1. Debate: How much medical supervision do women need to use medical abortion? Galina Maistruk, MD Coordinator, East European Alliance for Reproductive Choice

2. Regional perspective on medical supervision: 1. Legislation framework: In most countries in the region, abortion is legal Only doctors (Ob/Gyn) can be providers of abortion, including medical one Can only be provided in the hospital settings

3. 2. Level of education of health care providers: Ob/Gyn: Basic education in medical university Post-graduate training (including practical skills development) Other physicians: low knowledge, no practical skills, no possibilities for training Other health care providers (midwifes, nurses): not a part of their responsibility and training

4. 3. Pre- and post-abortion counseling Quality of the counseling is a key point for the success of medical abortion At the moment, Ob/Gyn has the best knowledge and skills in counseling, including post-abortion contraception.

5. 4. Second trimester abortion Usually, Ob/Gyn Council is the final approval body of indications for termination of pregnancy in second trimester and Ob/Gyn are the only possible providers for second trimester abortion

6. 5. Management of complications and incomplete abortion Referrals to other health care providers and health care facilities are not needed  Ob/Gyns may timely determine and manage complications.  Saves time to receive help in the same hospital  Reduces possible blaming of women Needed skills and equipment are available for other methods to terminate the pregnancy

7. Opportunities for the future: Strategic Assessment in the countries Development and implementation of comprehensive care for unwanted pregnancies programs Inclusion of other health care professionals into counseling and referral.

8. Thank you for your attention