self-administered medical abortion
Self-administered
medical abortion has been proposed as a strategy to reduce burden on the health
systems and to provide convenience for women. And there is data to support the
safety of such self managed abortions.
A systematic review of 18 randomized controlled trials and prospective cohort
studies from 10 countries, including India, Bangladesh, Nepal, Vietnam and
China, shows that self-administered medical abortion is as safe and effective
as the one that is administered by a healthcare provider. So, women can
effectively and safely induce their own early medical abortion through
self-administration and may not require full supervision of a provider during
any stage of the drug regimen.
Presenting these findings Katherine Gambir, Research Advisor at Women's Refugee
Commission, said that, "Policy makers at global and national levels should
consider amending medical abortion guidelines to offer women the choice to self
administer early medical abortion procedures with or without clinical guidance,
thereby alleviating the burden on overburdened healthcare systems. This is
especially important in the context of COVID-19 when health systems are
strained and access to clinic-based care is restricted. Also we are seeing an
increase in gender based violence including intimate partner violence, which
emphasises the urgency to ensure that women have access to sexual and
reproductive healthcare and contraceptives, including emergency contraceptives
and self-administered medical abortion".
comprehensive abortion care
Favourable
legal environments are the first step in providing comprehensive abortion care
by healthcare providers even in humanitarian settings, where women and girls
face increased risk of unsafe abortions arising out of various forms of sexual
and gender based violence and resulting in maternal mortality and morbidity.
Comprehensive abortion care includes menstrual regulation - a procedure to
regulate the menstrual cycle to ensure a non-pregnancy; post-abortion care; and
contraceptive provision and counselling.
Maria Persson, Sexual and Reproductive Health Expert at Ipas Bangladesh (who
was a Research Assistant at Karolinska Institutet when the study was conducted),
shared the example of comprehensive abortion care provision in Cox's Bazar in
Bangladesh, which is home to more than 900,000 Rohingya refugees displaced from
Myanmar. The Bangladesh government, with help from civil society organisations,
leads this humanitarian response, through healthcare facilities that provide
free abortion care services.
Induced abortion in Bangladesh is illegal, unless the woman's life is in
danger. But menstrual regulation (a simple and inexpensive procedure that uses
manual vacuum aspiration to make it impossible to be pregnant after missing a
period) is legally permitted up to 10 weeks of gestation and is widely
practised in healthcare facilities. Also a combination of mifepristone and misoprotol
for medical abortion has been legalised since 2012.
Persson said that the legalisation of menstrual regulation coupled with
collaboration between civil society organisations and the government has made
provision of comprehensive abortion care possible in Cox's Bazar. Integrating
the full package of comprehensive abortion care services in the primary
healthcare system to address women's multiple sexual and reproductive health
needs, training on menstrual regulation policy and abortion law and in-service
training can ensure provision of quality care that is woman-centred and
non-judgmental.
Indonesia- a Muslim nation- is another country where abortion is legally
permissible only in medical indications, severe congenital defects and rape
cases. The government's family planning programme is only for married couples
and contraceptives for unmarried women are not available. Abortion is generally
stigmatized and there is a sensitivity for using the word even in health
facilities. Sharing this information, Riznawaty Imma Aryanty, Reproductive
Health programme specialist at United Nations Population Fund (UNFPA)
Indonesia, made a case for having proper comprehensive sexual education for the
adolescents.
"It is also very important to have data on abortion and abortion related
complications. For example if there are so many abortion complications, it
would be an indication of unsafe abortion practices and force policy makers to
do something about it. So we have to bring more data to the discussion table,
and interpret it in an understanding manner to improve the situation", she
says.
While Indonesia's interpretation of Islam is fairly liberal, yet its
understanding of abortion is far more restrictive. Riznawaty sees the need of
enlisting the support of moderate religious leaders and raising their voices to
advance the cause of sexual and reproductive health and rights for women.
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