Community-Based Distribution of Misoprostol for Early Abortion

Location:

Introduction:

Although abortion is legal in Thailand for a number of indications, women from Burma residing in Thailand are rarely able to access safe services. However, misoprostol is widely available in clinics, pharmacies, and drug shops throughout northern Thailand.

Project Description:

In 2011, a multi-disciplinary team at Ibis Reproductive Health partnered with individuals associated with several local community-based organizations in Tak Province, Thailand to establish a misoprostol distribution network. Using a train-the-trainer model, Network leaders received a five-day training in the medical and legal aspects of misoprostol use for early pregnancy termination (defined as ≤ 9 weeks’ gestation), contact information for an on-call expert who could discuss complicated cases or review protocols, the indications for referral to post-abortion care services, and the logistical issues surrounding medication distribution and case documentation. After determination of eligibility based on self-report and counseling, trained Network members instructed women who desired an abortion to vaginally administer 800 mcg of misoprostol, a second 800 mcg dose 24 hours later, and a third 800 mcg dose one week later, if needed. Network providers gave women quality verified misoprostol.

Results:

Over the first 3 years, 918 women received early abortion care using misoprostol through the community-based distribution program. Of these, 885 women (96.4%) were not pregnant at follow-up, 29 were pregnant at follow-up (3.2%), and four women were lost to follow-up (0.4%). Interviews revealed that providers are motivated to participate due to concerns surrounding unsafe abortion in the community and frame their work as a public health intervention and women felt positively about their abortion experiences and the initiative. All providers and women that we interviewed, including those women who remained pregnant after taking the misoprostol, would recommend the initiative to others and felt expanding the reach of the Network was warranted.

Lessons Learned:

Global efforts to provide women with medically accurate information about medication abortion, including misoprostol-alone regimens for early abortion, have inspired harm reduction programming, dissemination of medically accurate information through telemedicine services and websites, and the establishment of call centers in contexts where access to safe services is limited, or unavailable. Findings from this initiative demonstrate that community-based distribution of misoprostol can be a safe, effective, and culturally resonant strategy for increasing access to safe abortion, even in a legally restricted, low-resource, conflict-affected setting. The findings and project model may be relevant for replication in similar settings where continued maternal morbidity and mortality resulting from unsafe abortion and restrictive abortion laws exist.