The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #70985

Jennifer Blum, MPH¹, Beverly Winikoff, MD, MPH¹, Charlotte Ellertson, MPA, PhD², and Katrina Abuabara³. (1) International Programs Division, Population Council, One Dag Hammarskjold Plaza, New York, NY 10017, (2) Ibis Reproductive Health, 2 Brattle Square, Cambridge, MA 02138, (3) Regional office for Latin America and the Caribbean, Population Council Mexico, Escondida 110, Col. Villa Coyoacan, Delegacion Coyoacan, Mexico, DF, 04000, Mexico, (52 55) 56598839, kabuabara@popcouncil.org.mx

Medical abortion is increasingly available worldwide. A regimen of mifepristone followed by a suitable prostaglandin (such as misoprostol) can be delivered in a manner that is safe, effective, and acceptable for women in developing countries. We are developing a guidebook to summarize the current state of knowledge and provide recommendations for use in low resource settings. We will present highlights on each of the guidebook’s main themes: choosing a regimen, selecting suitable clients, counseling, providing services, and expanding access. Efficacy depends on the regimen used, gestational age of the pregnancy, and provider experience. Both oral and vaginal administration of misoprostol are safe and oral administration may be more acceptable to women. Gestational age and pregnancy termination can be determined using clinical signs, serum b-HCG tests, or ultrasound, if available. Follow-up is extremely important to ensure pregnancy termination. This should be emphasized during counseling along with details of what the woman can expect and whom she can call if she experiences any complications. Medical abortion can be provided in any area where access to emergency services is available in the rare event of a complication. Providers of al levels can offer services if appropriately trained on the details of the method and patient counseling. Participants will gain a greater perspective as to how this method can be adapted for new settings and leave with concrete examples of medical abortion service provision in rural and low resource areas.

Learning Objectives:

• List the countries where medical abortion regimens have recently been approved.
• Discuss the issues to take into consideration when choosing a medical abortion regimen.
• Evaluate methods for dating gestational age and confirming abortion completion.
• Describe what counseling services should include.
• Articulate strategies for training providers and providing services in rural areas.

Keywords: Abortion, Third World

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.