| In
this section you will find information about Gynuity's work
to improve medical abortion services in four ways:
Complications of
abortion are among the most important causes of maternal death
globally. In Africa, it is estimated that there are 22 unsafe
abortions per 1,000 women; nearly one-fifth of all maternal
deaths in the region are linked to unsafe abortion practices.
In many low resource countries with limited access to health
care services and few trained surgical abortion providers,
medical methods of abortion promise to help reduce maternal
morbidity and mortality. Furthermore, many women prefer abortion
induced by drugs to surgery. Enabling women to choose an alternate
method of abortion will improve access to safe services and
increase satisfaction.
Gynuity Health Projects tracks the approval of the medical
abortion drugs, mifepristone and misoprostol, throughout the
world. To download maps that reflect our latest information
about the registration of these medications follow the link
below.
>
Maps of mifepristone and misoprostol availability 
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Introduction of Medical Abortion
in Developing Countries
Mifepristone medical abortion requires the use of two drugs:
mifepristone and misoprostol. Mifepristone is an antiprogestin
taken orally during the first trimester of pregnancy. It blocks
receptors of the hormone progesterone. As a result, the lining
of the uterus can no longer sustain the growing embryo. The
drug also increases prostaglandin levels and dilates the cervix,
facilitating abortion. Misoprostol is a prostaglandin analog
that is marketed worldwide in over 60 countries for treatment
and prevention of gastric ulcers. It is widely used “off-label”
for a number of reproductive tract indications.
One tablet of mifepristone is swallowed first, causing the
embryo to stop growing. Two days later, the woman takes misoprostol,
causing contractions of the uterus and expelling the uterine
products. The timing, dose, and route of administration of
misoprostol often vary slightly. Studies have shown that these
drugs effectively terminate more than 9 out of 10 pregnancies
in the early first trimester.
To date, mifepristone
has been registered in 35 countries, but most of these are
in the industrialized world. (The notable exceptions are China,
one of the first countries to use the drug and the one with
the most widespread use, Tunisia, South Africa, India, and
Vietnam.) Fewer developing countries have made this drug available
in part because of more restrictive abortion laws, the expense
of the drug, and reluctance to allow the pill on the market
(sometimes fostered by current providers of abortion services).
Even doing clinical testing of the acceptability and feasibility
of the use of the drug can be daunting because of unclear
regulatory requirements and political controversies.
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Current
or planned Gynuity activities in this area include:
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Demonstration
projects using medical abortion regimens to
introduce the technology in new settings,
particularly in places with limited access
to legal abortion services; |
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Studies to inform
service delivery protocols for low resource
settings |
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Collaboration with
pharmaceutical companies to facilitate the
registration of the drugs internationally; |
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Partnering with
large nongovernmental organization service
providers to introduce medical abortion;
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Creation of
policy, sharing of information, and advocacy
for medical abortion technologies; and |
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Organization of
seminars, educational opportunities, and training
courses to share information and stimulate
interest in the technology’s potential
among service providers and other interested
colleagues. |
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Download "Introduction of Medical Abortion in Developing
Countries" in PDF
Gynuity
produced a 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 Vietnamese in PDF format. Please
contact Gynuity to obtain the print version of the guidebook
in English, Russian or Spanish.
Follow
this link to download the guidebook in various languages.
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Improvements
in Medical Abortion Regimens
Medical abortion regimens using mifepristone with misoprostol
and misoprostol alone are quickly gaining support worldwide
as safe and effective alternatives to surgical abortion.
However, it is widely believed that the most frequently registered
regimen may not be ideal for use in a range of settings. Refinements
to the standard regimen of mifepristone and misoprostol promise
to increase access to this method while sustaining high safety,
efficacy, and acceptability profiles. Each of these refinements
also may lower the costs of providing safe abortion services.
Gynuity has helped to support a report that analyzes ways
in which early medical abortion services in the United Kingdom
can be improved. The report, produced by the Family Planning
Association of the United Kingdom, summarizes a framework
for action. The Executive Summary of “Early abortions:
Promoting real choice for women” is provided below.
> Download the Executive Summary
in PDF format 
Ways to improve the regimen:
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Reduce doses of mifepristone,
thereby lowering the cost of the method;
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Offer
home administration of misoprostol, entailing fewer
clinic visits;
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Implement improvements to misoprostol dosage,
timing, and route of administration that may increase
efficacy and decrease time to completion of abortion;
and
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Create simplified alternatives to management
of follow-up. |
Download "Improvements
in Medical Abortion Regimens" in PDF
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Decreased Use of Routine Sonography
Mifepristone medical abortion has been rapidly accepted in the United States since its 2000 approval. Yet the technology has not yet been able fully to deliver on its promise to offer American women a new, widely available alternative to surgical abortion for a number of reasons, among them the requirement that women come in to a clinic for a minimum of two visits and the tendency of those offering medical abortion to insist on pre- and post-procedure sonography as part of treatment. These two factors render medical abortion more burdensome and expensive than it might otherwise be and limit its provision to practitioners who have sonography machines and the skills to use them.
Gynuity Health Projects has launched a project to lay the groundwork for decreasing both the number of clinic visits and the use of sonography in medical abortion. The project involves more than 4,000 women recruited from four clinics providing medical abortion. The study aims to determine if the simplified approach to medical abortion is as successful as current practice of routine sonography at diagnosing ongoing pregnancies. The study also seeks to discover whether or not symptoms, examination, and a low-sensitivity pregnancy test can, without recourse to sonographic data, in most cases adequately determine duration of pregnancy, likelihood of ectopic pregnancy, and presence of ongoing pregnancy or other post-abortion complications.
For more information about this study contact Wesley Clark (wclark@gynuity.org).
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Misoprostol
Alone for Early Termination of Pregnancy
A wealth of evidence in the scientific literature indicates
that misoprostol alone can be used safely and effectively
for early pregnancy termination. However, no formal drug development
strategy or authoritative advice on appropriate regimens existed
for use of misoprostol for this indication—until now.
To address the need for clinical guidelines for early abortion
with misoprostol alone, Gynuity Health Projects and the Reproductive
Health Technologies Project convened a small expert meeting
in July 2003. Prominent researchers and experts on use of
misoprostol for early abortion, training and advocacy organizations,
and leading obstetrician-gynecologists attended this gathering.
They carefully reviewed the medical literature, discussed
the clinical aspects of various regimens, and agreed on clinical
advice for use of misoprostol alone for early pregnancy termination.
That advice can be found in “Instructions for Use:
Abortion Induction with Misoprostol in Pregnancies through
9 Weeks LMP.” The information in this document
can be used as the basis for training manuals, fact sheets,
and leaflets for providers and advocates.
| Follow this link to download this document in Arabic, English, French, Portuguese, Russian and Spanish. A reference list and annotated bibliography in support of these instructions are also available. |
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Other documents
available on this topic include:
> "Route
of misoprostol administration"
> "Misoprostol and teratogenicity:
Reviewing the evidence"
This document is available in English and Spanish
> "Misoprostol: An emerging
technology for women's health"
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