Ipas research focuses on the needs and perspectives of women, health-care providers and health systems. We examine ways to provide medical abortion safely and effectively in a range of health-care settings, including those with very limited resources. We share our findings with partners, policymakers and the broader public health community to improve existing services and make new services available. Ipas conducts research on abortion, the treatment of complications from clandestine abortion, and the management of miscarriage, exploring:

• Women’s experiences with medical abortion
• Providers’ knowledge, perceptions and practices
• Decentralization of services to improve access and availability

• Channels for informing women about medical abortion
• Access to medical abortion drugs

Research has established that medical abortion is a safe and effective option for women. However, further research is needed to better understand many issues, including what women think about medical abortion. Understanding women’s needs and desires, and what is important to them, is essential to successfully providing medical abortion as an option for pregnancy termination. Exploring women’s experiences with medical abortion can lead to higher-quality counseling, better information and, subsequently, higher levels of satisfaction with pregnancy terminations.

Ipas collaborated on one of the earliest medical abortion acceptability studies in Romania. We also have studied women’s use of misoprostol for abortion in Bolivia, Brazil, Mexico, Panama and Nicaragua. Ipas also examines where women get abortion drugs.

In 2001, Ipas researchers conducted a study on women’s and providers’ perspectives on ending pregnancy in a Latin American clinic. Clinic staff recorded quantitative medical information about more than 3,000 women who chose misoprostol and qualitative information from interviews with 78 women. The study found that misoprostol was a satisfactory and effective approach to ending pregnancy: 72 of the 78 women said they would recommend misoprostol to a friend and that they would use misoprostol again if they needed to end another pregnancy. (read more)

In India, Ipas and partners conducted a study examining women’s perspectives on medical abortion, including their reasons for selecting medical abortion, their experiences with it and their thoughts about removing medical supervision from part or all of the process. The study found that women appreciated the non-invasiveness of medical abortion. Family support and distance from the facility also influenced their choice. The degree of medical involvement that women wanted or felt was necessary also depended on the way health-care providers shaped women’s expectations of the experience. The findings of this research have provided more information about the circumstances under which women make reproductive choices and underscore the need to tailor service delivery to meet women's needs. (read more)

In Nigeria, Ipas is introducing a new choice for women seeking treatment for complications of unsafe abortion and miscarriage. In a study based in the postabortion care wards of three hospitals, women are now offered their choice of completing the abortion with misoprostol or manual vacuum aspiration. Women who choose to complete their abortions or miscarriages with misoprostol receive information and counseling. They also have the option to complete their abortions in their own homes. Women return for a follow-up visit to confirm the abortion is complete and are interviewed about the information they were given, side effects, and their satisfaction with the process.

Provider knowledge and perceptions have the potential to influence treatment options in all types of health care. Providing health-care workers with accurate information and confronting provider bias enables women to make free and informed choices about health-care options, including their choice of abortion technology. Ipas assesses gynecologists’ and midwives’ knowledge of and attitude toward medical abortion for the treatment of incomplete abortion or induced abortion. Understanding what makes providers uncomfortable, as well as their level of knowledge and experience, will continue to improve training interventions designed to offer information and improve skills.

In 2005, Ipas and the Cambodian Ministry of Health conducted a national study to assess the quality and use of abortion services in public hospitals and health centers. Although Cambodia’s law permits abortion through the first 12 weeks of pregnancy, and for some circumstances in the second trimester, many Cambodian women seek abortion care from unskilled providers, herbalists, drug sellers and traditional healers. The research also uncovered that attitudes and knowledge of health-care providers can often pose a significant barrier to women seeking abortion services. Nearly one-quarter of health-care providers reported that hospital staff may oppose abortion training, and that 40 percent of providers from hospitals erroneously believed elective abortion was not permitted by the ministry of health.

Providers who are properly trained in abortion and postabortion care have the potential to significantly reduce abortion-related complications and injuries in Cambodia. Ipas is currently working with Options UK, the Cambodian Ministry of Health and other partners through the Reduction in Maternal Mortality Project to address the many gaps in training and service provision identified in the research, with medical abortion training beginning in August 2009.

The introduction of medical abortion in Cambodia will improve access and acceptability of abortion care for Cambodian women in a manner that has previously been predominately available only in more developed countries. (read more)

In many parts of the developing world, women do not have the ability to reach doctors, hospitals or clinics on a regular basis or even at all. For many of these women, pharmacies are their first and main source for health care. In the case of medical abortion, pharmacists and pharmacy workers are in a unique situation. Women turn to pharmacists and pharmacy workers not only to obtain drugs, but also to seek medical advice. Ipas and partner organizations have conducted research in Mexico, India, Nepal, Kenya and Nigeria to examine the knowledge and attitudes of pharmacists and pharmacy workers regarding medical abortion.

In Nigeria, Ipas surveyed pharmacists and obstetrician-gynecologists about their knowledge of misoprostol. The study found that more than 95 percent of pharmacists and drug sellers did not stock misoprostol and most pharmacists lacked accurate information about the efficacy and dosages of the drug for gynecological purposes. 

Ipas's work with Nigerian pharmacists is just one of our many projects that focuses on the important role pharmacists play in delivering safe abortion services.(read more)

Even where abortion is permitted on broad legal grounds and available in the health system, abortion services are often out of reach for many women. Early abortion can be safely permitted at all levels of the health system – from large urban hospitals to small, rural health posts. Medical abortion in particular can be further decentralized and made available in communities where other abortion services would be hard to sustain. Research conducted on the decentralization of abortion services helps us increase access to high-quality care.

In 2007, elective abortion became legal in Mexico City. After the law change, area hospitals quickly mobilized to provide safe abortion services for the vast number of women who have needed them. Yet objective research is needed to understand how and if these services are benefitting the women of Mexico, as well as which women are being helped, and which women still lack access to safe abortion services.

In a study conducted by Ipas in a Mexico City hospital, health-care staff reported that the addition of a non-surgical abortion technology allowed them to better meet the needs for legal pregnancy termination in the city. The study followed a hospital training on World Health Organization (WHO)-recommended abortion methods. Researchers found that a majority of the women who access services tend to be highly educated, young - ages 15 to 24 - and single. In addition, four out of five women choose a family planning method after receiving abortion care. Results also show that since the training, changes in the standards of abortion care have been dramatic. D&C, which was previously used in more than half of cases, now accounts for less than a fifth of all procedures. Use of either manual vacuum aspiration or medical abortion has soared to more than 80 percent of procedures. “The doctors recognize that by using medical abortion they save a lot of time, avoid long hospital stays, and reduce the costs of services. This means they can attend to more women in less time,” says Raquel Alva, an Ipas Mexico research consultant. (read more)

Around the world, millions of women do not know that medical abortion exists, do not know the circumstances under which it can be used legally, or do not know how to use it or where to find it. Instead, many of these women use toxins, instruments and inappropriate medicines to induce their own abortions. Discovering the sources of information that inform women’s decisions – the pathways for disseminating information and the gatekeepers to both misinformation and accurate information – is key to replacing dangerous or ineffective methods of abortion with safe options.

Ipas explores and documents the ways in which women and men receive information in order to determine how best to provide women with information on the availability and safe use of medical abortion.

In Jharkhand, a mostly rural state in eastern India, Ipas research explored both the information that men and women have about pregnancy and abortion, as well as the channels through which they receive this information. Ipas used the findings of this research to construct an information campaign using locally staffed street dramas, wall signs, and interpersonal communications strategies to inform village women and men about the availability of safe abortion services. (read more)

For women to be able to benefit from scientific advances, they need to be able to afford them. Medical abortion, a high-quality technology at a relatively low cost, can potentially make ending unwanted pregnancies more feasible for women, especially poor women. In order to better understand how and where cost is a barrier for women, Ipas tracks and analyzes the costs of misoprostol where it is sold. The article, Assessing the Global Availability of Misoprostol in the International Journal of Gynecology and Obstetrics, presents market research analysis on the extent of misoprostol use worldwide from 2002 to 2007. (read more)