“A lot needs to be done to persuade people to accept [medication] abortion, as it has many advantages over the other [surgical] methods,” she told attendees. Medication abortion, using a combination of the two drugs, is typically 95-99 percent effective up to nine weeks. And for many women in developing nations, surgical abortion services are often difficult to reach or unsafe — due to lack of skilled medical providers or conditions that don’t meet medical standards.

But, as Ganatra pointed out, there are challenges. For example, the drugs are expensive, especially for poor women; the tablets can cost $90 each in the United States and between $4-9 in India and Vietnam. Five dollars equals roughly 195 Indian rupees, more than most Indian women have to spend. Indeed, a 2007 report by the Indian National Commission for Enterprises in the Unorganised Sector (NCEUS) found that 70 percent of Indians, or 800 million people, live on less than 20 rupees per day. The drugs can also be used inappropriately, which can lead to tighter controls and less availability, Ganatra added.

Ganatra said the best strategies to make medication abortion more accessible and save women from unsafe procedures are:

• to educate women and providers about medication abortion technologies;
• to go beyond large hospitals and reach out to midlevel providers, such as nurse-midwives, who are more likely to provide health care in communities;
• to put mifepristone and misoprostol on countries’ essential drug lists (as recommended by WHO).

In his presentation to the symposium, Dr. Phan Van Quy of the National Ob-Gyn Hospital in Vietnam noted that mifepristone and misoprostol have also been proven to be safe and effective later in pregnancy, advocating that Vietnam’s National Standards and Guidelines for Safe Abortion be amended to allow medication aboriton beyond the currently accepted seven weeks. 

The panel included two additional speakers. Dr. Sushanta Banerjee of Ipas India presented their collaboration with the Indian government to reduce unsafe abortion through training providers, as well as through ongoing performance monitoring. Dr. Lam Phirum discussed the challenges of providing safe abortion services in Cambodian government health facilities where abortion is legally permitted but little clinical training is available, and only 11 percent of all abortions are performed in government facilities. Many providers remain uncomfortable performing abortion services and as a result many women are unaware that abortion is legally permitted. In addition, public hospitals in Cambodia are often hours away from many women's homes and suffer from severe lack of resources and staff.