Access to safe abortion has changed over the past several decades – not just because of the ever-shifting global legal and funding landscapes, but also because of health technologies. For thousands of years, women have used herbal remedies to end unwanted pregnancies, but more recently medicines developed in labs provide a non-surgical safe abortion option.
Millions of women worldwide have safely terminated their pregnancies with medication since mifepristone -or RU 486- was first introduced in the late 1980s. Research in the past two decades has identified a highly effective regimen for early medical abortion with a success rate of 95 to 98 percent, consisting of 200 milligrams of mifepristone followed by 400 or 800 micrograms of misoprostol. Whether taken in a health center or at home by women themselves, the regimen offers an option that many women prefer to surgical procedures such as manual vacuum aspiration or dilation and curettage (D&C).
Because mifepristone is a registered abortion drug, its sale and use are not permitted in most countries with restrictive abortion laws. In contrast, misoprostol is an anti-ulcer medication that is registered under various trade names in more than 85 countries. Research has found that misoprostol used alone is about 85 percent successful in inducing abortion when used as recommended, offering a safe and accessible alternative for women who have no other option.
Not enough women know about misoprostol as an option for safe abortion, so we’ve collaborated with Gynuity Health Projects to release “Abortion With Self-Administered Misoprostol: A Guide For Women,” available in English, Spanish, Portuguese, and French.
Gynuity has also done research about the registration of misoprostol around the world, and has produced the map below, which shows where misoprostol is registered and available for off-label use (solid purple), where it is also approved for medical abortion (stripes), and where it is not approved for any use (yellow). You can also download a PDF of the map, with English or Spanish text, here.
As with anything related to women’s health, access is more complex than the legal registration of a medication. The publication “What Women Want – Meeting Global Demand for Medical Abortion” [link downloads a PDF], produced by Marie Stopes International (MSI), details the complexities of access to medical abortion. Both mifepristone and misoprostol are increasingly available in black markets in Africa and the Middle East, regions with the most restrictive laws around these drugs. Prices for the pills also vary widely from country to country; depending on legal status and local markets, pills can cost anywhere from $1 to $30 each. In 2007, the World Health Organization added misoprostol to their Essential Drugs List, and more recently it was “redefined as an essential medicine for incomplete abortion/miscarriage management,” according to MSI. However, the process of registration and approval for new medications can be lengthy. In the U.S., for example, the approval of new drugs can take eight to ten years.
While it is certainly important for health care practitioners to be trained on the administration of medical abortion so that they are capable of providing comprehensive information and services to the women they work with, it is also important for women themselves to have access to life saving information. MSI puts this really well in their “What Women Want” guide (pg 21):
Within the public health community there is increasing acknowledgement of the potential afforded by demedicalising the provision of some healthcare services. The increasing shift from surgical to medical abortion is an example of demedicalisation in practice: medical abortion requires less technology, can be carried out in non-clinical settings, does not necessarily need to be delivered by high-level providers such as physicians, and users can play a more active role in the process through self-administration of medication. Furthermore, some women and men prefer less clinical environments.
Medical abortion has the potential to transform traditional relationships between reproductive healthcare providers and their clients. In contrast to surgical abortion, medical abortion is not done to women but by them, with appropriate support provided by health professionals.
Wherever unwanted pregnancies happen –which is to say, all around the world– there will be women who choose to terminate their pregnancies. It’s essential that women get the information they need to make informed and safe choices about their bodies and reproductive health. The availability of misoprostol, and the distribution of multilingual information about how to use misoprostol, are both steps in that direction.