Tuesday, January 27, 2015 | News

Meet the expert: Up-to-date clinical guidance on abortion

Alice Mark, MD, Ipas senior clinical affairs advisor

Dr. Mark and her team of clinical experts recently published the third annual updated version of Ipas’s Clinical Updates in Reproductive Health. This resource offers providers, health systems staff, community-based organizations and policymakers the most up-to-date, evidence-based recommendations on comprehensive abortion care—including topics such as contraception, pain management, medical abortion regimens, and the safety of abortion for adolescent and young women.

Download and share the Clinical Updates: www.ipas.org/clinicalupdates

Available in Spanish: www.ipas.org/actualizacionesclinicas

What is the goal of the Clinical Updates?

Our goal is to ensure that safe abortion
trainers—along with providers and health systems around the world—have
access to the most current information on comprehensive abortion care.
We also hope to save providers and health systems time and resources:
It’s very time-consuming to review and distill the enormous amount of
evidence-based medical literature available on family planning topics,
and this information is not even readily available in some countries and
settings where we work.

Our guidance in the Clinical Updates is based on the World Health Organization’s 2012 Safe Abortion: Technical and Policy Guidance for Health Systems, Second edition, but we review new evidence regularly and update the recommendations as necessary.

How have you seen the Clinical Updates used to improve care for women?

During a quality-monitoring visit to a
clinic in Ethiopia, one of the health officers involved in
second-trimester care received a copy of the Clinical Updates,
which he reviewed overnight. The following day he was eager to report
that he planned to use the mifepristone and misoprostol recommended
regimen with a woman who was at the hospital that morning for an
abortion. The next day, he said the woman’s abortion was complete and
she was ready to leave the hospital, several hours earlier than usual
because of the change in the regimen. He shared this information on
evidence-based abortion care with his own colleagues.

Another time we were doing a clinic visit
in Ghana where we met two midwives preparing to perform a manual vacuum
aspiration for a young woman. We talked with them about pain
management: They were using paracetamol, which from their experience
wasn’t very effective for pain management. Using the Clinical Updates,
we talked about more effective methods of pain management, such as
non-steroidal anti-inflammatory drugs like ibuprofen. The midwives
immediately went to another department to secure a supply of ibuprofen,
administered some to the young woman they were about to treat, and went
forward with their procedure. The evidence-based recommendation—combined
with the experiences we conveyed of using it—gave these midwives the
confidence to put this recommendation into practice immediately.

In the two annual updates you’ve released since your first publication in 2012, what important new topics or evidence have you incorporated?

One important addition has been
information on the safety of medical abortion and vacuum aspiration when
performed by midlevel providers like nurse midwives, clinical officers
and nursing staff. Ipas has had wonderful experiences working with these
groups of health-care providers to perform abortion services, but in
some countries doctors are still the only ones allowed to perform
abortion. Limiting abortion provision to doctors really reduces women’s
choices and access to services—especially women living in areas where
doctors are scarce. Having evidence-based recommendations at the ready
on this topic allows us to support our programs and advocate for
policies allowing midlevel providers to perform abortion.

In addition, we’ve added information on
long-acting contraception methods after abortion, since there is rapidly
developing evidence on this topic worldwide. Because of Ipas’s focus on
serving young women and adolescents, every one of our Updates
talks about the evidence as it relates to young women; but we’ve also
added specific information on the safety and success of medical abortion
and vacuum aspiration for young women, which is important for ensuring
sound policies on care for youth. Finally, we’ve added information about
providing abortion and postabortion care in the second trimester. All
of these new Updates are on topics that are generating new
evidence, but they also provide information that meets the real daily
needs of our trainers and providers worldwide.

How have you decided which new topics to add each year?

We work hard to cultivate an on-going
dialogue with trainers and providers in the field to determine what
information gaps exist. For example, our staff and trainers in Nepal
told us they needed information on the intrauterine device (IUD) and
abortion to increase providers’ knowledge in this area, so we produced Updates on
postabortion IUD safety and use. In addition, we were seeing high
numbers of second-trimester abortion in some of our programs and needed
to give trainers and providers specific guidance on the procedure, so we
produced a series of Updates addressing all topics relevant to second-trimester procedures.

In addition to providers, trainers and health systems, who else do you encourage to use the Clinical Updates and in what ways?

Our hope is that all professionals
concerned with clinical aspects of abortion care find this an easy and
useful resource. For example, trainees working in a hospital or clinic
who are new to abortion care can use them as a free online resource and
know they are getting the most up-to-date information to answer key
questions in abortion care, such as:

  • What regimens should I use for medical abortion?
  • Should I give antibiotics before a routine abortion procedure?
  • What are the best methods of pain management for women?

Yes, we write the Clinical Updates
with our programs in Africa, Asia and Latin America in mind, but the
evidence applies anywhere in the world that women need care—whether it’s
in Nepal, Nigeria or New York City!

Download and share the Clinical Updates:

www.ipas.org/clinicalupdates

Available in Spanish: www.ipas.org/actualizacionesclinicas

For more information, contact media@ipas.org