Medical methods of early abortion in developing countries: Consensus statement

Abstract

Researchers, health care providers, women's health advocates, donors, and representatives of ministries of health convened in Bellagio, Italy, in July 1998, to assess the potential of medical methods of early pregnancy termination to improve the reproductive health of women in developing countries. Consensus was reached that a mifepristone-prostaglandin (e.g., misoprostol) regimen can be delivered in a manner that is safe, effective, and acceptable in developing country settings. As long as back-up care is available for complicated cases, medical abortion can be used safely even in the most rudimentary settings and provided by non-physician health workers. Given access to clinical assessment and counseling, some women can have the option of undergoing medical abortion outside of a clinical setting without direct medical supervision. Although the mifepristone-misoprostol regimen is most effective in women in the earliest durations of pregnancy, it has acceptable efficacy even after 57-63 days of amenorrhea. Medical abortion methods represent a critical advance in reproductive rights in countries where the consequences of unsafe abortion are most severe. If women are denied access to these methods, an unsafe "black market" for abortifacient agents may result.