This is the first in a series of articles from Keeping Our Promise: Addressing Unsafe Abortion in Africa this week.
Just a few pills could save an African woman’s life. Certainly, with roughly 250,000 dead each year from pregnancy-related causes, the need is great. Two major causes of maternal death in the region, postpartum hemorrhage and incomplete abortion, can be prevented and treated with access to misoprostol, a known medication that has been available for decades. Misoprostol, with or without another medicine, mifepristone, is also used for safe abortion.
Isn’t it time that African women benefit from the same simple technology that women around the world have?
Experts at Keeping our Promise: Addressing Unsafe Abortion in Africa, a meeting taking place this week in Accra, Ghana, say yes. The entire conference, full of policymakers, providers, advocates, health system workers and NGOs, is focused on finding and sharing effective ways to reduce unsafe abortion. The promise of medical abortion in Africa features prominently here at the conference.
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“The advantages of these medicines are many,” according to Dr. Davy Chikamata, medical advisor for the Concept Foundation, Africa.
“Medical abortion is proven safe and effective,” says Chikamata, “offers a choice to women and providers, and increases access to safe care through public health centers in both urban and rural areas.”
For women with limited access to reproductive health care, particularly those in remote areas, medical abortion gives them a safe alternative to dangerous methods of abortion and a proven treatment for incomplete abortion or miscarriage.
Dr. Joachim Osur, senior training and service delivery advisor with Ipas Africa Alliance, agrees and says the provision of medical abortion technology in Africa is still in its infancy, citing a paucity of standards and guidelines, very little training and a host of myths about the drugs. In addition, most African countries have restrictive laws that limit safe abortion services—though we know these laws don’t prevent abortion, just women’s ability to make safe reproductive health choices. Fortunately, he notes, there are programs working in a number of countries to build capacity of the health systems and communities to make medical abortion more available.
The medicines aren’t yet widely available in all of Africa, and where they are the indications for use most likely don’t include abortion. Misoprostol is registered for some obstetric uses in Ethiopia, Ghana, Kenya, Madagascar, Malawi, Mozambique, Nigeria, Somaliland, Tanzania, Uganda and Zambia. Mifepristone is registered in South Africa, Tunisia and Zambia and in process in Ethiopia and Ghana.
But some countries have emerged as leaders in the provision of the medicines for abortion and post-abortion care. In Ethiopia, women can get medical abortion in the public sector, where most women seek health care. Within two years of launching mifepristone and misoprostol, roughly 45 percent of women seeking abortion choose medical abortion there in the sites where it is available. And in Zambia, notes Dr. Osur, the Ministry of Health has added medical abortion to the national standards and guidelines. In Nigeria, a study has demonstrated the feasibility of using misoprostol to treat incomplete abortion, and policymakers are expected shortly to endorse this as an approved method of providing post-abortion care.
Misoprostol isn’t just a back door for abortion. “Misoprostol is key to advancing access to safe abortion in the region,” says Traci Baird, director of Ipas’s medical abortion initiative, “and it’s also a safe, acceptable option for treating incomplete abortion and a number of other ob-gyn problems.”
Let’s face it, women seek abortion, “even if by making this choice they risk their health or lives,” says Annie Nturubika, with SOS Femme et enfant et Catastrophe in the Democratic Republic of Congo. Women in the DRC have been subject to rape on a massive, systematic scale. Many of them seek unsafe abortion and their stories are never told. Her work there demonstrates that when women are given accurate information about medical abortion they will choose it. In fact, in the last two years, its use has significantly increased in DRC, according to Nturubika.
Challenges remain. Registration and procurement issues must be resolved. Standards must be established. Providers—from community health workers to mid-level providers to gynecologists—must have accurate information and be trained to help women use the medicines safely and effectively. Health systems throughout Africa must make medical abortion a priority and commit to increase access.
These medicines have the potential to reduce the thousands of deaths and countless injuries caused by unsafe abortion and pregnancy-related complications in low-resource settings and even in restricted legal settings. “We have the evidence, the knowledge, and the technologies to keep our promises to African women—now we must create the will,” says Getachew Bekele, senior advisor, Marie Stopes International Ethiopia.