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Gynuity Health Projects: Increasing access to medical abortion in ECE countries

Gynuity Health Projects: Increasing access to medical abortion in ECE countries. Tamar Tsereteli Senior Consulting Associate Chisinau, Moldova June 23, 2011. About Gynuity Health Projects.

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Gynuity Health Projects: Increasing access to medical abortion in ECE countries

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  1. Gynuity Health Projects:Increasing access to medical abortion in ECE countries Tamar Tsereteli Senior Consulting Associate Chisinau, Moldova June 23, 2011

  2. About Gynuity Health Projects Research and technical assistance organization committed to ensuring access to advances in medical science and technology development

  3. About Gynuity Health Projects • Mission: • Gynuity works globally to ensure that reproductive health technologies are widely available at reasonable cost, provided in the context of high-quality services, and offered in a way that recognizes the dignity and autonomy of each individual. • Our efforts are focused particularly on resource-poor environments, underserved populations, and challenging subject matter. • Goal for Gynuity’s Medical Abortion Program: • To make safe, effective, affordable acceptable regimens of medical abortions available to women worldwide.

  4. Common trends in ECE countries Availability of abortion on legal grounds for more than 50 years High abortion rates Access to abortion services has been challenged in recent years Concerns about declining birth rates, pressure from religious groups have further reduced support for family planning and abortion Widespread use of D&C Low quality of services: no choice of methods, no counseling, no post-abortion contraception services, poor infection prevention, general anesthesia for pain control Better quality on higher price at private sector

  5. Mifepristone & misoprostol approvals in Eastern Europe & Central Asia

  6. Regimen innovations

  7. Regimen innovations

  8. Clinical Research on Regimen and Service Delivery Innovations • Improving current regimens • Dose and route of misoprostol (buccal or sublingual administration) • Home use of mifepristone and misoprostol • Increasing gestational age limits: 70 days’ LMP • Developing alternatives to the routine follow-up visit • Testing low sensitivity pregnancy tests • Decreasing use of ultrasound

  9. Eastern & Central Europe • Georgia • Moldova • Other ECE Activities (Armenia, Azerbaijan, Ukraine, Uzbekistan)

  10. Georgia • 2009: National experts elaborated MA national guideline • 2010: Medical abortion research in two western regions of Georgia and dissemination meeting in Batumi • 2010-2011: Medical Abortion Research: • The effectiveness of medical abortion with mifepristone and misoprostol at 57-63 days vs. 64-70 • 2011: Expansion of MA services to two eastern regions of Georgia

  11. Moldova • Series of MA studies have led to inclusion of 200mg mife + 400mcg sublingual miso into national norms on MA • First trimester MA studies on: • 200mg mife + 400mcg sublingual miso • 400 mcg sublingual miso vs 400 mcg buccal miso • Mife home administration study • 2010-2011: The acceptability and feasibility of reducing the need for in-clinic follow-up for first trimester medical abortion • 2010-2011: Second trimester MA study

  12. Other ECE Countries Armenia • 2007-2008: Mifepristone and misoprostol registered and available in pharmacies only in Yerevan • 2007: Survey - Knowledge, attitudes, and practice of abortion among women and doctors in Armenia • 2008-2009: Acceptability and feasibility of medical abortion in Armenia: A study of 800 µg buccal misoprostol following 200 mg mifepristone for abortion up to 63 days gestation. • 2009: Study findings dissemination meeting • 2010: National experts developed MA national guidelines • 2010-11: Expansion of MA services to two regions of Armenia

  13. Other ECE Countries Azerbaijan • Misoprostol registered and available in pharmacies • Mifepristone NOT registered, though the negotiation for re-registration is in progress • 2008-2010: Acceptability and feasibility of medical abortion in Azerbaijan: A study of 800 µg buccal misoprostol following 200 mg mifepristone for abortion up to 63 days gestation. • 2010: Medical abortion research and dissemination meeting • 2010: Expansion of MA services to two regions of Azerbaijan • 2011: Providing technical support in developing MA national guideline

  14. Other ECE Countries Ukraine • Series of first trimester MA studies conducted • Dissemination meeting on MA study results in Yalta, April 2007 • Incorporation of reduced dose 200 mg mife + 400 g oral miso into national norms on medical abortion • Expansion of work to Crimea province and to rural areas of Odessa • 2010-11 Medical Abortion Research: • The effectiveness of medical abortion with mifepristone and misoprostol at 57-63 days vs. 64-70

  15. Other ECE Countries Uzbekistan • 2009-2010: Acceptability and feasibility of medical abortion in Uzbekistan: A study of 400 µg sublingual misoprostol following 200 mg mifepristone for abortion up to 63 days gestation • 2010: Dissemination meeting • 2010-2011: The acceptability and feasibility of reducing the need for in-clinic follow-up for first trimester medical abortion • 2011: Planned expansion of MA services to other regions

  16. THANK YOU…..

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