The introduction of first trimester medical abortion in Armenia

Abstract

In Armenia, abortion is the main means of fertility regulation; however, before research activities were initiated only surgical methods were available and the quality of services was low in some areas. Our clinical study from 2008-2011 aimed to show that early medical abortion is an acceptable and feasible option. A total of 700 eligible women with pregnancies up to 63 days LMP presenting for abortion were recruited for the study in five locations. Participants took 200 mg mifepristone and 800 μg buccal misoprostol 24-48 hours later. They returned for a follow-up visit two weeks after mifepristone administration. 95% of the women had successful abortions and 95% were satisfied with the method. In 2012-2013, we conducted a follow-up assessment to examine the ongoing provision and quality of medical abortion services at the former research sites. Medical record reviews, interviews and observations were carried out three times approximately six months apart. The assessment found that all five sites had continued providing medical abortion, with about half of eligible women choosing the medical method. Four of the five sites were achieving high success rates. Staff turnover and the lack of trained providers likely contributed to the higher failure rate at the fifth site. These findings provide evidence that first trimester medical abortion is an acceptable and feasible option for Armenian women and providers, and that high quality services are being delivered.

Prospective study of home use of mifepristone and misoprostol for medical abortion up to 10 weeks of pregnancy in Kazakhstan

“…Lastly, the option to take both medications at home did not create undue burden for providers, as evidenced in the few phone calls and unplanned visits to the clinic. Numerous studies support these findings, and home mifepristone and misoprostol is regularly offered to women in Moldova, Georgia, Azerbaijan, and Armenia [7,9,10,20].…”

“…Many clinical care guidelines, including the WHO 2012 safe abortion guidance [1], recommend outpatient medical abortion up to 63 days since the last menstrual period (LMP), including taking misoprostol at home to maximize the convenience and acceptability of the service. Recent evidence shows that medical abortion is safe, effective, and acceptable as an outpatient service up to 70 days after the LMP [2–6], and the option to take both mifepristone and misoprostol at home is safe and desired by a substantial proportion of women [7–11]. In some countries—e.g.…”

A prospective, non-randomized study of home use of mifepristone for medical abortion in the U.S.

“…Success and complication rates were not different between home users and clinic users [4][5][6][7][8]. Success and complication rates were not different between home users and clinic users [4][5][6][7][8].…”

If we can do it for misoprostol, why not for mifepristone? The case for taking mifepristone out of the office in medical abortion

“…In fact, research studies in settings as varied as Armenia, Azerbaijan, Nepal, the US and Kazakhstan have demonstrated that the outside-office-use option is popular and acceptable among women [6][7][8][9][10]. The proportion of women choosing to take the mifepristone at home ranged from 46%-74%, and among these users, 92%-99% would choose to take it out of the office again for a future abortion (Fig.…”