A different approach: A discussion with Cristina Villarreal, director of Fundación Oriéntame in Bogota, Colombia

Cristina Villarreal’s father dedicated his professional life to reducing maternal mortality in Colombia. In 1976, he
started Fundación Oriéntame, a clinic to treat women with incomplete abortions, using modern techniques “in a comprehensive way,” says Villarreal. In 2006, when abortion was decriminalized for certain indications: danger to woman’s life or health, when pregnancy is a result of rape or incest, or severe fetal abnormality incompatible with life, Oriéntame began providing abortion services using the same comprehensive service model.

From the beginning, responding to women’s physical and emotional needs has been the clinic’s mission. The clinic’s services include medical consultation, one-on-one discussion about options, counseling, misoprostol-only medical abortion or manual vacuum aspiration (MVA) for abortion, follow-up care and sexual and reproductive health education. Orientame also runs an adoption program.

“Women in our restrictive context need a lot of emotional support for abortion and for sexual and reproductive health issues in general,” says psychologist Villarreal, who began working at Oriéntame as a counselor in 1986 and moved into the role of director in 1992. “When a woman comes to us for an abortion we make sure she has all the information about both [MVA and medical abortion] and then we discuss all the indications for abortion—both physical and emotional.” She says women often come to the clinic with a lot of anxiety, low self-esteem and fear. “These issues have to be addressed so that the woman is empowered to make a decision for which she has the right,” she says. “Counseling has to do with not only information but each woman’s options, her previous experiences in relation to the process that she’ll choose,” she adds.

Medical abortion—challenges remain

Failed first experiences with medical abortion aren’t particularly uncommon in Colombia, Villarreal explains. Medical abortion—primarily using misoprostol only as mifepristone is not available—is widely available in Colombia, and became accessible sometime around 1998 through pharmacies, she says. “Women go to pharmacies first, before anything else, for everything in Colombia—it’s most people’s firsthand doctor.”

But, according to Villarreal, the medical abortion protocols vary from pharmacy to pharmacy. “We’ve found there are almost as many protocols as numbers of pharmacies we’ve interviewed,” says Villarreal. Women don’t get good information on dosages and in some cases the quality of the medications isn’t very good since it comes from the black market, she says. Many women have no trust in medical abortion if they’ve done it and failed.

“We’re really trying to work with pharmacies but we can’t provide training to them,” relates Villareal, because technically they can’t provide abortion. “We’re working to develop strategies to educate [pharmacists] about sexual and reproductive health issues, including medical abortion.”

“With medical abortion, we talk about the range of pain and bleeding—these things prepare her to overcome the physical effects,” notes Villarreal. Women who come to Oriéntame can choose individual counseling or group counseling, which, says Villarreal, can be especially beneficial for women to share and hear others’ experiences. “Sometimes we’ll have a woman who comes in with a failed medical abortion and she’ll ask a lot of questions of other women in the group who have good experiences with medical abortion.”

Given women’s differing experiences and views on abortion, including medical abortion, Villarreal contends that the counseling provided through Oriéntame is particularly important.

“When we began providing group counseling it had to do with our sense that some women were justifying their own experiences but still judging other women. It’s a great strategy to have them listening to others under different circumstances and from other backgrounds. We have very young women listening to not-so-young women and rich women listening to poor women. It really helps for them to share their experiences…and works to promote medical abortion as a safe alternative.”

Source: http://www.ipas.org