Making the Most of It: Maximizing the Potential of Medical Abortion

Prepared by Suchitra Dalvie

The 10th Annual Mifepristone Gynuity Health Projects Meeting was held on June 2nd, 3rd in New York.

Over 120 participants gathered to share a wide range of experiences and ideas from across the globe, though the largest proportion was from the US itself. Some highlights of the discussions and presentations at this meeting:

National Abortion Federation (Vicky Saporta) mentioned that they have added buccal misoprostol as an option for abortion through 63 days' LMP. Protocol and clinical policy guidelines are available on the NAF website. They also have CME programmes online for professionals at www.prochoice.org.

A patient assistance fund has been started for women below poverty line who live in states where Medicaid (government medical insurance) does not cover abortion services.

DANCO, the US pharmaceutical company that markets mifepristone , informed us that an estimated 950,000 women have used their product (Mifeprex) for early medical abortion through May 2008 in the US. Statistics reveal that 12% of all abortions in the US are MMA which represent 1.2 million in total. The Danco representative quoted the Guttmacher report (Jan 2008) and said that more than 50% of all abortion providers use MMA.

Helena von Hertzen from the Department of Reproductive Health and Research, WHO, shared the results of some studies:

• A study of vaginal and sublingual misoprostol for 2nd trimester abortions (gestation 13-20 weeks) at 400 microgm 3 hourly x 5 doses. They found that the efficacy of vaginal route was better especially in multiparous women.
• Another study compaed 200mg and 100 mg Mife with Miso 800 microgm vaginally after 24 or 48 hour intervals, and the results will be published shortly..
•  In the study looking at pre-treatment with misoprostol vs placebo before vacuum aspiration they found that the need for re-evacuation depends on gestational age but is lower in the misoprostol  group.

Dr. Paul Blumenthal shared information on a new and interesting FDA approved pregnancy test kit which shows bands at different βhCG concentrations from 25 miu to 10,000 miu. Stanford University and Gynuity Health Projects are studying the correlation of the pregnancy test results with serum βhCG.  Dr. Blumenthal also shared that they are working with a simplified telephone follow up protocol for MMA.

I chose to attend the break out session facilitated by Dan Grossman (Ibis Reproductive Health). The topic was "Talking about publicly challenging and controversial issues surrounding medical abortion: self induction, "easier" abortions for women and prophylactic provision of abortion drugs for women.

Fascinating discussions followed, with participants discussing issues like

• Why not have repeat abortions if they are safe ?
• Why not allow abortion as a family planning method?
• Lack of access currently makes abortion too difficult not too easy!!
• Self induction may have problems at higher gestations
• Continuum of birth prevention - pre coital to intracoital post coital including abortion

• Contraception itself not easy and abortion should be given as a responsible back up option.

Lynn Borgatta shared study findings of an RCT which showed that obese women and non obese women have the same risks of morbidity with MMA but surgical abortion has greater risk for obese women.

There was a discussion later about the ways to define success and if it should be different for 1st and 2nd trimester. In 1st it should be complete abortion but in second it should be only abortion (i.e. fetal expulsion).

Alison Bigrigg from the NHS, Scotland, made a very interesting presentation which included the reasons women choose MMA when eligible. I feel that even when a woman is eligible and wants an MMA , we need to be conscious of her post abortion contraception requirements - if she wants a sterilization or IUD she may prefer a one sitting MVA/EVA along with the method.

It was a very interesting meeting, giving a lot of food for thought, bringing together a wide range of expertise and experiences.

Congratulations to GYNUITY for doing this 10 years in a row!!

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BPAS Chief Executive appointed to government advisory committee

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Roundup: Latina Women Use Drugs and Home Remedies to Induce Abortion; Indian Call Center Fields Questions on Contraception

2 January 2009, Northern Ireland
Northern Ireland Sees Record Number of Women Head to England for Abortions

29 December 2008
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