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Medical Abortion Intervention in Nigeria

Medical Abortion Intervention in Nigeria. Ejike Oji MD Expanding Access to Medical Abortion: Building on Two Decades of Experience Lisbon, Portugal March 2-4, 2010. This is part of us. Why should we invest our time resources and energy on Medical abortion?. MMR 1,100/100,000

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Medical Abortion Intervention in Nigeria

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  1. Medical Abortion Intervention in Nigeria Ejike Oji MD Expanding Access to Medical Abortion: Building on Two Decades of Experience Lisbon, Portugal March 2-4, 2010

  2. This is part of us

  3. Why should we invest our time resources and energy on Medical abortion? • MMR 1,100/100,000 • Very restrictive environment. • 760,000 induced abortions with 34,000 deaths and for each death 20 others are maimed • The high level of maternal deaths and injuries from the use of instruments by quacks for terminating pregnancies • Unsafe abortion is the number one cause of infertility in the country

  4. Cassava plant, Leaf and Stem

  5. Alligator pepper, Native Chalk and Native Alum.

  6. A Necrotic Uterus Being removed- A 16 year Old Girl

  7. A 19 year old girl with the necrotic (dead) intestines sticking out from the vagina

  8. Objectives of MA intervention in Nigeria • Reduce abortion related deaths from unsafe abortion • Introduce medical abortion in the country in a way that it is safe for women without a back lash • Create an opportunity for women to act for themselves

  9. Is it available? • Are the drugs available in the country and where? • Are the providers knowledgeable about the use of drugs for uterine evacuation? • What are the regulations around the drug? • What formulations?

  10. Environmental scan • KAP amongst different practitioners especially gynecologists (SOGON) in 2002 • Availability study in the community pharmacies • Mystery client study • Miso for PAC feasibility study 2009

  11. Strategic activities • We worked with other stakeholders to provide information to public and private health care systems • We incorporated MA training interventions in both in-service and pre-service (medical schools and schools of midwifery) • Distribution of FLAGSOG cards and other MA materials

  12. Use of evidence to inform service protocols • Feasibility study documented women’s preference for miso for PAC • We are working with the SOGON and the FMOH to develop standards and guidelines and clinical protocols for the use of miso for all obstetric indications • Working with the National University Commission and the Nursing and Midwifery Council to incorporate the use of miso for all obstetric indications in the curriculum

  13. Women Act • We have been working to leverage Nigerian’s powerful women groups for the past four years. • Moving forward we plan to work with select community based organizations to empower women to seek information and act based on their best interests. • With our training of community pharmacists on medication abortion women will be able to access the drugs.

  14. Challenges • The knowledge of medical abortion is non existent or very low • Very restrictive environment makes it difficult to introduce the concept and the drugs directly into the health care system • The drugs are not always available in the pharmacy outlets except for cytotec brand meant for ulcer • Miso when registered was strictly hospital/clinic based and was for PPH; lowest cadre to prescribe is nurse midwife

  15. Barriers • The restrictive law in Nigeria • The drugs are not yet widely available in Nigeria • The vocal anti choice groups • Not yet integrated in the health care system • No national framework for delivery of legal abortion care or the use of medication for abortion care

  16. Preventing a back lash • Media strategy of recruiting, training and sensitizing of the journalists on women’s sexual and reproductive health and rights issues • Our robust anti choice tracking and engagement through our media strategy • Mobilizing the women groups to speak up • Working with SOGON to address some of the issues, e.g. the unsafe working group of FIGO/SOGON

  17. Facilitating events • Miso was registered for the treatment of Post partum hemorrhage • A recently disseminated study on the use of community health extension workers for the use of miso in the community to treat women with PPH under a strict guidance of NMs. • The feasibility study results from miso for PAC study that shows preferred use of the drug by women for the treatment of PAC

  18. Lessons learned • When you are committed to a cause you will always find a way. • The use of community pharmacists to reach women directly • This gives them added protection and confidence • Giving women the skills and knowledge to act based on their own self interests

  19. Visit us online atwww.ipas.org/medicalabortionor write tomedicalabortion@ipas.org

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