For women in Africa, medical abortion can save lives

Wednesday, November 7, 2012

This post is part of our coverage of FIGO 2012.

African women bear the greatest burden from unsafe abortion, something women in the United States aren’t very familiar with. Millions die or suffer needlessly because of unwanted pregnancy or unsafe abortion. But women deserve better; they have a right to safe abortion. They have a right to make decisions about their fertility.

In international contexts, everyone talks of meeting Millennium Goal 5—reducing maternal mortality. “Now people are saying we won’t meet it,” says Dr. Joachim Osur of Ipas Africa Alliance.

 “We know the killers of women,” says Dr. Osur. And we know preventing unsafe abortion is a key strategy in preventing deaths. Medical abortion, sometimes called abortion with pills, can increase African women’s access to safe abortion care, particularly in rural and poor areas.

The good news is in a very short time, there has been progress in bringing this lifesaving method to women in Africa. “There are a number of countries that have registered the drugs for all indications,” notes Dr. Osur. Mifepristone has been registered in Kenya, and in Zambia a third brand of the drug has been registered.

“It’s positive and the future looks bright,” says Osur. Even with a well-organized and powerful anti-abortion rights movement in Africa, registration has not stopped.

Overwhelmingly, women in Africa—particularly young women—seem to prefer medical abortion when given a choice. Dr. Yirgu Gebrehiwot, president of the Ethiopian Society for Obstetricians and Gynecologists and presenter at FIGO 2012 on medical abortion, speculates that confidentiality and the desire to avoid a surgical abortion fuel women’s decision to choose medical abortion.

Ethiopia and Zambia both provide good examples of medical abortion introduction.

In Ethiopia, a new abortion law was implemented in 2005 and just three years later, medical abortion was introduced. With the second largest population in Africa and huge unmet need for contraception, the Ministry of Health got behind the move to increase access to safe abortion—recognizing women were dying when faced with no safe options for terminating an unintended pregnancy.

Public facilities are expanding to reach more Ethiopian women in rural, underserved areas. Ipas and partners have monitored five regions containing 416 public health centers, determining that in just one year, medical abortion accounted for 70 percent of roughly 70,000 abortion cases in these five regions where 90 percent of Ethiopians live.

“The take-home message is that commitment from the government, provision of medical abortion by midlevel providers, strategies based on evidence, support for providers and a strong distribution system have proven to be best practices,” says Dr. Gebrehiwot.

In an Ipas-supported study of 1,170 women on the impact of medical abortion introduction in KwaZulu Natal, South Africa, of 923 women who were less than 9 weeks gestation, 865 chose to have medical abortion.

In Zambia, pregnancy termination has been legal since 1972, but stigma and lack of knowledge about the law mean unsafe abortion continues to be a problem. In 2009, Ipas and partners studied the introduction of medical abortion in 25 facilities in Lusaka and the Copperbelt. More than 13,000 women sought abortion care from January 2010-September 2011—and overwhelmingly, most chose medical abortion. During the study period, postabortion care cases declined, presumably because safe abortion care was improved.

“Termination of pregnancy services never took off until the introduction of medical abortion,” said Dr. Reuben Mbewe of the Zambia Ministry of Health while speaking at FIGO.

There is now enough evidence for the benefits of medical abortion and governments are subscribing to World Health Organization recommendations, which include updated medical abortion regimens.

“Governments need to step down to the country level,” says Dr. Osur, and ensure women have access to these lifesaving drugs. Certainly challenges remain. Stigma and restrictive laws are barriers that must be overcome, he adds.

Speaking at FIGO, Dr. Roland Edgar (Eddie) Mhlanga, whose own outspoken prescription for change includes more use of medical abortion, and stepped-up education and mobilization around women’s reproductive health and rights, said “There is no shortcut when trying to advance sexual health and rights.”

Medical abortion is indeed a prescription for change—for improving women’s access to safe abortion, particularly in Africa, where the burden of unsafe abortion continues to claim women’s health and lives.