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Challenges Faced and Lessons Learned in Expanding access to Medical Abortion in Mexico City

Challenges Faced and Lessons Learned in Expanding access to Medical Abortion in Mexico City Facilitators, Successes, Problems, Barriers and Failures Patricio R. Sanhueza, MD Ministry of Health, Mexico City ICMA Conference Lisbon, Portugal March 2010. Law Approval. Challenge :

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Challenges Faced and Lessons Learned in Expanding access to Medical Abortion in Mexico City

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  1. Challenges Faced and Lessons Learned in Expanding access to Medical Abortion in Mexico City Facilitators, Successes, Problems, Barriers and Failures Patricio R. Sanhueza, MD Ministry of Health, Mexico City ICMA Conference Lisbon, Portugal March 2010

  2. Law Approval Challenge: To implement a program, develop the guidelines and abide to the law in 24 hrs. • 14 Hospitals: • Existing infrastructure: G&O Services, Surgical Rooms, US, Labs, ICU. • We felt safe. • Reducing the chance of mistakes. • Volunteer staff. • Pressure: • Political. • Media. • Within the Ministry. • Anti-choice groups.

  3. Getting Prepared • Assessing the potential number of requests for the service. • Only 20 Ob&Gyn. doctors available. • Service was to be provided on a show-up, no appointment basis. • Anti-choice activities outside the hospitals. • Friendly fire (inside-outside). • Confusion on choosing the “right” model of care among the different options suggested by NGOs.

  4. Initital Steps • The law was approved, but there was no budget assigned to the program. • Visits to international models of care. • In-site training for health providers by Ipas. • Competing for surgical room time in hospitals. • Pro-Choice go at last. • Hospitals’ Administrations didn’t acquire enough manual vaccum aspirators.

  5. Problems • Adjusting to the new terminology: • From “Ob&Gyn doctor” to “provider” to “Doctors for Choice”. • Temporary job contracts with no benefits. • Volunteer doctors: • Committed with reducing MM. • Worked extra shifts. • A minority within the hospitals. • Teamed to fight for women’s lives. • Doctors for choice.

  6. Medical Abortion with Misoprostol • Doctors were trained to perform D&C. • Many regimes, different uses. • Follow-ups: 24hr, 48hr, 72hr, 1 week, 2 weeks. • US on Follow-up: Incomplete abortion and ongoing pregnancy. • Complications at home. • Women don’t show up on follow-up visits. • Lack of control on patients.

  7. Medical Abortion withMisoprostol Gynuity meeting on 2007 Consensus meeting among NGOs on 2007 (sponsored by The Population Council and Gynuity) Official support by the Minister of Health (Dr. Manuel Mondragóny Kalb) Buccal Regime

  8. Day 1 Misoprostol 800 µg buccal 4 hours after Misoprostol 800 µg buccal Day 15 Follow-up visit Medical Abortion with Misoprostol MA Protocol

  9. AVERAGE MONTHLY PROCEDURES BY TECHNOLOGY 69% 42% 32% 30% 25% 52% 67% 69% 41% 5% 1% 1%

  10. PROCEDURES PER MONTH BY TECHNOLOGY Total: 37,104 February 25, 2010

  11. Medical abortion accounts for 70% of all legal abortions. • The majority of women request a legal abortion before the 9 weeks. • Women are taking misoprostol at home, following the indications given by doctors. • Informational material, call centers and job-aids are keyelementstoprovidetheservices and addresscomplications. • Medical abortion has had a good impact in women and providers. • The procedure is safer and less traumatic. Results

  12. MA as a first-line treatment for the majority of women, thus reducing surgical procedures. • The success of the buccal regime in terms of efficacy, comparable to that of WHO sublingual regimes. • Expansion of services to primary care level. Results NAF affiliation which speaks of the quality of the services.

  13. COFEPRIS approval for a clinical study on Mifepristone-Misoprostol to be conducted jointly by Gynuity Health Projects and Mexico City’s MOH. Good News

  14. Good News

  15. New Health Center StaCatarina Center BW

  16. New Health Center

  17. New Health Center Clínica BeverlyWinikoff

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