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Medical Abortion: An International Forum on Policies, Programmes and Services

Conference objectives:

  • To share information on the use of medical abortion internationally.
  • To analyse the influence of alternative policies, programmes and services on access to medical abortion in a range of country settings.
  • To propose strategies for improving women's access to medical abortion, in the context of safe abortion, with a focus on developing countries and countries in transition.
  • To create a forum for dialogue and networking to broaden the constituency working for medical abortion worldwide.
Conference coordination and organization
 The ICMA Steering Committee appointed a conference planning committee from among its members, which included:
  • Marge Berer, UK
  • Kim Dickson, Nigeria
  • Peter Fajans, Switzerland
  • Bela Ganatra, India
  • Nadine Gasman, Mexico
  • Sharad Iyengar, India
  • Wanda Nowicka, Poland
  • Beverly Winikoff, USA
Financial support
  • Swedish International Development Authority
  • Canadian International Development Agency
  • Department for International Development UK
  • William & Flora Hewlett Foundation
  • Soros Foundation/Open Society Institute
  • Global Fund for Women
  • Ford Foundation Indonesia
  • Ford Foundation Mexico
  • GTZ Nepal
  • Ipas
  • International Women's Health Coalition
  • Concept Foundation
  • Gynuity Health Projects
  • Ibis International Health
  • PATH
  • Population Council Ghana
  • Medi-Team Trust South Africa
  • Fourteen additional NGOs plus the World Health Organization in Geneva and New Delhi funded the travel and in some cases also the conference attendance costs of members of their own staff.

 Participants included those with expertise on medical abortion and those who are likely to have an impact on the visibility and accessibility of medical abortion at country level, who needed to know more about medical abortion. There was a good balance between policymakers, researchers, service providers, women's health and rights advocates and other NGOs in the field. The planning committee consulted widely in each region to find and include key figures. In all, about 160 people were invited, of whom 108 attended from 50 countries, representing all world regions (see table). There were 74 participants from developing countries, 11 from countries in transition and 23 from developed countries.

Eastern Europe
Western Europe
Latin America & Carribean
Mediterranian & North America
North America
United States
United Kingdom
South Africa
St Lucia

Friday-Saturday 15-16 October

Conference planning committee meeting
ICMA Steering Committee meeting (4pm Saturday)

Sunday morning, 17 October

Pre-Conference meeting for all presenters, chairpersons and workshop facilitators with planning committee members

Sunday afternoon, 17 October

Forum opening

[Chair: Kim Dickson]
Welcome speech - Loyiso Mpuntsha, Director of Women's Health and Genetics, Department of Health, South Africa

Introduction of conference programme, ICMA and Steering Committee - Marge Berer

Introduction of participants by region/country - Nadine Gasman

[Chair: Helen Rees]

Keynote speech
Fred Sai: The Promise and Future of Medical Abortion

International overview- what is medical abortion

History and method development of mifepristone and misoprostol for first and second trimester abortion, dosage, regimens, safety and efficacy, route of administration and number of weeks of pregnancy, other ob-gyn indications for use. Alternative methods and regimens where mifepristone is not available, world overview on where the drugs are available (approved or not) [Beverly Winikoff, USA]

Patents, drug production, variability of the cost of drugs across countries, generic vs. brand names, WTO rules and approval for medical abortion drugs at national level. [Peter Hall, Switzerland]

Current research issues in the provision of medical abortion [Helena von Hertzen, Switzerland]

Why medical abortion is important, issues of acceptability and choice from the perspective of women and providers [Marge Berer, UK]

Monday morning, 18 October

Legal and policy framework

Regional overviews

[Chairs: Olive Sentumbwe Mugisa; Wanda Nowicka]

Legal and policy framework for abortion, and the context in which medical abortion is available or provided [Gunta Lazdane (Central and Eastern Europe); Eunice Brookman-Amissah (Africa); Bela Ganatra (Asia); Ralph Parrado (Latin America)]

Country case studies

[Chairs: Cristina Villarreal; Friday Okonofua]

Introduction of medical abortion, influence of existing policies, programmes and services on access to medical abortion, including the public/private mix, and strategies to improve these [Selma Hajri (Tunisia); China (Wu Shang-Chun); Ann Gerhardt (USA); Tran Thi Phuong Mai (Vietnam); Nikki Naylor (South Africa)]

Monday afternoon, 18 October

Use of medical abortion in legally restricted situations

[Chairs: Nadine Gasman; Leila Adesse]

Use of medical abortion in legally restricted situations, including self-medication by women, over the counter and other "unapproved" uses [Latin America; Radnaabazar Erdenetungalag (Mongolia)]

Regional workshops - Country reports

What are the issues that need to be addressed at country level and how to address them.
Eastern Europe - [Chair: Jivka Marinova; Rodica Comendant] - Albania, Armenia, Belarus, Bulgaria, Georgia, Latvia, Lithuania, Moldova, Poland, Romania, Ukraine

Africa - [Chair: Kim Dickson; Nana Oye Lithur] Egypt, Ethiopia, Ghana, Kenya, Namibia, Nigeria (part one), Nigeria part two), South Africa, Uganda

Asia - [Chair: Sharad Iyengar; Meiwita Budiharsana] Bangladesh, Cambodia, China, India, Indonesia, Mongolia, Nepal, Pakistan, Philippines, Thailand, Vietnam

Latin America + Caribbean - [Chair: Nadine Gasman; Felipe Santana] Argentina, Bolivia, Brazil, Colombia, Cuba, Guatemala, Guyana, Mexico, Peru, St Lucia, Uruguay

Western Europe + North America - [Chair: Beverly Winikoff; Ayse Akin] Canada, France, Netherlands, Tunisia, Turkey, UK, USA

[Discuss positive and negative lessons learnt with reference to: political and religious environment, drug regulatory situation, cost issues, role and attitudes of health professionals, and extent of advocacy for abortion rights nationally. Spend 10-15 minutes before the end talking about regional networking and interaction.]

Tuesday morning, 19 October

Use of medical abortion within health service delivery settings

[Chairs: Eunice Brookman-Amissah; Mariana Romero]
Medical and surgical abortion - service delivery requirements - best conditions for both medical and surgical abortions, differences between the two, and problems in providing both of them given the differences [Ann Furedi (UK); Sunita Mittal (India)]

Home use (both mifepristone+misoprostol OR misoprostol only after mifepristone) in a range of settings [Danielle Hassoun (France), Selma Hajri (Tunisia), Carolina Rodriguez (Mexico)]

Research and terminology

[Chairs: Kelly Blanchard; Junice Melgar]

New and ongoing research on medical abortion [Participant reports from the floor - Sodnompil Tserendorj (Mongolia); Mary Kawonga (South Africa); Daniel Grossman (Mexico) to start off]

Terminology - medical abortion vs. medication abortion [Kim Dickson (Nigeria)]

[Chairs: Ann Leonard; Suryono SI Santoso]

Early medical abortion in primary health care

Delivery of early medical abortion in relation to other reproductive technology and commodities [Sharad Iyengar (India)]

Politics of cost and financing

Cost to women out of pocket vs. health system financing - both of medical methods themselves and of back-up if surgical treatment for incomplete abortion and ongoing pregnancy is required [Lee Cullingworth (South Africa)]

Tuesday afternoon, 19 October

Simultaneous workshops

Type of training, type of facility and class of provider
[Facilitators: Danielle Hassoun, Boniface Oye-Adeniran]
[Resource persons: Ralph Parrado, Enrique Guevara, Mosotho Gabriel, Ann Furedi, Cheng Linan]

Choice of abortion method and access issues: preferences of providers and women
[Facilitators: Susanna Rance, Susan Yanow]
[Resource persons: Elizabeth Aubeny, Fang Aihua, Agustin Gonzalez, Miguel Gutierrez]

Institutional involvement/partnership building; getting the public and private sector involved, including doctors, midwives, pharmacists and others; raising the issues in relevant professional associations and networks. Introducing medical abortion into national protocols and norms.
[Facilitators: Peter Fajans, Iryna Mogilevkina]
[Resource persons: Rivaldo Mendes de Albuquerque, Daniela Draghici, M Prakasamma, Friday Okonofua, Jaydeep Tank]

Providing information to women, providers and policymakers; building national-level advocacy for medical abortion; bringing on board people who support safe abortion more generally.
[Facilitators: Phan Bich Thuy; Elizabeth Saar de Freitas]
[Resource persons: Maria Luisa Sanchez, Iatamze Verulashvili, Susana Chavez]

Wednesday, 20 October

Advocacy for safe abortion, information dissemination, broadening the constituency and dealing with anti-abortion activities
[Chairs: Marge Berer, Fred Nunes]

Country case studies
[Sharon Camp (USA); Rivaldo Mendes de Albuquerque (Brazil); Nana Oye Lithur (Kenya); Sabitri Kishore (Nepal); Ninuk Widyantoro (Indonesia); Wanda Nowicka (Poland)]


  1. Ann Furedi - Medical and surgical abortion service delivery requirements
  2. Ann J. Gerhardt & Vicki Saporta - National Abortion Federation's Role in Introducing Mifepristone to Providers and Women in the United States
  3. Prof. Dr. Ayse Akin - Current situation on medical abortion in Turkey
  4. Bela Ganatra - Contrasts and Common Ground ..The Context of Abortion in Asia
  5. Carolina Rodriguez Lara - Mexican women's experience
  6. Cristina Villarreal - Safe Choices under Restrictive Settings
  7. Danielle Hassoun - Medical Abortion Home Use
  8. Hala El Damanhoury - Abortion is Illegal and Common in Egypt. Medical Abortion The Situation in Egypt
  9. Eunice Brookman Amissah - The Legal and Policy Framework for Abortion and the context in which Medical Abortion is available in Africa
  10. Gunta Lazdane - Legal and policy framework Central and Eastern Europe
  11. Iheonu N. Obineche - One-step use of misoprostol only in early pregnancy termination - Part 1
  12. Iheonu N. Obineche - Use of misoprostol in mid-trimester pregnancy termination in a Third World Setting - Part 2
  13. Kim Dickson - What's in a Name?? Medical vs. Medication Abortion
  14. Lee Cullingworth - A Cost Analysis of Service Provision of Medical Abortions in the Public Health Sector at Primary and Secondary Level
  15. Marge Berer - Why medical abortion is important: issues of choice and acceptability
  16. Meiwita Budisharana - Bringing on board people who support and work for safe abortion, but who have not yet shown interest in medical abortion
  17. Nana Oye Lithur - Advocacy for safe abortion, information dissemination, anti-abortion activities in Ghana
  18. S. S. Jha & Sabitri Kishore - Medical Abortion in Nepal Issues and how to address them
  19. Nikki Naylor - The long walk to freedom of choice in South Africa, a country case study
  20. Peter Hall - Product issues in medical abortion
  21. R. Erdenetungalag - Use of medical abortion in legally restricted situation
  22. Ralph Parrado - Legal and Political Framework for Abortion in Latin America
  23. Rivaldo Mendes de Albuquerque - Advocacy for safe abortion, information disseminations, broadening the constituency and dealing with anti-abortion activities
  24. Sabitri Kishore - Implementing Safe Abortion Services under the New Law: Experiences in Nepal
  25. Selma Hajri - Introduction of medical abortion. Influence of existing policies programmes and services on access to MA
  26. Sharad D. Iyengar - Medical abortion in primary health care. Delivery of medical abortion in relation to other reproductive technology and commodities
  27. Olive Sentumbwe - Mugisa - Uganda Issues at Country Level. Situation Analysis on Abortion
  28. Tran Thi Phuong Mai - Medical Abortion - Vietnam's Experience
  29. Wanda Nowicka - Advocacy for safe abortion Poland
  30. Wu Shangchun - Medical Abortion in China
Final Conference Statement

Conference Statement from:
Medical Abortion: An International Forum on Policies, Programmes and
Services, 17-20 October 2004, Johannesburg, South Africa
[en]  [es]  [fr]   [ro]  [ru]

Over 19 million women globally resort to unsafe abortion each year, largely among the world's poorest and most vulnerable women, especially young women. The deaths of 68,000 women and injury to countless more each year represents a continuing injustice that cannot be tolerated. Governments across the world have committed themselves to achieving the Millennium Development Goal of reducing maternal mortality by three-quarters by 2015.Expanding access to safe abortion is an essential measure to realize this goal.

Women have the right to life and health and to the benefits of scientific progress. Advances in technology, including the development of safe, effective and acceptable regimens for medical abortion, have created increased options for women to exercise reproductive choice. However, medical abortion is still not available to many of the women who could benefit from its use.

Medical abortion involves the use of pills to cause a miscarriage that takes place over a period of several days, and is a fundamentally different experience from surgical abortion for both women and providers. Policymakers and health managers and service providers need to recognize the differences, as they affect service delivery requirements. Different regimens of medical abortion drugs exist for use up to nine weeks of pregnancy, for the remainder of the first trimester and for the second trimester of pregnancy.

The role of the provider of medical abortion is to give the woman information and access to the drugs, support the woman as required during the abortion process and check that the abortion is complete. A full surgical abortion service is not necessary in order to provide medical abortion; however, back-up with vacuum aspiration should be available if and as required.

Where both medical and surgical abortions are available, women should be able to choose between them, based on unbiased and accurate information. The focus should not be on promoting one or the other method but on ensuring that women can choose the method that best meets their needs.

Medical abortion services should be viewed as an integral component of comprehensive reproductive health care. For abortions up to nine weeks, the pills can be provided through primary health care services and women can safely use the method at home or in a clinical setting, according to their own preferences and personal circumstances. Medical abortion after nine weeks and in the second trimester can be carried out in a health centre or hospital.

Safe Abortion: Technical and Policy Guidance for Health Systems (World Health Organization, 2003) offers evidence-based standards and norms for providing medical abortion and may be utilized to determine requirements for specific national and local contexts.

Some of the first countries to approve medical abortion have now recognized that they instituted unnecessarily complex requirements for providers and facilities and over-medicalized medical abortion protocols. The avoidance of over-medicalization is essential for ensuring equitable access to medical abortion, particularly in low-resource settings.

Mid-level providers, including nurses, midwives, family planning workers and physician assistants, can and should be trained to provide early medical abortion services. The emphasis should be on providers who are closest to women geographically and socially. Pre-service and continuing education curricula in general medicine, nursing, family planning, midwifery and obstetrics and gynaecology should all include appropriate information on medical abortion methods so that providers are well informed and can help women to exercise their rights.

In legally restricted settings, there is a special need to build alliances across sectors, including doctors, mid-level providers, NGOs, policymakers, legal experts and women's health advocates to provide information about and access to safe abortion, including medical abortion, within national policies and standards. Even in legally restricted environments, governments must recognize their responsibility to provide safe abortion services to the full extent of the law.

Medical abortion can only become a real option for the majority of the world's women when the recommended drugs, mifepristone and misoprostol, are available, accessible and affordable. Both mifepristone and misoprostol have wider obstetric and gynaecological applications, in addition to induced abortion, and should be included in the WHO Model List of Essential Medicines.

Medical abortion is a safe, effective means of inducing abortion and has been shown to be widely acceptable to women in both developed and developing countries in all world regions. In legally restricted settings, medical abortion offers the opportunity to reduce the number of tragic and unnecessary deaths and injuries arising from complications of unsafe abortions. In all settings, medical abortion is contributing to women's ability to exercise the right to terminate an unwanted pregnancy safely.

4 November 2004