1. Promoting access to medical abortion in the context of safe abortion worldwide… Rodica Comendant MD, PhD, ICMA Coordinator ICMA Coordinator ICMA – Ipas Meeting “Developing an African network on safe/medical abortion” 11-13 March, 2009, Johannesburg, SA

2. Safe abortion services are essential for women Unsafe abortions are a major public health problem. Unsafe abortions are a major public health problem. Of 210 million pregnancies yearly, an estimated 46 million end in induced abortion. Of 210 million pregnancies yearly, an estimated 46 million end in induced abortion. Of the estimated 19 million unsafe abortions in the world each year, 18.5 million occur in developing countries. Of the estimated 19 million unsafe abortions in the world each year, 18.5 million occur in developing countries. About 68 000 women die each year from unsafe abortion. About 68 000 women die each year from unsafe abortion. Abortion-related complications cause up to 50% of obstetrical-gynaecological hospital admissions for women in some developing countries. Abortion-related complications cause up to 50% of obstetrical-gynaecological hospital admissions for women in some developing countries.

3. Safe abortion services are essential for women  Young and unmarried women are often afraid to tell anyone they are pregnant and are more likely to seek terminations from unqualified practitioners.  They account for a disproportionate share of death and illness from the complications of dangerous abortions.

4. What is medical abortion? “Medical abortion” is the use of drugs to terminate a pregnancy. It is sometimes also called non-surgical abortion. “Medical abortion” is the use of drugs to terminate a pregnancy. It is sometimes also called non-surgical abortion. The regimen for first trimester medical abortion, registered in more than 35 countries, consists of two drugs, included in 2005 on the WHO Essential Medicines list: The regimen for first trimester medical abortion, registered in more than 35 countries, consists of two drugs, included in 2005 on the WHO Essential Medicines list: mifepristone (an anti-progestogen that blocks progesterone, the hormone necessary to sustain a pregnancy), followed 1–3 days later by misoprostol (a prostaglandin that makes the uterus contract). mifepristone (an anti-progestogen that blocks progesterone, the hormone necessary to sustain a pregnancy), followed 1–3 days later by misoprostol (a prostaglandin that makes the uterus contract). These drugs can be taken to cause a miscarriage to occur, starting from the time a woman misses her period. These drugs can be taken to cause a miscarriage to occur, starting from the time a woman misses her period. Where mifepristone is not available, misoprostol can be used alone to cause the miscarriage. Where mifepristone is not available, misoprostol can be used alone to cause the miscarriage.

5. WHO: Safe Abortion: Technical and Policy Guidance for Health Systems, 2004 Methods of abortion

6. Why medical abortion is important? Medical abortion can make abortion:  earlier,  more accessible,  safer,  less traumatic,  less medicalised and less expensive.  It has increased access to safe abortion and reduced maternal mortality, including in legally restricted settings.

7. Why medical abortion is important?  Medical abortion has been shown to be safe and effective in both the first and second trimesters of pregnancy, with efficacy rates as high as 95  98%.  Acceptability among women is high, because medical abortion does not involve surgery or anaesthesia, and is a simple procedure that happens entirely in the woman’s body.  Acceptability among providers is high too, because they feel that it is safe and offers women an alternative to surgical abortion, and is a choice that many women prefer.

8. ICMA ICMA was formed in June 2002 with the ICMA was formed in June 2002 with the aim: aim: to promote access to medical abortion in the context of support for safe abortion worldwide, focusing on the needs of women in developing countries, especially those where safe abortion is not easily accessible. to promote access to medical abortion in the context of support for safe abortion worldwide, focusing on the needs of women in developing countries, especially those where safe abortion is not easily accessible.

9. ICMA International non-governmental, non-profit organization International non-governmental, non-profit organization Growing number of international networks: Growing number of international networks: Latin-American network CLACAI established in 2006. Latin-American network CLACAI established in 2006. Asian network, ASAP, March 2008 Asian network, ASAP, March 2008 Eastern European network, EEARC, May 2008 Eastern European network, EEARC, May 2008 African network, 2009? African network, 2009? SC with the chair and co-chair, WHO observer, coordinator, advisory group, networks liaison officer SC with the chair and co-chair, WHO observer, coordinator, advisory group, networks liaison officer

10. ICMA Activities: International Conference in SA in 2004. Conference accomplishments: The sharing of information on the use of medical abortion internationally, The sharing of information on the use of medical abortion internationally, An analysis of the influence of alternative policies, programmes and services on access to medical abortion in a range of country settings, An analysis of the influence of alternative policies, programmes and services on access to medical abortion in a range of country settings, The identification of strategies for improving women's access to medical abortion, in the context of safe abortion, with a focus on developing countries and countries in transition, The identification of strategies for improving women's access to medical abortion, in the context of safe abortion, with a focus on developing countries and countries in transition, The creation of a forum for dialogue and networking to broaden the constituency working for medical abortion worldwide. The creation of a forum for dialogue and networking to broaden the constituency working for medical abortion worldwide. The creation of a Consensus Statement advocating for wider availability of medical abortion. The creation of a Consensus Statement advocating for wider availability of medical abortion.

11. ICMA Activities: Information Package on Medical abortion Comprehensive information package in seven languages that can be adapted and used in many settings, addressed to: Comprehensive information package in seven languages that can be adapted and used in many settings, addressed to: women women health service providers women’s organizations, NGOs policymakers and parliamentarians, and selected recourses on MA. health service providers women’s organizations, NGOs policymakers and parliamentarians, and selected recourses on MA. Available on the web and on CDs Available on the web and on CDs

12. ICMA Activities: ICMA website, www.medicalabortionconsortium.org www.medicalabortionconsortium.org Created in 2003 and expanded and updated in 2007, French, Spanish and Russian sections have been added. Created in 2003 and expanded and updated in 2007, French, Spanish and Russian sections have been added. The site provides up-to-date information on developments and events related to medical abortion worldwide as well as current and upcoming ICMA activities. The site provides up-to-date information on developments and events related to medical abortion worldwide as well as current and upcoming ICMA activities. It has links to references, resources and articles on medical abortion and to the web pages of other organizations working in the same field. It has links to references, resources and articles on medical abortion and to the web pages of other organizations working in the same field.

13. ICMA Activities: Conference on Second Trimester, London, March 2007 Conference Recommendations: “…access to good quality second trimester services is an essential part of comprehensive safe abortion services. Conference Recommendations: “…access to good quality second trimester services is an essential part of comprehensive safe abortion services. Advocates must work to build support for safe, legal abortion in the second trimester of pregnancy. This work should include: Advocates must work to build support for safe, legal abortion in the second trimester of pregnancy. This work should include: developing better data on the occurrence and need for second trimester abortion, developing better data on the occurrence and need for second trimester abortion, the elimination of legal, regulatory and social barriers to second trimester abortion, the elimination of legal, regulatory and social barriers to second trimester abortion, a commitment of resources to training clinicians to provide later abortions, and a commitment of resources to training clinicians to provide later abortions, and research on the best medical methods in different settings…” research on the best medical methods in different settings…” RHM/ICMA Supplement, based on the conference presentations RHM/ICMA Supplement, based on the conference presentations

14. ICMA Activities: the third Conference, February 2010. Objectives: To share information on the current situation of access to MA in different situations with an emphasis on lessons learned and challenges faced in expanding access. To share information on the current situation of access to MA in different situations with an emphasis on lessons learned and challenges faced in expanding access. To examine strategies that have succeeded in improving access. To examine strategies that have succeeded in improving access. To examine barriers to access and how they have been addressed. To examine barriers to access and how they have been addressed. To discuss issues causing contention within the MA community. To discuss issues causing contention within the MA community.

15. The outcome at the end of the conference is expected to be a “consensus” statement highlighting strategies and means of expanding access to MA. at the end of the conference is expected to be a “consensus” statement highlighting strategies and means of expanding access to MA. The statement is expected to be used to motivate action at national and local levels. The statement is expected to be used to motivate action at national and local levels.

16. African network ??? The other regional networks associated with ICMA are independent entities, choose their own staff and steering committees, and develop their own activities. The other regional networks associated with ICMA are independent entities, choose their own staff and steering committees, and develop their own activities. We envisage that any such network in Africa would do the same. We envisage that any such network in Africa would do the same.

17. ICMA Thank you! Questions…