Unsafe abortions account for 24% of maternal deaths in region (WHO, 1998)
Unsafe abortions account for 24% of maternal deaths in region (WHO, 1998)
Abortion rates remain high
Percentage of women using modern contraception remains low (Population Reference Bureau, 2002)
Abortion commonly used as a primary means to regulate fertility
Widespread availability of abortion on legal grounds for 50 years in many countries, but…
Widespread availability of abortion on legal grounds for 50 years in many countries, but…
Poor access for social-vulnerable groups
Poor quality of services in public sector: main method D&C, no counseling, no choice of the methods, general anaesthezia for pain control, poor infection prevention, no contraception post-abortion,
No evidence-based guidelines, no trainings in CAC
Access to abortion services has been challenged in recent years
Access to abortion services has been challenged in recent years
Concerns about declining birth rates, pressure from religious groups have reduced support for family planning and abortion
MVA not only an other abortion technique
MVA not only an other abortion technique
MVA as a possibility to improve abortion care, to implement patient care system, to change practice and policy…
Partners: NAF, OSY-New York, Soros Ipas
In the region: Ministries of Health, Medical Universities, Key-people,Hospitals, NGOs, abortion providers, distributors, women
It’s a safe, efficient, recommended by WHO method, that can be used in all the situations when uterine evacuation is needed.
It’s a safe, efficient, recommended by WHO method, that can be used in all the situations when uterine evacuation is needed.
No ‘checking curettage’ is needed (tissue exam)!
It’s a cost-efficient method: Procedure costs, staff time and other resources are significantly reduced where MVA is used.
Local anaesthezia, less risky than general can be used
MVA increases the patients’ satisfaction and patients’ flow
MVA as educational tool for both – providers and patients!
Training of Trainers in Comprehensive MVA abortion care, conducted by experts from NAF, with the support of Ipas and OSI (USA)
Training of Trainers in Comprehensive MVA abortion care, conducted by experts from NAF, with the support of Ipas and OSI (USA)
Training curricula is based on adult learning principles and includes: patient-centered elements of care, counseling, use of local anaesthezia, infection prevention, postabortion care and contraception following abortion.
Lectures, case studies and practice with models and patients are used.
Countries: Moldova, Russia (Moscow and St. Petersburg)/ Ukraine, Georgia, Kyrgyzstan / Kazakhstan, Albania
Trainings were done after an assessment of local situation
Trainings were done after an assessment of local situation
Trainings satisfied the real needs of national context (both providers and women)
Offered a new for us approach - women centered and evidence-based approach, changed the mentality…
Built a team of local experts – the real “pioneers” and champions of the method and of CAC
Pushed the things forward, initiated changes in abortion policy…
Trainings in cascade of national abortion providers, provided by local team of trainers
Trainings in cascade of national abortion providers, provided by local team of trainers
Publication of training materials, MVA is incorporated in University curricula
Official approval by MoHs of MVA equipment and method (<=12 weeks), Establishment of local distributor
Guidelines, protocols on MVA with the elements of CAC were developed and approved
Education-information campaigns on safe abortion, raising community awareness and increasing the demand for better quality of services
Russia
Russia
Georgia
Moldova
Ukraine
Lithuania
Uzbekistan
Kazakhstan
Tajikistan
Turkmenistan
Kyrgyzstan
Armenia (?)
Romania
Turkey
Albania
Establishment of MVA National Centre, with the goal of
Establishment of MVA National Centre, with the goal of
MVA implementation as a routine method on the national level, and at primary level of care
Medical abortion implementation
Strategic assessment of abortion services: (with WHO, Ipas, EEIRH,UNFPA) was conducted in September 2005
New MoH order, abortion standards are developed and submitted
National Strategy of RH for 2005-2015 developed, with WHO expertise (abortion quality is one of the priority)
System of continuing CAC education (MVA & Medical abortion) is developing now
WHO meeting on Safe abortion and Strategic Approach in Riga, June 2004 (Russia, Ukraine, Moldova, Lithuania, Latvia)
WHO meeting on Safe abortion and Strategic Approach in Riga, June 2004 (Russia, Ukraine, Moldova, Lithuania, Latvia)
Strategic Assessment of Abortion services (WHO, MoH):
done in Romania, Moldova. Soon Russia, Ukraine (?)
NAF: www.prochoice.org
NAF: www.prochoice.org
Astra www.astra.org.pl
Ipas: Training Forum www.ipas.org
ICMA: International Consortium for medical Abortion www.medicalabortionconsortium.org
Gynuity Health Projects:
www.gynuity.org
Safe Abortion: Technical and Policy Guidance for Health Systems, WHO, 2004
Traci Bird, Sarbaga Folk and Entela Shehu Shifting focus to the women: comprehensive abortion care in central and eastern. Europe. Entre-nous, No 59-2005.p. European Magazine for Sexual and Reproductive Health
Bird, Harvey, et al. Similarities in women’s perceptions and acceptability of manual
vacuum aspiration and electric vacuum aspiration for first trimester abortion. in 2003 Contraception 67 (2003) 207-212.
Greenslade, Forrest, Ann Leonard, Janie Benson and Judith Winkler. 1993. Manual vacuum aspiration: A summary of clinical and programmatic experience worldwide. Carrboro, NC: Ipas
International Planned Parenthood Federation (IPPF). 2001. International Medical Advisory Panel (IMAP) statement on safe abortion. IPPF Medical Bulletin, 35(5).
International Planned Parenthood Federation (IPPF). 2001. International Medical Advisory Panel (IMAP) statement on safe abortion. IPPF Medical Bulletin, 35(5).
Cates, Willard J. and David A. Grimes. 1981. Morbidity and mortality of abortion in the United States. In Hodgeson, J.E., ed. Abortion and sterilization: Medical and social aspects. London, Academic Press.
Grimes, David A., Kenneth F. Schulz, Willard Cates, Jr. and Carl W. Tyler, Jr. 1977. The Joint Program for the Study of Abortion/CDC: A preliminary report. In Hern, Warren and B. Andrikopoulos. eds. Abortion in the Seventies. New York, National Abortion Federation.
Thonneau, Fougeyrollas, et al. Complications of abortion performed under local anesthesia. In European Journal of Obstetrics & Gynecology and Reproductive Biology 81 (1998) 59–63
G. Dean, L. Cardenas, et al. Acceptability of manual versus electric aspiration for first trimester abortion: a randomized trial. In Contraception 67 (2003), 202-2007
Blumenthal PD and Remsburg RE. A time and cost analysis of the management of incomplete abortion with manual vacuum aspiration. International Journal of Gynecology and Obstetrics 1994; 45:261-267.
Joffe, C. Abortion in historical perspective. In Paul, M, Lichtenberg, ES, Borgatta, L, Grimes, DA, & Stubblefield, PG (Eds.). A Clinician’s Guide to Medical and Surgical Abortion. Philadelphia: Churchill Livingstone, 1999.
