The ICMA Information Package on Medical Abortion
Selected resources on medical abortion
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| 1. Introduction | |||||
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The International Consortium for Medical Abortion (ICMA) works to promote medical abortion within the framework of support for safe abortion worldwide, focusing on the needs of women in developing countries, including those countries where abortion is unsafe or not accessible. This chapter is part of a comprehensive information package developed by the Consortium. The information package consists of five chapters. Each of the first four chapters is aimed at a specific audience: women and women’s groups, women’s health advocates, providers of sexual and reproductive health services and health managers, and policy makers. This fifth and final chapter presents a list of select resources for those interested in obtaining further information on medical abortion. The chapter is organised into five sections. The first section lists sources of information materials for users or potential users of medical abortion. Section two contains a list of sources of technical and clinical information aimed mainly at health providers. Section three provides a list of resources on international experiences with the use of medical abortion. This includes publications on women’s perspectives on medical abortion and health system and policy issues related to medical abortion, for use by advocates and policy makers.
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| 2. Information for women thinking of using medical abortion | |||||
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Most of the information materials for users of medical abortion are from the United States and UK. The eligibility criteria, regimens and clinic visit requirements mentioned in them pertain to the countries for which the materials were developed, and need to be suitably modified for other settings. 1. Ibis Reproductive Health operates the Medication Abortion (another term used for medical abortion) Website, which provides education information for women considering the option of medical abortion. The website is http://www.medicationabortion.com/ Especially useful are the answers to “Frequently Asked Questions” . 2. Ipas, which works internationally to increase women's ability to exercise their sexual and reproductive rights and to reduce deaths and injuries of women from unsafe abortion, has produced the following factsheets for medical abortion users:
3. Reproductive Health Matters Journal issue "The abortion pill". Volume 13 Number 26 November 2005. http://rhmjournal.org.uk/26abs.html 4. The Food and Drug Administration of USA has updated its information for patients in July 2005, after the reporting of deaths from infection following medical abortion.
5. bpas is the leading provider of abortion services in the UK, with a national network of consultation centres and clinics. It has produced pamphlets for clients on medical abortion up to 20 weeks of the last menstrual period.
6. The National Abortion Federation (NAF) is the professional association of abortion providers in North America. It has produced the following materials for women thinking about having a medical abortion:
Describes what to expect during a medical abortion and outlines the similarities and differences between medical and surgical abortion. Available in six languages: Chinese, Croatian, English, Russian, Spanish and Vietnamese.
This video for women considering or choosing medical abortion provides a balanced overview of early abortion options and informs women about what to expect during a medical abortion. Available in English and Spanish from National Abortion Federation 7. ‘How can I do an abortion? A woman’s guide to inducing an abortion using misoprostol. From “Women on waves”, a non-profit feminist organization which operates a mobile clinic on a ship that sails to countries where abortion is illegal. Women on Waves aims to prevent unsafe abortions and empower women to exercise their human rights to physical and mental autonomy, by combining free healthcare services and sexual education with advocacy. Information is available in English, Spanish, Portugese, Polish, French. 8. The RU486 website, RU486facts.org is designed to answer the most common questions about medical abortion simply and directly, and is meant for women thinking of using medical abortion and health providers. http://www.ru486facts.org/index.cfm . 9. “What's the difference? The morning-after pill and The Abortion Pill (RU-486)”: Two-side information cards available in 9 different languages (English, Russian, Haitian Creole, Spanish, Vietnamese, Portugese, Chinese (simplified), Arabic and French) From the Abortion Access project (AAP), a US-based organization of reproductive rights activists and women's health care providers dedicated to making abortion truly accessible. Available at: www.abortionaccess.org 10. ‘Questions and answers about the safety of mifepristone’. Information for patients and advocates produced by the Abortion Access Project, addressing questions related to safety of mifepristone which were raised after the death of four women who had taken mifepristone. 11. The Planned Parenthood Federation of America Inc and its various branches have information available for users of medical abortion. For example:
12. Information for users of medical abortion is also available from the websites of several women’s health centres in the US and UK. The following are some examples
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| 3. Clinical and technical information on medical abortion | |||||
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I. Standards and guidelines There are standards and guidelines for the provision of medical abortion for each country where medical abortion has been approved. Materials relevant to the development of standards and guidelines based have been produced by the World Health Organization, by manufacturers of mifepristone such as DANCO laboratories, and also by NGOs working on sexual and reproductive health nationally and/or internationally, such as Gynuity, bpas and Ibis. The following is a list of select standards and guidelines. Please note that some of the guidelines have not been updated based on the most recent evidence. For example, the US FDA recommends a mifepristone dose of 600 mg whereas most others recommend a mifepristone dose of 200 mg based on subsequent research evidence. Also, guidelines developed for specific countries would need to be suitably adapted for other settings.
Clinical guidance 1. World Health Organization. Safe abortion: technical and policy guidance. Geneva: WHO, 2003. This guidance presents strategies for improved clinical care for women undergoing procedures, and the appropriate placement of necessary services. Medical abortion is discussed as one of the procedures and guidance is provided on regimens and health system requirements. The book’s annexes present guidance to further reading, and international consensus documents on safe abortion.
2. von Hertzen H, Baird D; Bellagio Study and Conference Center. Frequently asked questions about medical abortion. Contraception. 2006 Jul;74(1):3-10. Epub 2006 May 15. This article provides an overview of some of the frequently asked questions about medical abortion by service providers in various countries, and the answers to these as discussed in a consensus meeting of experts held in November 2004. A useful update of the information provided in WHO’s Guidance document.
3. Gynuity. Providing Medical Abortion in Developing Countries: An Introductory Guidebook. New York, Gynuity Health Projects, 2004. A list of almost 1100 articles on medical abortion has been created by Gynuity Health Projects. www.gynuity.org A tool for providers and policy makers who are interested in introduction of medical methods for safe termination of early pregnancy. Available in Arabic, English, French, Portuguese, Romanian, Russian, Spanish, and in Vietnamese in PDF format. 4. Consensus Statement: Instructions for use – Abortion induction with misoprostol in pregnancies up to 9 weeks LMP. Expert Meeting on misoprostol sponsored by Reproductive Health Technologies Project and Gynuity Health Projects. Washington D.C, July 28, 2003. This document represents consensus reached by professionals with epidemiological, clinical and programmatic expertise on the appropriate use of misoprostol for abortion, in an expert meeting convened by Gynuity Health Projects and Reproductive Health Technologies Project. Available in Arabic, English, French, Portuguese, Russian , Spanish and Turkish.
5. National Abortion Federation. Protocol for mifepristone/misoprostol in early abortion. National Abortion Federation, Washington DC, 2006. This is a recently updated protocol revised to reflect new data concerning the safety and efficacy of buccal administration of misoprostol, as well as evidence for an effective alternative regimen for oral misoprostol in addition to a regimen for vaginal use of misoprostol. 6. Foster A. Medication abortion - A guide for health professionals. Ibis Reproductive Health, Cambridge, 2005. English and Arabic. Updated guidelines providing alternative regimens for medical abortion, including regimens using misoprostol alone. Also available in Arabic. 7. Ipas has produced two clinical practice notes, one for the mifepristone/misoprostol regimen and another for the misoprostol-only regimen. Ipas. Early abortion with misoprostol and mifepristone: Clinical practice notes. Chapel Hill, Ipas, 2004. Ipas. Misoprostol alone for first-trimester medication abortion: Clinical practice notes. Chapel Hill, Ipas, 2004. 8. Bpas, UK has a series of pamphlets for health professionals, on abortion options at different durations of pregnancy, and includes information on medical abortion regimens. There is also a pamphlet with guidance for health providers who are opposed to abortion
9. DANCO laboratories, manufacturer of Mifeprex (mifepristone) provides clinical information to health providers on prescription of mifepristone. 10. The US Food and Drug Administration has produced information for health providers updated in November 2005. 11. American College of Obstetricians and Gynecologists (ACOG). Medical management of abortion (available for members only) Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2005 Oct. 12 p. (ACOG practice bulletin; no. 67). 12. Royal College of Obstetricians and Gynaecologists. National clinical guidelines. The care of women requesting induced abortion. London: RCOG, 2004. Clinical guidelines for providers of induced abortion in the United Kingdom, including medical abortion. Provides guidance on regimens and protocols for management and the evidence-base on which these are based. 13. Medical abortion clinical guidelines for British Columbia, India and New Zealand, respectively are available at the following websites: Medical abortion clinical guidelines for British Columbia Medical abortion clinical guidelines for India Medical abortion clinical guidelines for New Zealand
Guidance for counseling in medical abortion
14. Talluri-Rao, Sudha and Baird Traci. Information and training guide for medical-abortion counseling. Chapel Hill, Ipas, 2003. Available in English , Portugese and Russian. 15. Tabbutt-Henry J and Graff K. Client-provider communication in post-abortion care. International family planning perspectives 2003; 29(3): 126-129. 16. Akinyemi L, Laschalt B, Fiala C and Safar P. Counseling aspects of pregnancy termination with Mifegyne. Department of Obstetrics and Gynaecology, General Public Hospital, Korneuburg, Vienna, 2000. Unpublished paper.
II. Updated (2005 July and later) information on safety of mifepristone Recently, the deaths of four women who had taken mifepristone have caused concern about its safety. The following sources provide unbiased and medically sound information for clinicians.
III. Journal articles To keep abreast with the latest technical and clinical evidence on medical abortion, refer to articles from scientific journals, using PubMed, the National Library of Medicine's search service that includes over 16 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s, at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed
IV. Resources for training of and self-study by health professionals 1. Ibis Reproductive Health. Medication abortion: a training module for health professionals. Power point presentation. Ibis Reproductive Health. 2003. 2. Paul M, Stewart FH, Weitz TA et al. Early abortion training workbook. UCSF Center for Reproductive Health Research and Policy, San Fransisco, CA (2003) 3. The National Abortion Federation (NAF) has a Web-based continuing medical education (CME/CE) activity which provides health care professionals with the information necessary to safely and effectively offer medical abortion to their patients seeking abortion services. For further details, go to: http://www.prochoice.org/education/cme/online_cme/default.asp 4. NAF produces a monthly newsletter for medical professionals, NAF Early Options Health Care Professionals Updates. To receive these, write to healthcare_professionals@lyris.prochoice.org 5. NAF has produced a training and resource binder, which includes eight PowerPoint training modules, practical resources for providing medical abortion, an August 2000 NAF-sponsored American Journal of Obstetrics and Gynaecology supplement on medical abortion, and an Early Options Self-Study Guide. Available from: National Abortion Federation Some of the resources in the binder are available for download from: http://www.prochoice.org/pubs_research/publications/downloads/#education
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| 4. Experiences with the use of medical abortion in different country settings | |||||
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I. Women’s perspectives
II. Health system issues
The following papers, presented at “Medical Abortion: An International Forum on Policies, Programmes and Services”, 17-20 October 2004, Johannesburg, South Africa, are available for download from the website of the International Consortium for Medical Abortion (ICMA):
III. Legal and policy issues
The following papers, presented at “Medical Abortion: An International Forum on Policies, Programmes and Services”, 17-20 October 2004, Johannesburg, South Africa, are available for download from the website of the International Consortium for Medical Abortion (ICMA):
IV. Advocacy for medical abortion The following papers, presented at “Medical Abortion: An International Forum on Policies, Programmes and Services”, 17-20 October 2004, Johannesburg, South Africa, are available for download from the website of the International Consortium for Medical Abortion (ICMA):
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| 5. References in Spanish | |||||
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1. Carbonell, J L; Varela, L; Velazco, A; Tanda, R; Sánchez, C. Misoprostol vaginal para el aborto del segundo trimestre temprano / Vaginal misoprostal for early second trimester abortion. Rev. cuba. obstet. ginecol;26(1):28-35, ene.-abr. 2000.
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