Provision Of Abortion Services Research Articles

The Cost of Postabortion Care and Legal Abortion in Colombia

Although Colombia partially liberalized its abortion law in 2006, many abortions continue to occur outside the law and result in complications. Assessing the costs to the health care system of safe, legal abortions and of treating complications of unsafe, illegal abortions has important policy implications. The Post-Abortion Care Costing Methodology was used to produce estimates of direct and indirect costs of postabortion care and direct costs of legal abortions in Colombia. Data on estimated costs were obtained through structured interviews with key informants at a randomly selected sample of facilities that provide abortion-related care, including 25 public and private secondary and tertiary facilities and five primary-level private facilities that provide specialized reproductive health services. The median direct cost of treating a woman with abortion complications ranged from $44 to $141 (in U.S. dollars), representing an annual direct cost to the health system of about $14 million per year. A legal abortion at a secondary or tertiary facility was costly (medians, $213 and $189, respectively), in part because of the use of dilation and curettage, as well as because of administrative barriers. At specialized facilities, where manual vacuum aspiration and medication abortion are used, the median cost of provision was much lower ($45). Provision of postabortion care and legal abortion services at higher-level facilities results in unnecessarily high health care costs. These costs can be reduced significantly by providing services in a timely fashion at primary-level facilities and by using safe, noninvasive and less costly abortion methods.

Hospital-based abortion in Colombia: the relationship of age and postabortion care versus induced abortion service provision

Despite partial decriminalization of abortion in Colombia, challenges to accessing safe abortion persist. Adolescents are particularly vulnerable to the risks and negative outcomes of unsafe abortion; however, little is known about their experience obtaining abortion care in restrictive settings. We evaluated the relationship between age and type of abortion service provided in Colombia.

Knowledge of State-level Abortion Laws and Regulations Among Reproductive Health Care Providers

ObjectiveTo assess the accuracy of knowledge of state-level abortion laws and regulations among clinicians who provide reproductive health care. MethodsMembers of several reproductive health professional organizations completed a self-administered survey. Respondents were asked if laws and regulations were present in their state. Responses were graded according to the Guttmacher Institute's monthly publication State Policies in Brief: An Overview of Abortion Laws. ResultsThree hundred forty-one surveys were completed. Fifty-nine respondents met exclusion criteria and were excluded. Of the remaining 282, most (80.1%) were physicians, and over half (55.0%) reported currently providing abortion services. Most (86.5%) considered themselves to be informed about abortion laws and regulations in their state. Knowledge of laws and regulations involving spousal involvement, mandatory waiting periods, and availability of private insurance coverage was high (77.0%–86.2%). Receiving reminders of state abortion laws and regulations was associated with significantly more accurate knowledge of parental notification and spousal consent laws, mandatory waiting periods, and availability of Medicaid and private insurance coverage (all p < .05). Receiving reminders and being a provider of abortion services were independent predictors of better knowledge of state abortion laws and regulations among clinicians who provide reproductive health care. ConclusionClinicians who provide reproductive health care had highly accurate knowledge of some abortion laws and regulations, but less accurate knowledge of others. Reminders of laws and regulations may increase knowledge among clinicians. Given the importance of accurate information, evaluation of mechanisms to increase knowledge of abortion laws and regulations may be warranted.

ARSH 6: Reproductive Health Needs Assessment of Adolescents and Young People (15–24 y): A Qualitative Study on ‘Perceptions of Program Managers and Health Providers’

To understand the perceptions of program managers and service providers using in depth interview technique, a well-accepted qualitative research that can also offer semi quantitative input. Need assessment was done qualitatively using in-depth interviews, among program managers of health care system including District Medical Officers and RCH Officers and program service providers, both in rural and urban areas. In total 34 in-depth interviews were conducted. Nearly half (2+) of the program managers and service providers of adolescent programs opined that the important problems faced by adolescents were issues related to sexuality, psychosocial conflict, identity crisis, adjustment problems and scholastic problems. Approximately half of them thought that improper parenting, negative attitude of parents, separated parents, ignorance of parents, family background, nuclear family setup etc. are the most important factors, which influence adolescent problems and that friends and media are their major source of reproductive sexual health information. Nearly half of them pointed out that pain and psychological disturbances like anxiety, tension and anger were the important menstrual problems faced by adolescents. Again nearly half of them, felt that FLE (Family Life Education) should be given at school and ARSH services at PHCs, but there was little consensus on provision of contraceptive service and abortion services to adolescents. All the service providers and program managers are ready to cooperate but they had varied opinions about who should impart adolescent reproductive sexual health education and how the program should be done.

Shaping legal abortion provision in Ghana: using policy theory to understand provider-related obstacles to policy implementation

BackgroundUnsafe abortion is a major public health problem in Ghana; despite its liberal abortion law, access to safe, legal abortion in public health facilities is limited. Theory is often neglected as a tool for providing evidence to inform better practice; in this study we investigated the reasons for poor implementation of the policy in Ghana using Lipsky’s theory of street-level bureaucracy to better understand how providers shape and implement policy and how provider-level barriers might be overcome.MethodsIn-depth interviews were conducted with 43 health professionals of different levels (managers, obstetricians, midwives) at three hospitals in Accra, as well as staff from smaller and private sector facilities. Relevant policy and related documents were also analysed.ResultsFindings confirm that health providers’ views shape provision of safe-abortion services. Most prominently, providers experience conflicts between their religious and moral beliefs about the sanctity of (foetal) life and their duty to provide safe-abortion care. Obstetricians were more exposed to international debates, treaties, and safe-abortion practices and had better awareness of national research on the public health implications of unsafe abortions; these factors tempered their religious views. Midwives were more driven by fundamental religious values condemning abortion as sinful. In addition to personal views and dilemmas, ‘social pressures’ (perceived views of others concerning abortion) and the actions of facility managers affected providers’ decision to (openly) provide abortion services.In order to achieve a workable balance between these pressures and duties, providers use their ‘discretion’ in deciding if and when to provide abortion services, and develop ‘coping mechanisms’ which impede implementation of abortion policy.ConclusionsThe application of theory confirmed its utility in a lower-middle income setting and expanded its scope by showing that provider values and attitudes (not just resource constraints) modify providers’ implementation of policy; moreover their power of modification is constrained by organisational hierarchies and mid-level managers. We also revealed differing responses of ‘front line workers’ regarding the pressures they face; whilst midwives are seen globally as providers of safe-abortion services, in Ghana the midwife cadre displays more negative attitudes towards them than doctors. These findings allow the identification of recommendations for evidence-based practice.

Comprehensive abortion care: evidence of improvements in hospital-level indicators in Tigray, Ethiopia

ObjectiveApproximately 18% of maternal deaths in East Africa is attributable to unsafe abortion. Availability of comprehensive abortion care (CAC) services at all levels of the healthcare system, including medical abortion,...

Abortion-care education in Japanese nurse practitioner and midwifery programs: A national survey

While various reports have been published concerning ethical dilemmas in nursing and midwifery, and while many nurses and midwives struggle with the conflict between personal feelings raised by abortion and the duties of their position, few studies investigate the extent and conditions of abortion-care education for registered nurses (RNs) and certified nurse-midwives (CNMs) in Japan. To describe Japanese abortion-care education programs and to investigate program directors' or other relevant persons' perceptions of abortion-care education. Descriptive study was used to determine the extent of abortion-care education programs and the respondents' perceptions of abortion-care education. All 228 Japanese nursing and/or midwifery schools were invited to participate in the study. The response rate was 33.8% (n=77). Response rate varied by program type: 18.4% (n=45) for nursing programs and 29.0% (n=32) for midwifery programs. A confidential survey requesting information about curricular coverage of ten reproductive health topics related to abortion was mailed to program directors. The results show that the majority of CNM and RN programs surveyed offer didactic exposure to instruction in family planning and contraception, emergency contraception, legal considerations, and possible medical complications. However, few programs offer clinical exposure to all 10 topics. Of the respondents, 36% reported that lack of time and the low priority given to abortion-care education were issues of curriculum priority. As for educational materials, few textbooks or guidebooks exist on abortion care in Japan, and most educators use general nursing textbooks to cover this topic. Regardless of interest in or intention to provide abortion services as part of their practice, all providers of abortion-care education need to be knowledgeable about the full range of reproductive health options, including family planning and abortion, and to be able to convey this information to clients.

Unsafe abortion after legalisation in Nepal: a cross‐sectional study of women presenting to hospitals

To investigate abortion practices of Nepali women requiring postabortion care. Cross-sectional study. Four tertiary-care hospitals in urban and rural Nepal. A total of 527 women presenting with complications from induced abortion in 2010. Women completed questionnaires on their awareness of the legal status of abortion and their abortion-seeking experiences. The method of induction and whether the abortion was obtained from an uncertified source was documented. Multivariable logistic regression was used to identify associated factors. Induction method; uncertified abortion source. In all, 234 (44%) women were aware that abortion was legal in Nepal. Medically induced abortion was used by 359 (68%) women and, of these, 343 (89%) took unsafe, ineffective or unknown substances. Compared with women undergoing surgical abortion, women who had medical abortion were more likely to have obtained information from pharmacists (161/359, 45% versus 11/168, 7%, adjusted odds ratio [aOR] 8.1, 95% confidence interval 4.1-16.0) and to have informed no one about the abortion (28/359, 8% versus 3/168, 2%, aOR 5.5, 95% CI 1.1-26.9). Overall, 291 (81%) medical abortions and 50 (30%) surgical abortions were obtained from uncertified sources; these women were less likely to know that abortion was legal (122/341, 36% versus 112/186, 60%, aOR 0.4, 95% CI 0.2-0.7) and more likely to choose a method because it was available nearby (209/341, 61% versus 62/186, 33%, aOR 2.5, 95% CI 1.5-4.3), compared with women accessing certified sources. Among women presenting to hospitals in Nepal with complications following induced abortion of pregnancy, the majority had undergone medically induced abortions using unknown substances acquired from uncertified sources. Women using medications and those accessing uncertified providers were less aware that abortion is now legal in Nepal. These findings highlight the need for continued improvements in the provision and awareness of abortion services in Nepal.

WHO technical and policy guidance emphasizes the health systems' responsibility to provide safe abortion services

Despite widespread availability and use of modern contraception, among 208 million pregnancies each year worldwide, 41% (85 million) are unintended. Many of these women will seek abortion, whether under safe or unsafe conditions [1]. Indeed, the likelihood that a woman will seek an abortion for an unintended pregnancy is about the same regardless of legal restrictions [2]. The rate of safe induced abortion has declined over recent years from 35 per 1000 women aged 15–44 in 1995 to 26 per 1000 in 2008. In contrast, the rate of unsafe abortion has remained relatively constant since 2000 at around 14 per 1000 women aged 15– 44 [3]. Unsafe abortion occurs almost exclusively in low and middle income countries, where maternal mortality rates are high and access to safe services is limited. Deaths resulting from unsafe procedures number approximately 47,000 per year while an additional 5 million women are left disabled [3]. Tragically, almost every one of these deaths and disabilities could have been prevented with the provision of safe abortion services. Use of contraceptive methods and services decreases the chance of unintended pregnancy substantially, but even universal contraceptive use would never eliminate the need for induced abortion given the intrinsic failure rates, however small, of modern methods. Approximately 36 million women worldwide annually experience an unintended accidental pregnancy while using a contraceptive method [4]. Additionally, contraception is not available in cases of forced sexual intercourse. Lack of access to contraception

Making it legal: Abortion providers' knowledge and use of abortion law in New South Wales and Queensland

To explore the knowledge of state abortion law of doctors providing abortion in New South Wales and Queensland, their attitudes towards this law, and their application of both knowledge and attitudes to their day-to-day practice of abortion. Qualitative study using interviews of twenty-two medical practitioners agreeing to participate and identified as providing surgical and/or medical abortions in NSW or Queensland. Specific questions about practice as well as responses to ten common clinical scenarios formed the basis of each interview. Familiarity of participants with abortion law of their state, documentation of views on legality and probable availability of abortion in each scenario provided. All participants were aware that abortion in their state is covered by criminal legislation, which they believe is out-of-date with current medical practice, in particular with regard to the diagnosis of serious fetal abnormality, and that there is limited case law to assist doctors in a defence to a charge of abortion. All were concerned about requirements to conform to state law when agreeing to provide abortion services to women, and about the possible constraints of these requirements on women's accessibility to abortion services. Review and reform of abortion laws in Queensland and NSW, as has occurred in other states and territories, has the potential to bring the law into conformity with current medical practice and to clarify the legal position of doctors providing abortion services, thereby providing an opportunity to improve women's accessibility to these services.

Professional quality of life of Japanese nurses/midwives providing abortion/childbirth care

This study explored the relationship between professional quality of life and emotion work and the major stress factors related to abortion care in Japanese obstetric and gynecological nurses and midwives. Between October 2011 and January 2012, questionnaires that included questions concerning eight stress factors, the Professional Quality of Life Scale, and the Japanese version of the Frankfurt Emotional Work Scale, were answered by 255 nurses and midwives working in abortion and childbirth services. Professional Quality of Life scores (compassion fatigue, compassion satisfaction, burnout) were significantly associated with stress factors and emotion work. Multiple regression analysis revealed that of all the evaluated variables, the Japanese version of the Frankfurt Emotional Work Scale score for negative emotions display was the most significant positive predictor of compassion fatigue and burnout. The stress factors "thinking that the aborted fetus deserved to live" and "difficulty in controlling emotions during abortion care" were associated with compassion fatigue. These findings indicate that providing abortion services is a highly distressing experience for nurses and midwives.

Pattern of Sexual Behavior of Hawassa University Students, Ethiopia: A Qualitative Study

B ackground : The body of quantitative literature that described risky sexual behavior as a predisposing factor for HIV and o ther sexually transmitted infection are plenty. However, little is known how risky the sexual practices of university students are in this era, particularly in Ethiopia. M ethods : A qualitative research method was employed to explore the sexual behavior of undergraduate university students. Ten students’ focus group discussions and twenty three in - depth interviews were conducted. The study participants were purposively selected students, night time taxi drivers, nightclub owners, abortion service providers, members of campus police and addictive substance sellers. R esults : Both the focus group discussants and key informants emphasized that the sexual practices of some of Hawassa University female students were more risky than their counterpart male student s. Some of the evidence the discussants pointed out were: the high number of female students competing with commercial sex workers in the night clubs; being the majority among women coming for abortion service; several local businessmen coming to the unive rsity campus to pick female students at night; and some female students being observed working in hotels as bar lady. B eing away from family, academically poor, watching a sex film, peer pressure, attending night clubs, lack of

Health care providers’ attitudes towards termination of pregnancy: A qualitative study in Western Nigeria

Background: Despite restrictive abortion law in Nigeria, women still seek abortion services. Restrictive policies on abortion make it difficult for safe and legal abortion to be obtained. Hence, abortion is provided on clandestine basis in some private health facilities, and where the cost of such service is prohibitory, women resort to unsafe methods, including visiting quacks and self medication, resulting in severe complications including death. In Nigeria, little is known about the personal and professional attitudes of individuals who are currently providing abortion services. Exploring the factors which determine health care providers’ involvement in or disengagement from abortion services may facilitate improvement in the planning and provision of future services. Methods: Data were collected using qualitative research methods. Thirty-six in-depth interviews and one focus group discussion were conducted between January 2010 and July 2010 with health care providers who were involved in a range of abortion services provision in theWestern Nigeria. Data were analysed using a thematic analysis approach. Results: Complex patterns of service delivery were prevalent throughout many of the health care facilities. Fragmented levels of service provision operated in order to accommodate health care providers’ willingness to be involved in different aspects of abortion provision. Closely linked with this was the urgent need expressed by many providers for liberalization of abortion laws inNigeriain order to create a supportive environment for both clients and providers. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre and post abortion counselling including contraceptive counselling and provision. Conclusion: This is the first known qualitative study undertaken in Nigeria exploring providers’ attitudes towards abortion and it adds to the body of information addressing the barriers to safe abortion services. In order to provide an enabling environment and sustain a pool of abortion service providers, a drastic change in Nigerian abortion laws is mandatory, after which policies that both attract prospective abortion service providers and retain existing ones can be developed.

Medical students' attitudes toward abortion education: Malaysian perspective.

BackgroundAbortion is a serious public health issue, and it poses high risks to the health and life of women. Yet safe abortion services are not readily available because few doctors are trained to provide such services. Many doctors are unaware of laws pertaining to abortion. This article reports survey findings on Malaysian medical students’ attitudes toward abortion education and presents a case for including abortion education in medical schools.Methods and ResultsA survey on knowledge of and attitudes toward abortion among medical students was conducted in two public universities and a private university in Malaysia in 2011. A total of 1,060 students returned the completed questionnaires. The survey covered about 90% of medical students in Years 1, 3, and 5 in the three universities. About 90% of the students wanted more training on the general knowledge and legal aspects of abortion, and pre-and post-abortion counseling. Overall, 75.9% and 81.0% of the students were in favor of including in medical education the training on surgical abortion techniques and medical abortion, respectively. Only 2.4% and 1.7% were opposed to the inclusion of training of these two methods in the curriculum. The remaining respondents were neutral in their stand. Desire for more abortion education was associated with students’ pro-choice index, their intention to provide abortion services in future practice, and year of study. However, students’ attitudes toward abortion were not significantly associated with gender, type of university, or ethnicity.ConclusionsMost students wanted more training on abortion. Some students also expressed their intention to provide abortion counseling and services in their future practice. Their desire for more training on abortion should be taken into account in the new curriculum. Abortion education is an important step towards making available safe abortion services to enable women to exercise their reproductive rights.

El Programa de Interrupción Legal del Embarazo en la Ciudad de México: experiencias del personal de salud

Identify the perceptions and opinions of people who provide abortion services in Mexico City, three years after implementation of elective abortion legal reforms. Nineteen in-depth interviews of health workers assigned to the legal abortion programs at a clinic and a hospital in Mexico's Federal District were carried out between February and June of 2010. Information on sociodemographic data, professional training, and experience in providing services was collected. Some interviewees thought the provision of free services was beneficial because it allowed lower-income women to access this type of care, whereas others interviewed disapproved of the lack of fees, since other gynecological and obstetric health services have to be paid for. Conscientious objection prevailed among newly hired health workers, which can be attributed to their lack of knowledge about the legal abortion program's legal and technical guidelines. Some workers were ambivalent because they did not accept a postabortion contraception method used by some women, perceiving it to be a factor in significant repeated demand for legal abortion services. Health workers evince divided and ambivalent opinions with regard to abortion rights. Analyzing their experiences and opinions will facilitate the creation of a baseline on the subject, and future studies will be able to document changes in and any lessening of approval for this law in Mexico.

Stigma, Abortion, and Disclosure—Findings from a Qualitative Study

This study qualitatively explores perceptions of women who have experienced abortion care. It explores women's journey through abortion from confirmation of pregnancy to post-abortion. The study seeks to understand the implications of these perceptions for policy and practice. A qualitative study involving in-depth semi-structured interviews with 17 women, aged between 22 and 57 years, who had undergone legal induced abortion in the UK when they were 16 years or older. Participants were not recruited under the age of 16 because of the ethical and legal complexities of interviewing minors. Additionally, 16 years was deemed to be the most appropriate age as this is the legal age of consent in the UK. Participants were recruited from 12 community contraception and sexual health clinics in two NHS trusts, one in England and one in Wales. Participant recruitment was set at a minimum of 12 and participants were recruited on a "first come first served basis" (i.e., the first 12 who contacted the researcher). The number of participants was raised to seventeen as this was the number deemed to be the most suitable for data saturation in this particular qualitative research. Women in this study understood abortion as highly taboo and a potentially personally stigmatizing event. These perceptions continued to affect disclosure to others, long after the abortion, and affected women's perceptions of the response of others, including society in general, significant others, and health professionals. Women's experiences of abortion may be influenced by perceived negative social attitudes. Health professionals and abortion service providers might combat the perceived isolation of women undergoing abortion by attending not only to clinical/technical aspects of the procedure but also to women's psychological/emotional sensitivities surrounding the event.

Proud, not yet satisfied: The experiences of abortion service providers in the Kathmandu Valley, Nepal

ObjectivesIn Nepal, the change of the abortion law in 2002 extended the staff duties at family planning clinics to include performing induced abortions. This study investigated the experiences, opinions and attitudes of the staff about their work at safe abortion service centres in the Kathmandu Valley and identified areas in which the health care staff stated the need for improvement. Study designFifteen qualitative semi-structured interviews were conducted with doctors and nurses working with induced abortion at one hospital and five clinics in the Kathmandu Valley. The interviews were transcribed verbatim and analysed using the constant comparative method. ResultsThe core category ‘Proud, not yet satisfied’ comprised a strong perception of providing an important service that is beneficial for women’s health and a feeling of pride in providing quality service. Four related categories were identified: ‘Beneficial legal framework’, ‘A will to reach out to all women’, ‘Frustration about misuse’ and ‘Dilemma of sex-selective abortion’. The respondents emphasised that improvements are necessary to (1) ensure that all women have access to safe abortion services; (2) prevent abortions from being used instead of contraceptives; (3) stop illegal medical abortions; and (4) deal with the dilemma of sex-selective abortions. ConclusionsRespondents were proud of and had psitive experiences from their work. They stated they have the opportunity to secure women’s rights and health; however, changes are needed to bring the quality of abortion care to a satisfactory level.

Medical abortion service in rural areas of Henan Province, China: A provider survey

The aim of this study was to explore the knowledge, attitudes and practices on medical abortion of abortion service providers in rural areas of China. A cross-sectional study via self-administered questionnaire was conducted among 362 abortion service providers from family planning service centers (FPSC) and hospitals in rural areas of Henan Province, China, between November 2009 and May 2010. Most of the providers were female (99.4%) and obstetricians/gynecologists (63.3%). The knowledge score achieved ranged from 9.4 to 78.1 points, with both the median and the mode of 56.3 points. Of the 52.2% (189/362) of providers having a preference on abortion method, 30.2% (57/189) preferred medical abortion, while 69.8% (132/189) preferred surgical abortion. In total, 50.7% (174/343) of the providers indicated the provision of medical abortion should be expanded, with the three biggest challenges in its further expansion being increased complications/failures, poor client knowledge/awareness, and problems with drug/equipment supplies. Of all the providers, 81.7% and 92.2% reported they had experience in providing medical abortion and surgical abortion, respectively. Medical abortion providers were mainly experienced in misoprostol with oral (81.8%)/vaginal (79.6%) prostaglandin (misoprostol/gemeprost). Knowledge on medical abortion of providers working in rural China was at a moderate level. Providers preferred surgical abortion to medical abortion. Providers have more experience in providing surgical abortion than medical abortion. Efforts should be made to overcome the perceived challenges in future expansion of medical abortion.

Exploring pregnancy termination experiences and needs among Malaysian women: A qualitative study

BackgroundMalaysia has relatively liberal abortion laws in that they permit abortions for both physical and mental health cases. However, abortion remains a taboo subject. The stagnating contraceptive prevalence rate combined with the plunging fertility rate suggests that abortion might be occurring clandestinely. This qualitative study aimed to explore the experiences of women and their needs with regard to abortion.MethodsWomen from diverse backgrounds were purposively selected from an urban family planning clinic in Penang, Malaysia based on inclusion criteria of being aged 21 and above and having experienced an induced abortion. A semi-structured interview guide consisting of open ended questions eliciting women’s experiences and needs with regard to abortion were utilized to facilitate the interviews. Audio recordings were transcribed verbatim and analyzed thematically.ResultsThirty-one women, with ages ranging from 21–43 years (mean 30.16 ±6.41), who had induced surgical/medical abortions were recruited from an urban family planning clinic. Ten women reported only to have had one previous abortion while the remaining had multiple abortions ranging from 2–8 times. The findings revealed that although women had abortions, nevertheless they faced problems in seeking for abortion information and services. They also had fears about the consequences and side effects of abortion and wish to receive more information on abortion. Women with post-abortion feelings ranged from no feelings to not wanting to think about the abortion, relief, feeling of sadness and loss. Abortion decisions were primarily theirs but would seek partner/husband’s agreement. In terms of the women’s needs for abortion, or if they wished for more information on abortion, pre and post abortion counseling and post-abortion follow up.ConclusionsThe existing abortion laws in Malaysia should enable the government to provide abortion services within the law. Unfortunately, the study findings show that this is generally not so, most probably due to social stigma. There is an urgent need for the government to review its responsibility in providing accessible abortion services within the scope of the law and to look into the regulatory requirements for such services in Malaysia. This study also highlighted the need for educational efforts to make women aware of their reproductive rights and also to increase their reproductive knowledge pertaining to abortion. Besides the government, public education on abortion may also be improved by efforts from abortion providers, advocacy groups and related NGOs.

Use of Medicines Changing the Face of Abortion

Medication abortion (also commonly referred to as medical abortion) is arguably the most important advance in reproductive health technology since the discovery of oral contraceptives. This simple process, involving the use of pins rather than invasive surgical instruments, has been shown to be safe and up to 98% effective for early pregnancy termination. (1-3) In settings where abortion is legal, medication abortion has expanded the array of effective options available, thus improving the abortion experience for those who wish to avoid surgery. In settings where abortion is illegal or highly restricted, it has provided many women for the first time with a safe and discreet means for early termination of unwanted pregnancy. Further, in all settings where it is available, medication abortion has reduced women's dependence on medical systems, providing them with greater autonomy and control over their most important reproductive decisions. Administration of mifepristone, followed by a prostaglandin, is the gold standard for medication abortion. Mifepristone was initially approved in the late 1980s in China and France and has since been safely and effectively used by many millions of women worldwide. (4-7) Mifepristone diminishes the biological availability of progesterone, the hormone needed to sustain pregnancy. It is typically used in combination with misoprostol, which helps empty the uterus by inducing uterine contractions. (1) However, mifepristone is not available in many settings because of legal restrictions on the provision of abortion services. It is also unavailable in numerous settings where the population of reproductive-age women is small, since the high cost of drug registration makes entering the market unappealing to commercial entities. As a result, mifepristone is registered for pregnancy termination in only about 50 of the world's countries, the majority of which are in the developed regions of Europe. (8) Of the 20 developing countries where mifepristone is registered, two-thirds are in Asia. At present, mifepristone is registered in just five African countries (Mozambique, Zambia, Tunisia, South Africa and Ghana) and two Latin American countries (Mexico and Guyana). In many settings where mifepristone is unavailable, misoprostol is commonly used alone for early pregnancy termination. Misoprostol was originally developed in the mid-1980s for gastrointestinal indications and is licensed for such purposes in about 90 countries worldwide. (9), (10) The drug is inexpensive and stable at room temperature, making it ideal for inducing abortion in low-resource settings. The first reported widespread use of misoprostol for pregnancy termination was in Brazil in the late 1980s. (11),(12) Since then, knowledge and use of misoprostol by itself as a means of early pregnancy termination have grown throughout Latin America, as well as in other regions where abortion is legally restricted and mifepristone is unavailable. (13), (14) Although use of misoprostol alone is less effective than its use with mifepristone, misoprostol-only abortions are nevertheless a safe, acceptable and effective means of early pregnancy termination. (6), (15), (16) In still other settings, women lack access to both misoprostol and mifepristone. These include much of northern and western Africa; some parts of middle, eastern and southern Africa; and a number of countries in Asia and South America. (10) Perhaps not surprisingly, some of the world's most restrictive abortion laws and highest rates of abortion-related mortality are found in these same places. (17), (18) The acceptability of medication abortion among women seeking an abortion is high in developing countries, regardless of the setting or regimen used. (5), (6), (19) Furthermore, demand for the procedure appears to be increasing rapidly in many places. It is difficult to document specific trends in the use of medication abortion, because mifepristone is frequently unavailable and use of misoprostol is largely off-label or clandestine. …