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Magalona S, Thomas HL, Akilimali PZ, Kayembe D, Moreau C, Bell SO. Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC. BMC Health Serv Res 2023; 23:658. [PMID: 37340470 DOI: 10.1186/s12913-023-09647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/05/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The Democratic Republic of Congo (DRC) legalized abortion in 2018 to preserve health and pledged to provide quality postabortion care (PAC), yet little is known about the availability of abortion care services and if facilities are prepared to provide them; even less is known about the accessibility of these services. Using facility and population-based data in Kinshasa and Kongo Central, this study examined the availability of abortion services, readiness of facilities to provide them, and inequities in access. METHODS Data on 153 facilities from the 2017-2018 DRC Demographic and Health Survey Service Provision Assessment (SPA) were used to examine signal functions and readiness of facilities to provide services across three abortion care domains (termination of pregnancy, basic treatment of abortion complications, and comprehensive treatment of abortion complications). To examine PAC and medication abortion provision before and after abortion decriminalization, we compared estimates from the 2017-2018 SPA facilities to estimates from the Performance Monitoring for Action (PMA) data collected in 2021 (n = 388). Lastly, we assessed proximity to PAC and medication abortion using PMA by geospatially linking facilities to representative samples of 2,326 and 1,856 women in Kinshasa and Kongo Central, respectively. RESULTS Few facilities had all the signal functions under each abortion care domain, but most facilities had many of the signal functions: overall readiness scores were > 60% for each domain. In general, readiness was higher among referral facilities compared to primary facilities. The main barriers to facility readiness were stock shortages of misoprostol, injectable antibiotics, and contraception. Overall, provision of services was higher post-decriminalization. Access to facilities providing PAC and medication abortion was almost universal in urban Kinshasa, but patterns in rural Kongo Central showed a positive association with education attainment and wealth. CONCLUSION Most facilities had many of the necessary signal functions to provide abortion services, but the majority experienced challenges with commodity availability. Inequities in accessibility of services also existed. Interventions that address supply chain challenges may improve facility readiness to provide abortion care services, and further efforts are needed to narrow the gap in accessibility, especially among poor women from rural settings.
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Affiliation(s)
- Sophia Magalona
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Haley L Thomas
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Pierre Z Akilimali
- Department of Biostatistics and Epidemiology, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dynah Kayembe
- Performance Monitoring for Action DRC, Kinshasa, Democratic Republic of Congo
| | - Caroline Moreau
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Suzanne O Bell
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Fiala C, Agostini A, Bombas T, Lertxundi R, Lubusky M, Parachini M, Gemzell-Danielsson K. Abortion: legislation and statistics in Europe. EUR J CONTRACEP REPR 2022; 27:345-352. [PMID: 35420048 DOI: 10.1080/13625187.2022.2057469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective: The Parliamentary Assembly invited the member states of the Council of Europe to 'guarantee women's effective exercise of their right of access to a safe and legal abortion'. While abortion legislation and statistics give an impression of the legislative, cultural, and religious views of the societies and the socio-economic health of the female population, only one study conducted in 2011 looked into the current legislation and trends in terminations of pregnancy in the European Union.Materials and Methods: From January 2017 to December 2018, a group of experts, the authors of the present article, liaised with colleagues practising in 32 European countries to collect data on abortion legislation and statistics using three different questionnaires.Results: The article presents the results of this initiative and compares the status quo and recent trends in abortion legislation and statistics across Europe.Conclusions: The European legislations are still very heterogenous and abortion rates vary widely between countries, confirming that laws do not correlate with abortion rates. This compilation of data, also available on a website (www.abort-report.eu), may help to change laws to better meet the needs of women who decided to have an abortion as a solution to the underlying problem of an unwanted pregnancy.
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Affiliation(s)
- Christian Fiala
- Gynmed Clinic, Vienna, Austria.,Department of Women's and Children's Health, Karolinska Institutet, and WHO collaborating centre, Karolinska University Hospital, Stockholm, Sweden
| | | | - Teresa Bombas
- Obstetric Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Roberto Lertxundi
- Department of Gynaecology and Human Reproduction, Clinica Euskalduna, Bilbao, Spain
| | - Marek Lubusky
- Department of Obstetrics and Gynaecology, Palacky University Hospital, Olomouc, Czech Republic
| | | | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, and WHO collaborating centre, Karolinska University Hospital, Stockholm, Sweden
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Assis MP, Erdman JN. Abortion rights beyond the medico-legal paradigm. Glob Public Health 2021; 17:2235-2250. [PMID: 34487487 DOI: 10.1080/17441692.2021.1971278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abortion rights in international law have historically been framed within a medico-legal paradigm, the belief that regulated systems of legal and medical control guarantee safe abortion. However, a growing worldwide practice of self-managed abortion (SMA) supported by feminist activism challenges key precepts of this paradigm. SMA activism has shown that more than medical service delivery matters to safe abortion and has called into question the legal regulation of abortion beyond criminal prohibitions. This article explores how abortion rights have begun to depart from the medico-legal paradigm and to support the novel norms and practices of SMA activism in a transformation of the abortion field. Abortion rights as reimagined in SMA activism increasingly feature in human rights agendas related to structural violence and inequality, collective organising and international solidarity, and democratic engagement.
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Affiliation(s)
| | - Joanna N Erdman
- Schulich School of Law, Dalhousie University, Halifax, Canada
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Berro Pizzarossa L, Skuster P. Toward Human Rights and Evidence-Based Legal Frameworks for (Self-Managed) Abortion: A Review of the Last Decade of Legal Reform. Health Hum Rights 2021; 23:199-212. [PMID: 34194213 PMCID: PMC8233026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Since the late 1980s, people have safely self-managed their abortions with medication, changing the landscape of abortion. This practice continues to evolve and expand and has been identified as a cause of decline in severe abortion-related morbidity and mortality. However, developments in medical abortion and self-management have yet to be reflected in the way abortion is regulated. Building on the need for evidence and human rights-based laws, this article explores developments in abortion laws from around the world between 2010 and 2020 to explore the extent to which they have contributed to an enabling environment for self-managed abortion. We focus on recent laws-those adopted in the past 10 years-for which we had access to information for analysis. We observe that laws in force still retain clinical settings and the involvement of medical professionals as the desirable circumstances for an abortion to take place and that even those that have liberalized access still retain some degree of criminalization for the pregnant person who carries out a self-managed abortion or for those who support the process. We conclude that there is enough evidence and support from international human rights standards to ground legal developments that enable self-managed abortion.
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Affiliation(s)
- Lucía Berro Pizzarossa
- Associate at the O’Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA.,Please address correspondence to Lucía Berro Pizzarossa.
| | - Patty Skuster
- Visiting Professor of Law at Temple University Beasley School of Law, formerly Ipas, Philadelphia, USA
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Tran NT, Greer A, Dah T, Malilo B, Kakule B, Morisho TF, Asifiwe DK, Musa H, Simon J, Meyers J, Noznesky E, Neusy S, Vranovci B, Powell B. Strengthening healthcare providers' capacity for safe abortion and post-abortion care services in humanitarian settings: lessons learned from the clinical outreach refresher training model (S-CORT) in Uganda, Nigeria, and the Democratic Republic of Congo. Confl Health 2021; 15:20. [PMID: 33823880 PMCID: PMC8022315 DOI: 10.1186/s13031-021-00344-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Fragile and crisis-affected countries account for most maternal deaths worldwide, with unsafe abortion being one of its leading causes. This case study aims to describe the Clinical Outreach Refresher Training strategy for sexual and reproductive health (S-CORT) designed to update health providers’ competencies on uterine evacuation using both medications and manual vacuum aspiration. The paper also explores stakeholders’ experiences, recommendations for improvement, and lessons learned. Methods Using mixed methods, we evaluated three training workshops that piloted the uterine evacuation module in 2019 in humanitarian contexts of Uganda, Nigeria, and the Democratic Republic of Congo. Results Results from the workshops converged to suggest that the module contributed to increasing participants’ theoretical knowledge and possibly technical and counseling skills. Equally noteworthy were their confidence building and positive attitudinal changes promoting a rights-based, fearless, non-judgmental, and non-discriminatory approach toward clients. Participants valued the hands-on, humanistic, and competency-based training methodology, although most regretted the short training duration and lack of practice on real clients. Recommendations to improve the capacity development continuum of uterine evacuation included recruiting the appropriate health cadres for the training; sharing printed pre-reading materials to all participants; sustaining the availability of medication and supplies to offer services to clients after the training; and helping staff through supportive supervision visits to accelerate skills transfer from training to clinic settings. Conclusions When the lack of skilled human resources is a barrier to lifesaving uterine evacuation services in humanitarian settings, the S-CORT strategy could offer a rapid hands-on refresher training opportunity for service providers needing an update in knowledge and skills. Such a capacity-building approach could be useful in humanitarian and fragile settings as well as in development settings with limited resources as part of an overall effort to strengthen other building blocks of the health system.
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Affiliation(s)
- Nguyen Toan Tran
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia. .,Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206, Genève, Switzerland. .,Training Partnership Initiative of the Inter-Agency Working Group on Reproductive Health in Crises, Women's Refugee Commission, 15 West 37th Street, New York, NY, 10018, USA.
| | - Alison Greer
- Training Partnership Initiative of the Inter-Agency Working Group on Reproductive Health in Crises, Women's Refugee Commission, 15 West 37th Street, New York, NY, 10018, USA
| | - Talemoh Dah
- Federal Medical Centre, Keffi, Nasarawa State, PMB 1004, Nigeria
| | - Bibiche Malilo
- Save the Children International DRC, 16 Avenue Avenue des Ecoles, Quartier les Volcans, Commune de Goma, North Kivu, Democratic Republic of the Congo
| | - Bergson Kakule
- CARE International DRC, Kinshasa, Democratic Republic of the Congo
| | | | | | - Happiness Musa
- CARE International Nigeria, 289 Amolai Road, GRA, Maiduguri, Nigeria
| | - Japheth Simon
- CARE International Nigeria, 289 Amolai Road, GRA, Maiduguri, Nigeria
| | - Janet Meyers
- Save the Children, 899 N Capitol Street, NE, Washington, DC, 20002, USA
| | | | - Sarah Neusy
- Doctors of The World/Médecins du Monde, France Headquarters, 62 rue Marcadet, 75018, Paris, France
| | - Burim Vranovci
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206, Genève, Switzerland
| | - Bill Powell
- Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, USA
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Ushie BA, Juma K, Kimemia G, Ouedraogo R, Bangha M, Mutua M. Community perception of abortion, women who abort and abortifacients in Kisumu and Nairobi counties, Kenya. PLoS One 2019; 14:e0226120. [PMID: 31830102 PMCID: PMC6907763 DOI: 10.1371/journal.pone.0226120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022] Open
Abstract
Background Abortion draws varied emotions based on individual and societal beliefs. Often, women known to have sought or those seeking abortion services experience stigma and social exclusion within their communities. Understanding community perception of abortion is critical in informing the design and delivery of interventions that reduce the gaps in access to safe abortion for women. Objective We explored community perceptions and beliefs relating to abortion, clients of abortion services, and abortifacients in Kenya. Methods We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) in Kisumu and Nairobi counties in Kenya among a mix of adult men and women, pharmacists, nurses, and community health volunteers. Results Community perspectives around abortion were heterogeneous, reflecting a myriad of opinions ranging from total anti-abortion to more pro-choice positions, and with rural-urban differences. Notably, negative views on abortion became more nuanced and tempered, especially among young women in urban areas, as details of factors that motivate women to seek abortion became apparent. Participants were mostly aware of the pathways through which women and girls access abortion services. Whereas abortion is commonplace, multiple structural and socioeconomic barriers, as well as stigma, are prevalent, thus impeding access to safe and quality services. Conclusion Community perceptions on abortion are heterogeneous, varying by gender, occupation, level of education, residence, and position in society. Stigma and the hostile abortion environment limit access to safe abortion services, with several negative consequences. There is urgent need to strengthen community-based approaches to mitigate predisposing and enabling factors for unsafe abortions.
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Affiliation(s)
| | - Kenneth Juma
- African Population and Health Research Center, Nairobi, Kenya
- * E-mail:
| | - Grace Kimemia
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Martin Bangha
- African Population and Health Research Center, Nairobi, Kenya
| | - Michael Mutua
- African Population and Health Research Center, Nairobi, Kenya
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Perehudoff K, Berro Pizzarossa L, Stekelenburg J. Realising the right to sexual and reproductive health: access to essential medicines for medical abortion as a core obligation. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:8. [PMID: 29390996 PMCID: PMC5796451 DOI: 10.1186/s12914-018-0140-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/03/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND WHO has a pivotal role to play as the leading international agency promoting good practices in health and human rights. In 2005, mifepristone and misoprostol were added to WHO's Model List of Essential Medicines for combined use to terminate unwanted pregnancies. However, these drugs were considered 'complementary' and qualified for use when in line with national legislation and where 'culturally acceptable'. DISCUSSION This article argues that these qualifications, while perhaps appropriate at the time, must now be removed. First, compelling medical evidence justifies their reclassification as a 'core' essential medicine. Second, continuing to subjugate essential medicines for medical abortion to domestic law and cultural practices is incoherent with today's human rights standards in which universal access to these medicines is an inextricable part of the right to sexual and reproductive health, which should be supported and realised through domestic legislation. CONCLUSION This article shows that removing such limitations will align WHO's Model List of Essential Medicines with the mounting scientific evidence, human rights standards, and its own more recently developed policy guidance. This measure will send a strong normative message to governments that these medicines should be readily available in a functioning and human-rights-abiding health system.
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Affiliation(s)
- Katrina Perehudoff
- University Medical Center Groningen, Department of Health Sciences - Global Health Unit, University of Groningen, Groningen, The Netherlands
- Global Health Law Groningen Research Centre, Transboundary Legal Studies Department, University of Groningen, Groningen, The Netherlands
- Comparative Program on Health & Society, Munk School of Global Affairs, University of Toronto, Toronto, Canada
| | - Lucía Berro Pizzarossa
- Global Health Law Groningen Research Centre, Transboundary Legal Studies Department, University of Groningen, Groningen, The Netherlands
- MYSU (Women & Health), Montevideo, Uruguay
| | - Jelle Stekelenburg
- University Medical Center Groningen, Department of Health Sciences - Global Health Unit, University of Groningen, Groningen, The Netherlands
- Medical Centre Leeuwarden, Department Obstetrics and Gynecology, Leeuwarden, The Netherlands
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Goldstone P, Michelson J, Williamson E. Early medical abortion using low‐dose mifepristone followed by buccal misoprostol: a large Australian observational study. Med J Aust 2012; 197:282-6. [DOI: 10.5694/mja12.10297] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Seth S, Nagrath A, Goel N. Low dose Mifepristone (100 mg) for medical termination of pregnancy. Afr J Prim Health Care Fam Med 2011. [PMCID: PMC4565415 DOI: 10.4102/phcfm.v3i1.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Abortion is the most common entity in the practice of obstetrics and gynaecology. Different methods and modes have been opted for until now to find an effective regimen with the least complications. We have tried the minimal dose (100 mg) of Mifepristone (PO) instead of the presently recommended 200 mg for medical abortion in early first trimester cases. Objectives: The objective of the study was to determine the efficacy of low dose (100 mg) Mifepristone for medical termination of early pregnancy with oral Misoprostol 800 μg, 24 hours later.Design: A prospective analytical study was conducted on a population of 82 early-pregnant patients who have requested medical abortions.Method: Pregnant women of less than 56 days gestation age from their last menstrual period, requesting medical abortion were selected over a period of 14 months from January 2007 to March 2008. They were given 100 mg Mifepristone orally on Day-1, followed by 800 μg Misoprostol orally 24 hours later on Day-2, keeping the patient in the ward for at least 6 hours. Abortion interval, success rate, post-abortion bleeding and side-effects were noted. Success was defined as complete uterine evacuation without the need for surgical intervention.Results: The total success rate of this minimal dose Mifepristone regimen was 96.25%. Pain and nausea were the predominant side-effects noted. In total 72 (90%) women had completely aborted within 5 hours of taking Misoprostol. Three (3.75%) women only required suction aspiration, hence termed as failed medical abortion. The abortion interval increased with the gestation age. All three failures were of the more-than-42-day gestational age group. The overall mean abortion interval was 4.68 ± 5.32 hours.Conclusion: Mifepristone 100 mg, followed 24 hours later by Misoprostol 800 μg orally, is a safe and effective regimen for medical abortion.
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Affiliation(s)
- Shikha Seth
- Department of Obstetrics & Gynaecology, U.P. Rural Institute of Medical Sciences & Research Saifai, Etawah, India
| | - Arun Nagrath
- Department of Obstetrics & Gynaecology, U.P. Rural Institute of Medical Sciences & Research Saifai, Etawah, India
| | - Neeru Goel
- Department of Obstetrics & Gynaecology, Era's Medical College, Sarfarazganj, Lucknow, India
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van Bogaert LJ, Sedibe TM. Efficacy of a single misoprostol regimen in the first and second trimester termination of pregnancy. J OBSTET GYNAECOL 2009; 27:510-2. [PMID: 17701803 DOI: 10.1080/01443610701478967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A total of 273 women underwent termination of pregnancy (TOP) with a single regimen of misoprostol (400 microg orally and 800 microg vaginally), without mifepristone. A total of 98 (35.9%) were first trimester and 175 (64.1%) second trimester gestations. Of these women, 189 (69.2%) responded to a single administration of misoprostol and 84 (30.8%) required between two and six administrations of misoprostol. The medical TOP was complete in 90.8% of all cases. A surgical intervention was needed in 23 (27.4%) of those requiring repeated administrations of misoprostol vs only two (1.1%) of those responding to a single administration. Age, parity and gestational age did not affect the response rate to the misoprostol regimen. The need for a D&C was related to the response to misoprostol: most D&Cs were needed in cases of repeat administrations of misoprostol. This study shows the feasibility of medical TOP in the developing world. It has the great advantage of significantly reducing the need for surgical termination where the required skills are scarce.
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Affiliation(s)
- L-J van Bogaert
- Department of Obstetrics and Gynaecology, St Rita's Hospital, Glen Cowie, South Africa.
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Harper CC, Blanchard K, Grossman D, Henderson JT, Darney PD. Reducing maternal mortality due to elective abortion: Potential impact of misoprostol in low-resource settings. Int J Gynaecol Obstet 2007; 98:66-9. [PMID: 17466303 DOI: 10.1016/j.ijgo.2007.03.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 03/02/2007] [Accepted: 03/15/2007] [Indexed: 10/23/2022]
Abstract
Over 99% of deaths due to abortion occur in developing countries. Maternal deaths due to abortion are preventable. Increasing the use of misoprostol for elective abortion could have a notable impact on maternal mortality due to abortion. As a test of this hypothesis, this study estimated the reduction in maternal deaths due to abortion in Africa, Asia and Latin America. The estimates were adjusted to changes in assumptions, yielding different possible scenarios of low and high estimates. This simple modeling exercise demonstrated that increased use of misoprostol, an option for pregnancy termination already available to many women in developing countries, could significantly reduce mortality due to abortion. Empirical testing of the hypothesis with data collected from developing countries could help to inform and improve the use of misoprostol in those settings.
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Affiliation(s)
- C C Harper
- Bixby Center for Reproductive Health Research and Policy, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
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Lalonde A, Daviss BA, Acosta A, Herschderfer K. Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006. Int J Gynaecol Obstet 2006; 94:243-53. [PMID: 16842791 DOI: 10.1016/j.ijgo.2006.04.016] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postpartum hemorrhage (PPH) is the main cause of maternal mortality. Yet, even though solutions have been identified, governments and donor countries have been slow to implement programs to contain the problem. While poverty and low educational level remain the underlying cause of PPH, the current literature suggests that active management of the third stage of labor can prevent it. The International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) are attempting to address the chronic PPH crisis by educating their members on best practices and on troubleshooting where resources are inadequate. Some studies found oxytocin to be preferable to misoprostol in settings where active management is the norm. However, secondary clinical effects may prove more troublesome with oxytocin than with misoprostol, and misoprostol may prove to be more practical and equally effective in low-resource settings. Two new interventions are also proposed, the anti-shock garment and the balloon tamponade.
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Affiliation(s)
- A Lalonde
- FIGO Safe Motherhood and Newborn Health, The Society of Obstetricians and Gynaecologists of Canada (SOGC), Ottawa, ON, Canada.
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De Costa CM. Medical abortion for Australian women: it's time. Med J Aust 2005; 183:378-80. [PMID: 16201958 DOI: 10.5694/j.1326-5377.2005.tb07088.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Accepted: 08/16/2005] [Indexed: 11/17/2022]
Abstract
Medical termination of pregnancy with mifepristone, a progesterone antagonist, is available to women in North America, the United Kingdom, much of Western Europe, Russia, China, Israel, New Zealand, Turkey and Tunisia, but not Australia. Experience of mifepristone use in around two million abortions has shown that it is safe, effective, cheap to produce, and highly acceptable to women. Mifepristone is usually used in combination with a prostaglandin analogue, such as misoprostol; these drugs have been added to the World Health Organization's list of essential medicines for developing countries. Availability of this drug in Australia might largely overcome many of the inequities of access to abortion, and is critical for many women in rural areas and women in some ethnic groups whose access to surgical abortion is limited.
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Affiliation(s)
- Caroline M De Costa
- Department of Obstetrics and Gynaecology, James Cook University School of Medicine, Cairns Campus, PO Box 902, Cairns, QLD
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