Publications

Reference: http://www.who.int/reproductive-health/publications/safe_abortion/index.html

2003        

At the Special Session of the United Nations General Assembly in June 1999, Governments agreed that “in circumstances where abortion is not against the law, health systems should train and equip health-service providers and should take other measures to ensure that such abortion is safe and accessible. Additional measures should be taken to safeguard women’s health.” This document provides technical guidance for health systems to turn this agreement into reality.

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Reference: http://www.rcog.org.uk/resources/Public/pdf/induced_abortionfull.pdf   

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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Reference: http://www.gynuity.org/pub_b.html#q5

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.

Download “Instructions for Use: Abortion Induction with Misoprostol in Pregnancies through 9 Weeks LMP":

Arabic, English, Spanish, French, Portuguese, Russian (PDF format).

Download “Instructions for Use: Misoprostol for Treatment of Incomplete Abortion and Miscarriage”

Arabic, English, Spanish, French, Portuguese, Russian (PDF format).

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Reference: http://www.gynuity.org/pub_b.html#q2

 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.

Arabic, English, French, Portuguese, Romanian, Russian, Spanish, Vietnamese

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 Reference: www.guttmacher.org

New York: The Alan Guttmacher Institute, 1999

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.

Full text on: www.guttmacher.org/pubs/sharing.pdf

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Medical Abortion : A fact sheet

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Reference: http://www.who.int

Unsafe abortion is entirely preventable. Yet, it remains a significant cause of maternal morbidity and mortality in much of the developing world. Over the past decade, the World Health Organization has developed a systematic approach to estimating the regional and global incidence of unsafe abortion and the mortality associated with it. Estimates based on figures for the year 2000 indicate that 19 million unsafe abortions take place each year, that is, approximately one in ten pregnancies end in an unsafe abortion, giving a ratio of one unsafe abortion to about seven live births. Almost all unsafe abortions occur in developing countries.

Women who resort to unskilled or untrained abortion providers put their health and life at risk. Worldwide an estimated 68 000 women die as a consequence of unsafe abortion. In developing countries the risk of death is estimated at 1 in 270 unsafe abortion procedures. Where contraception is inaccessible or of poor quality, many women will seek to terminate unintended pregnancies, despite restrictive laws and lack of adequate abortion services. Prevention of unplanned pregnancies by improving access to quality family planning services must therefore be the highest priority, followed by improving the quality of abortion services, where legal, and of post-abortion care.

Full text on: www.who.int/reproductive-health/publications/unsafe_abortion_estimates_04/estimates.pdf

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Reference: http://www.who.int

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This report gives estimates of the number of unsafe abortions and associated mortality for the year 2003. Nearly 20 million unsafe abortions took place that year,
98% of them in developing countries with restrictive abortion laws. These countries often also have low rates of use of modern reversible contraceptives and high levels of unmet need for family planning. Regional and global estimates of the incidence rate of unsafe abortion (per 1000 women aged 15–44 years) and unsafe abortion
ratios (per 100 live births) are presented. The report identifies areas where data on unsafe abortion are particularly scarce and estimates therefore tenuous. Trends in the estimated incidence of unsafe abortion are examined, and relevant background information is provided on the legal context of abortion, fertility transition, unplanned pregnancy, family planning and contraceptive method mix. The health consequences of unsafe abortion and their global burden for women and for society are discussed. This is the fifth update of this document since the first edition was published by WHO in 1990.

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Reference: www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=17466303

Int J Gynaecol Obstet.

2007 Jul;98(1):66-9. Epub 2007 Apr 27.

Harper CC, Blanchard K, Grossman D, Henderson JT, Darney PD.

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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Reference: 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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Reference: 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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International Women’s Health Coalition (IWHC) is pleased to present you with 2006 Annual Report, Invest in Women, Invest in the World.

Click here to download a copy

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Reference: http://www.contraceptionjournal.org

Abstract

Introduction

To increase access to safe abortion in rural India, the feasibility and acceptability of mifepristone–misoprostol abortion was assessed in a typical government run primary health center (PHC) in Nagpur district, Maharashtra State, that does not offer surgical abortion services and must refer off-site for emergency and backup services.

Materials and Methods

Consenting pregnant women (n=149) with ≤56 days amenorrhea seeking terminations received 200 mg mifepristone, and returned 48 h later for 400-μg sublingual misoprostol and 12 days later for abortion confirmation. Surgical backup was conducted at a nearby community health center (CHC).

Results

Nearly all women (98.6%) with known outcomes had successful medical abortions, and those who did not (1.4%) were successfully referred to the CHC for surgical backup. Women reported the method\'s ease and simplicity as the best features.

Conclusion

Medical abortion provision is feasible and acceptable in an Indian rural PHC that does not offer surgical abortion services. This study suggests that introduction of medical abortion at lower levels of the health-care system could increase access to safe abortion in rural India.

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Reference: www.un.org/esa/population/publications/

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.

 
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Table (Excel)

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 Reference: http://content.nejm.org

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

ABSTRACT

Background The long-term safety of surgical abortion in the first trimester is well established. Despite the increasing use of medical abortion (abortion by means of medication), limited information is available regarding the effects of this procedure on subsequent pregnancies.

Methods We identified all women living in Denmark who had undergone an abortion for nonmedical reasons between 1999 and 2004 and obtained information regarding subsequent pregnancies from national registries. Risks of ectopic pregnancy, spontaneous abortion, preterm birth (at <37 weeks of gestation), and low birth weight (<2500 g) in the first subsequent pregnancy in women who had had a first-trimester medical abortion were compared with risks in women who had had a first-trimester surgical abortion.

Results Among 11,814 pregnancies in women who had had a previous first-trimester medical abortion (2710 women) or surgical abortion (9104 women), there were 274 ectopic pregnancies (respective incidence rates, 2.4% and 2.3%), 1426 spontaneous abortions (12.2% and 12.7%), 552 preterm births (5.4% and 6.7%), and 478 births with low birth weight (4.0% and 5.1%). After adjustment for maternal age, interval between pregnancies, gestational age at abortion, parity, cohabitation status, and urban or nonurban residence, medical abortion was not associated with a significantly increased risk of ectopic pregnancy (relative risk, 1.04; 95% confidence interval [CI], 0.76 to 1.41), spontaneous abortion (relative risk, 0.87; 95% CI, 0.72 to 1.05), preterm birth (relative risk, 0.88; 95% CI, 0.66 to 1.18), or low birth weight (relative risk, 0.82; 95% CI, 0.61 to 1.11). Gestational age at medical abortion was not significantly associated with any of these adverse outcomes.

Conclusions We found no evidence that a previous medical abortion, as compared with a previous surgical abortion, increases the risk of spontaneous abortion, ectopic pregnancy, preterm birth, or low birth weight.

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Reference: www.ipas.org

This four-page brochure discusses the basic facts about emergency contraception for clinicians in Europe. Topics of discussion include emergency contraception\'s effectiveness, how and when it should be used, emergency contraception\'s potential side effects and its availability throughout Europe.

Available online at:
http://www.ipas.org/Publications/asset_upload_file433_3149.pdf

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

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

Cairns Base Hospital, Cairns, QLD, Australia. caroline.decosta@jcu.edu.au

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.

Early medical abortion in Cairns, Queensland: July 2006 - April 2007. de Costa CM, Russell DB, de Costa NR, Carrette M, McNamee HM. The Medical Journal of Australia. 2007 Aug 6;187(3):171-3.

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Reference: http://www.amwa-doc.org

Martin Donohoe, MD

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.

Full article Increase In Obstacles to Abortion: The American Perspective in 2004

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Reference: http://www.ipas.org

Bela Ganatra and Wendy Darby

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.

Full text (PDF)  3 Mb

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Source: http://ssrn.com/abstract=1041321

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   

International Journal of Gynecology and Obstetrics, Vol. 99, pp. 157-161, 2007

 
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.

 
Keywords: reproductive health, abortion, termination of pregnancy, law, ethics, transparency, rights

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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.pac-consortium.org/site/PageServer?pagename=Newsletter

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

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

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The Winter 2008 issue focuses on abortion rights as human rights. It includes articles about human rights in Latin America, reproductive justice, and using a human-rights framework to teach health providers, as well as interviews with Monica Roa, an attorney who worked to overturn Colombia’s restrictive ban on abortion, and Marianne Mollmann, advocacy director for the Women’s Rights division of Human Rights Watch.

 Ipas: The abortion magazine, volume 3

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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 

[Đánh giá hiệu quả phá thai đến 49 ngày bằng Mifestad 200 và Alsoben] / Nguyễn Đức Hinh,Nguyễn Thị Ngọc Khanh,Nguyễn Thị Hồng Minh // TC Y học Việt Nam . -2006. -Vol 321. -No 4. -p. 27-32. -(vie). -ISSN 0686-3174.

Classification (rubrics): 76.29.48
Key words: Medical abortion; Mifepristone; Misoprostol;

Location: TTKHCNQG, CVv 46

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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.figo.org

Asia and Oceania Federation of Obstetrics and Gynaecology (AOFOG)

A declaration adopted at the 20th AOCOG meeting in Tokyo, Japan, 21-25 September 2007.

See http://www.figo.org/docs/AOFOG%20declaration%20on%20unsafe%20abortion%202007.pdf

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Source: http://www.wgnrr.org

This brochure was developed in consultation with young people and organizations working with young people in 33 countries from across Asia, Africa and Latin America. Its aim is to provide correct
information to young people, without fear or guilt, and to dispel the myths that exist around abortion.

Download the brochure in

English: text [PDF, 577 KB] and cover [PDF, 164 KB], and

French: text [PDF, 500 KB] and cover [PDF, 282 KB].

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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://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.

Improved Access to Safe Abortion Care: Karnataka, India, 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 Abort