Transcript Victor Lara - International Consortium for Medical Abortion

How much medical supervision do
women need to use medical
abortion safely and effectively?
Victor Lara MD MPH
ICMA Conference Lisbon
March 2010
Medical Supervision?
• Becoming rapidly unfeasible
because:
– Few medical providers (in general)
– Less medical providers with enough
knowledge on safe MA, and
– Drug widely available
page 2
Knowledge about Medical Abortion
(Peru, Guatemala, Angola, DRC, Pakistan and
Nepal)
• Most of women know multiple methods
of medical abortion (traditional or
modern & safe or unsafe)
• Few women know about the availability
of mefipristone & misoprostol as a
combination currently recommended for
safe MA
page 3
Knowledge of where to get a medical
abortion
Where to look
for MA (no
Peru Guate Angola DRC Pak Nepal
complications)
MoH
Private
providers
Chemist/Phar
macist
+
+
-
++
++
+
+
+
++
Source: DHS Gua, Nepal & Pak; local surveys
-
-
+
+ ++ ++
++
+++ + ++ ++
page 4
Availability of MA
• Unsafe: multiple drugs
• WHO recommended:
– Mefipristone and misoprostol becoming widely
available
• 13 manufacturers/exporters in China
• 11manufacturers/exporters in India
• India sales of misoprostol reached several
millions
• More than 11 different co-packed mefipristone
and misoprostol available in India, Bangladesh,
Brazil, Chile, China, etc.
page 5
What to do?
Face the reality:
• Expand knowledge of safe MA to women through
multiple channels including
– Chemist/pharmacies and private providers
– Commercial drugs’ insert must be in as clear as possible
(graphical) and in local languages
– Referral information available in case of complications or
adverse events
• Expand the availability of referral centers for adverse
events and complications (MVA)
page 6