abortion in Tunisia: women\'s experiences from a multi-site expansion study. Contraception. 2004 Dec;70(6):487-491.
Lafaurie MM, Grossman D, Troncoso E, Billings DL, Chavez S. Women\'s perspectives on medical abortion in Mexico, Colombia, Ecuador and Peru:a qualitative study. Reproductive Health Matters. 2005 Nov;13(26):75-83.
Rosing MA, Archbald CD. The knowledge, acceptability, and use of misoprostol for self-induced medical abortion in an urban US population. Journal of American Medical Women’s Association. 2000;55(3 Suppl):183-185.
Harvey SM, Sherman CA, Bird ST, Warren J. Understanding medical abortion. Policy, politics and women’s health. Eugene, University of Oregon, Centre for the study of women in society, 2002.
II. Health system issues
Akin A, Kocoglu GO, Akin L. Study supports the introduction of early medical abortion in Turkey. Reproductive Health Matters. 2005 Nov;13(26):101-109.
Barbosa R and Arilha M. The Brazilian experience with Cytotec. Studies in Family Planning, 1993: 24(4):236-240.
Billings DL. Misoprostol alone for early medical abortion in a Latin American clinic setting. Reproductive Health Matters. 2004 Nov;12(24 Suppl):57-64.
Bygdeman M, Danielsson KG, Marions L. Medical termination of early pregnancy: the Swedish experience. Journal of American Medical Women’s Association. 2000;55(3 Suppl):195-6, 204.
Coeytaux F, Moore K, Gelberg L. Convincing new providers to offer medical abortion: what will it take? Perspectives on Sexual and Reproductive Health. 2003 Jan-Feb;35(1):44-7.
Cohen J, Ortiz O, Llaguno SE et al. Reaching women with instructions on misoprostol use in a Latin American country. Reproductive Health Matters. 2005 Nov;13(26):84-92.
Comendant R. A project to improve the quality of abortion services in Moldova. Reproductive Health Matters. 2005 Nov;13(26):93-100.
Cooper D, Dickson K, Blanchard K et al. Medical abortion: the possibilities for introduction in the public sector in South Africa. Reproductive Health Matters. 2005 Nov;13(26):35-43
Costa SH. Commercial availability of misoprostol and induced abortion in Brazil. International Journal of Gynecology and Obstetrics 1998; 63 Suppl 1: S131-139.
Costa SH and Vessey M. Misoprostol and illegal abortion in Rio de Janeiro Brazil. Lancet 1993; 341 (8855):1258-1261.
Coyaji K. Early medical abortion in India: three studies and their implications for abortion services. Journal of American Medical Women’s Association. 2000;55(3 Suppl):191-194.
Elul B, Hajri S, Ngoc NN et al. Can women in less-developed countries use a simplified medical abortion regimen? Lancet. 2001 May 5;357(9266):1402-5.
Foster AM, Wynn L, Rouhana A et al. Providing medication abortion information to diverse communities: use patterns of a multilingual web site. Contraception. 2006 Sep;74(3):264-71. Epub 2006 Jun 6.
Ganatra B, Manning V, Pallipamulla SP. Availability of medical abortion pills and the role of chemists: a study from Bihar and Jharkhand, India. Reproductive Health Matters. 2005 Nov;13(26):65-74.
Ganatra B, Bygdeman M, Phan BT, Nguyen DV, Vu ML. From research to reality: the challenges of introducing medical abortion into service delivery in Vietnam. Reproductive Health Matters. 2004 Nov;12(24 Suppl):105-113.
Iyengar SD. Introducing medical abortion within the primary health system: comparison with other health interventions and commodities. Reproductive Health Matters. 2005 Nov;13(26):13-19
Jones RK, Henshaw SK. Mifepristone for early medical abortion: experiences in France, Great Britain and Sweden. Perspectives on Sexual and Reproductive Health. 2002 May-Jun;34(3):154-61.
Ramachandar L, Pelto PJ. Medical abortion in rural Tamil Nadu, South India: a quiet transformation. Reproductive Health Matters. 2005 Nov;13(26):54-64.
Tamang A, Tamang J. Availability and acceptability of medical abortion in Nepal: health care providers\' perspectives. Reproductive Health Matters. 2005 Nov;13(26):110-119.
Wu S. Medical abortion in China. Journal of American Medical Women’s Association. 2000;55(3 Suppl):197-199, 204.
The following papers, presented at “Medical Abortion: An International Forum on Policies, Programmes and Services”, 17-20 October 2004, Johannesburg, South Africa, are available for download from the website of the International Consortium for Medical Abortion (ICMA), http://www.medicalabortionconsortium.org/
El Damanhoury H. Medical abortion: The situation in Egypt.
Centre for Reproductive Rights. Promote access to the full range of abortion technologies: Remove barriers to medical abortion. Washington D.C, CRR, September 2005
Centre for Reproductive Rights. Crafting an abortion law that respects women’s rights: Issues to consider” New York, CRR, August 2004. Both the above are available for download from www.reproductiverights.org
The following papers, presented at “Medical Abortion: An International Forum on Policies, Programmes and Services”, 17-20 October 2004, Johannesburg, South Africa, are available for download from the website of the International Consortium for Medical Abortion (ICMA), http://www.medicalabortionconsortium.org/
The following papers, presented at “Medical Abortion: An International Forum on Policies, Programmes and Services”, 17-20 October 2004, Johannesburg, South Africa, are available for download from the website of the International Consortium for Medical Abortion (ICMA), http://www.medicalabortionconsortium.org/
1. Carbonell, J L; Varela, L; Velazco, A; Tanda, R; Sánchez, C. Misoprostol vaginal para el aborto del segundo trimestre temprano / Vaginal misoprostal for early second trimester abortion. Rev. cuba. obstet. ginecol;26(1):28-35, ene.-abr. 2000.
2. Duarte, Adrianne Maria Berno de Rezende; Araújo, Dimas Augusto Carvalho; Andrade, Amaury Teixeira Leite. Uso do Misoprostol em ginecologia e obstetrícia / Misoprostol use in ginecology and obstetrics. Bol. Centro Biol. Reprod. Reprod;18:5-13, 1999.
3. Espinoza H, Ellertson C, García S, Schiavon R. Medicamentos para la interrupción de la gestación: una revisión de la literatura y sus posibles implicaciones para México y América Latina. Gac Med Mex 2002; 138 (4): 347-356
4. Faúndes, Anibal; Andalaft Neto, Jorge; Díaz, Juan. Métodos farmacológicos para interrupção legal da gestação: relatória de um seminário sobre tema. Femina;31(7):641-644, 2003
5. Faúndes A. Uso de misoprostol en Ginecología y Obstetricia. Federación Latinoamericana de Sociedades de Obstetricia y Ginecología FLASOG. Santa Cruz – Bolivia. 2005
6. FIGO, “Directrices éticas relativas al aborto provocado por razones no médicas” en Recomendaciones sobre temas de ética en obstetricia y ginecología hechas por el Comité para los Aspectos Éticos de la Reproducción Humana y Salud de la Mujer de la FIGO, Londres, 2003, pp. 223-224
7. FLASOG, Reporte Taller Pre-Congreso sobre Derechos Sexuales y Reproductivos, Santa Cruz de la Sierra, Bolivia, 19 de octubre de 2002. Disponible en http://www.flasog.org/informat.html [consulta: 14/08/06].
8. Fonseca, Walter et al. Características sócio-demográficas, reprodutivas e médicas de mulheres admitidas por aborto em hospital da Região Sul do Brasil. Cad. Saúde Pública, Abr 1998, vol.14, no.2, p.279-286.
9. Fonseca, Walter et al. Determinantes do aborto provocado entre mulheres admitidas em hospitais em localidade da região Nordeste do Brasil. Rev. Saúde Pública, Fev 1996, vol.30, no.1, p.13-18.
10. Grossman, D., “Métodos médicos para el aborto en el primer trimestre: comentario de la BSR (última revisión 3/9/04)”, en Biblioteca de Salud Reproductiva de la OMS, N° 8, Update Software Ltd, Oxford, 2005.
11. Ipas. 2004. El uso de la mifepristona y el misoprostol para inducir el aborto en las etapas iniciales de la gestación: Notas para la práctica clínica. Chapel Hill, Carolina del Norte, Ipas. Disponible en: http://www.ipas.org/publications/es/Medical_Abortion/mife_miso_es.pdf
13. Menéndez-Velázquez JF. El manejo del aborto espontáneo y de sus complicaciones
14. Ministério da Saúde, Norma Técnica “Prevenção e Tratamento dos Agravos Resultantes da Violencia Sexual contra Mulheres e Adolescentes”, Brasilia, 2005
15. Murad, C; Beltramone, F; De Giusto, R; Travella, C; Ruiz Orrico, G; Morozovsky, J. Misoprostol: una nueva alternativa para el tratamiento del aborto incompleto / Misoprostol: a nuew alternative for theMisoprostol: a new alternative for the incomplete abortion treatment. Obstet. ginecol. latinoam;55(1):37-40, 1997.
16. OMS, Aborto sin riesgos. Guía técnica y de políticas para sistemas de salud, Ginebra, 2003.
17. Osava, Ruth Hitomi; Amorim, Maria Helena Costa; Castro, Denise Silveira de; Marques, Maira Santos. Perfil reprodutivo e padröes de consumo do misoprostol (Cytotec) como droga abortiva em usuárias de baixa renda / Reproductive profile and misoprostol (cytotec) consumption standards as an abortive drug in low income users. Rev. enfermagem UERJ;5(1):325-30, maio 1997.
18. Parry R., Santiago; Bravo Oliva, Erasmo. Uso de misoprostol en el manejo del aborto inevitable de segundo trimestre / Use of misoprostol in the management of the unavoidable abortion of second trimester. Rev. chil. obstet. ginecol;66(6):472-479, 2001
19. Pereira, Pedro Paulo; Pfiffer, Tatiana; Maganha, Carlos Alberto; Armelin, Adriano Rotger; Zugaib, Marcelo. O uso do misoprostol no tratamento da perda gestacional precoce / Use of misoprostol for the treatment of early pregnancy failure. Rev. ginecol. obstet;14(1):26-28, jan.-mar. 2003
20. Rodríguez Cárdenas, Antonio; Velasco Boza, Alejandro. Uso de 600 mg de Misoprostol para inducir el aborto temprano / Use of 600 mg of Misoprostol to induce early abortion. Rev. cuba. obstet. ginecol;29(1), ene.-abr. 2003.
21. Rodríguez Cárdenas, Antonio; Velazco Boza, Alejandro. Uso de 800 mg de Misoprostol para inducir el aborto temprano / Use of 800 mg of Misoprostol to induce early abortion. Rev. cuba. obstet. ginecol;29(2), mayo.-ago. 2003
22. Rodríguez Cárdenas, Antonio; Velazco Boza, Alejandro; Gallego Ramos, Jany. Empleo de 800 µg de misoprostol para la interrupción de embarazos hasta 9 semanas / Use of 800 ug of misoprostol for abortions up to 9 months. Rev. cuba. obstet. ginecol;30(3), sept.-dic. 2004
24. Schiavon R. Aborto médico: Alternativas terapéuticas actuales. Gac Med Mex 2003; 139 (Supl 1): 55-64
25. Souza, Ariani Impieri de; Cecatti, José Guilherme; Ferreira, Luiz Oscar C; Santos, Luís Carlos. Hospitalização por abortamento no Centro de Atençao à mulher (CAM) - IMIP - Recife / Hospitalization for abortion at the Center for Woman\'s Care (CAM) - IMIP - Recife. J. bras. ginecol;106(9):355-61, set. 1996.
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