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ICMA 3Rd International Conference ICMA April 2010 NEWS newsletter n.2 Asia Safe Abortion Partnership Latin American Consortium Eastern European Alliance African Network Against Unsafe Abortion For Reproductive Choice for Medical Abortion SHARING NEWS! ICMA 3rd international conference On March 2, 2010 over 170 clinicians, • Mifepristone has been approved in ad- public health officials and advocates from 60 ditional countries countries around the world came together for the Third International Conference on Medical • Information about medical abortion is more Abortion sponsored by the International available to women across borders Consortium on Medical Abortion (ICMA) in collaboration with IPAS and Gynuity. • Nepal, Ethiopia, Columbia, Mexico City, Switzerland, Portugal and Spain have either The conference “Expanding access to medical legalized abortion or expanded the grounds abortion: Building on two decades of experi- on which an abortion is considered legal Ended with a lively session on “next ence” steps” in which the four ICMA-affiliated • Low-cost mifepristone and misoprostol regional networks shared their action Reviewed the current status of medical products, including combined products, have plans, ICMA pledged to convene a fourth abortion internationally and highlighted become more available international conference to move the key issues in advancing access to medical global agenda forward while continuing abortion, including strategies for mak- • Several new provision models, including so- to support regional work, and the floor ing medical abortion more accessible, cial marketing of misoprostol and education suggested innovative ideas and strate- overcoming political opposition, and of pharmacists, have been piloted gies such as convening regional network the debate over how much supervision meetings of physicians and midwives, women need when using medications to • Safe internet provision of medical abortion partnering with the International end a pregnancy. has become a reality Federation of Gynecology and Obstetrics (FIGO) to work closely with obstetric/ Shared information about the experiences Motivated participants to share how the gynecological associations on the national in several specific countries with unique conference had shaped their individual plans and regional levels, inviting more policy successes in introducing medical abortion for continuing work in their countries: New makers to regional and international or overcoming barriers to illustrate in- partnerships and relationships were fostered forums on abortion, and collaborating on novative approaches and strategies. by the conference, and the convening of a Worldwide Day of Action. regional caucuses generated new ideas for Celebrated the increased diffusion of collaborative work. After three days of inspiring exchange and medical abortion around the world and debate, the conference finished with a strong highlighted the progress in expanding Included regional caucuses sessions to discuss sense that there will more gains to celebrate access to medical abortion in recent years safe abortion and medical abortion access in on the global, regional, and national levels as Africa, Asia, Eastern Europe, Latin America and ICMA continues to work to improve women´s • Misoprostol and mifepristone have been the Caribbean, North America and Western health and to guarantee women´s rights by included in the WHO list of essential Europe, and to present the plan of work of the expanding women’s access to safe medical medicines four ICMA´s affiliated regional networks. abortion. For more information: http://www.medicalabortionconsortium.org ICMA NEWSLETTER n.2 | APRIL, 2010 Page 1 Medical abortion: where are we now? where are we going? Marge Berer, Chairperson, Steering Committee, ICMA Medical abortion offers a choice both for women countries) but it is registered not as an abortion many international, regional, national and local and providers; it increases access to safe abortion, drug but for treatment of gastric ulcers, and more stakeholders are involved in advocacy activi- and can put the means of abortion into women’s recently also for prevention of post-partum haem- ties, in the provision of information and medical hands. After 20 years of use and research, it is orrhage. The prices of both drugs differ markedly abortion pills through a range of outlets. There also safer and more effective. between countries and where misoprostol is being are many more drug companies producing generic used outside the law, the price can be very high. brands of the drugs and now, with the support of But despite all these gains, access to medical the Concept Foundation, the two drugs are being abortion is still a problem worldwide owing to packaged and sold together. many obstacles. The provision of medical abortion is often over-medicalized (e.g. when a physician We are certainly in a better position to make is the only provider allowed to offer it, when medical abortion a real choice for women. To there is only hospital-based provision, and when move the process forward even more, we need to ultrasound is required to determine length of put policies in place that will increase the role of pregnancy and/or to check abortion is complete). mid-level providers at primary care level, where Training of providers is haphazard and treatment they are closest to women (nurses, midwives, of complications is not always assured. Barriers family planning workers and, and physician as- also exist due to women lacking accurate informa- sistants) to provide medical abortion pills. We also tion, which leads to incorrect use (doses too large need to improve the quality of information given or too small or self-medication beyond 9 weeks, to women so that all women can understand it which can be risky), and uncertainty whether (including how to take the drugs safely). Health bleeding is normal or abortion is complete. Drug Despite all these barriers and problems, access to services need to allow home use of both drugs availability is also a problem; the registration medical abortion is much better than it used to be (until at least 9 wks of pregnancy); and women’s and approval process is more complicated than ten years ago. An important sign of this trend was health advocates and others must support bona it needs to be, given that the drugs have been the inclusion of mifepristone and misoprostol for fide web provision as a form of distance medicine registered and approved in so many countries induced abortion in the WHO Essential Medicines and self-medication where services are lacking already, and in some cases drug companies have List in 2005. Also, in recent years, more countries and/or illegal. even refused to apply in developed countries like have been approving medical abortion, more Canada where abortion is legal. In some countries, women are choosing it, and more providers are And as it has always been an imperative in the outdated, overly stringent regulatory conditions offering it. In addition, national laws and policies reproductive health and rights´ arena, we need have been imposed, or the method has not been have begun to incorporate regulations specific a knowledgeable, committed and creative social allowed to be used in the public sector at all. At to medical abortion, which help to make it more movement advocating for access to medical abor- present, mifepristone is registered/approved in accessible. To complete this encouraging picture, tion everywhere that is coordinating its efforts at only 44 countries (since 1988 when it was first more global stakeholders are currently engaged in the global, regional and national levels. registered in France and China). Misoprostol, on disseminating information about medical abortion. the other hand, can be found in most countries When ICMA started in 2002, few people around (except a few sub-Saharan African and Asian the world knew about medical abortion. Today, Bolivian national strategy to reduce maternal mortality includes guidelines on misoprostol use Bolivia has one of the highest maternal mor- national strategy aimed at reducing maternal and cology Societies (FLASOG in Spanish), these tality rates in the western hemisphere—229 neonatal mortality by promoting evidence-based protocols cover all of the evidence-based maternal deaths per 100,000 live births—and practices and by community mobilization, among indications for misoprostol use, including the main causes of death are hemorrhage other approaches. labor induction, abortion and prevention and (33%), infection (17%), and abortion treatment of postpartum hemorrhage. Ipas (9%). Poor and indigenous women, as well As part of this strategy, in 2009 the Ministry of collaborated with the Ministry on the devel- as those with less education and who live Health also issued norms and clinical protocols for opment of the national guidelines, making Bo- in rural areas are much more likely to die the use of misoprostol in obstetrics and gynecol- livia one of the first countries in Latin America during pregnancy. Faced with such daunting ogy. Based on the guidelines published by the to incorporate this drug into its national public statistics, the Bolivian government launched a Latin American Federation of Obstetrics and Gyne- health policy. For more information (in Spanish ): http://www.clacai.org/home/images/img/manualdelmisoprostolbolvia.pdf http://www.scribd.com/doc/20961603/Plan-Estrategico-Nacional-para-Mejorar-la-Salud-Materna-Perinatal-y-Neonatal-en-Bolivia-2009-2015 ICMA NEWSLETTER n.2 | APRIL, 2010 Page
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