Challenges Faced and Lessons Learned in Expanding access to Medical Abortion in

Mexico City

Facilitators, Successes, Problems, Barriers and Failures

Patricio R. Sanhueza, MDMinistry of Health, Mexico City

ICMA ConferenceLisbon, Portugal

March 2010

Law Approval

Challenge:To implement a program, develop the guidelines

and abide to the law in 24 hrs.

Challenge:To implement a program, develop the guidelines

and abide to the law in 24 hrs.

14 Hospitals: Existing infrastructure: G&O Services, Surgical Rooms, US, Labs,

ICU. We felt safe. Reducing the chance of mistakes. Volunteer staff.

Pressure: Political. Media. Within the Ministry. Anti-choice groups.

Assessing the potential number of requests for the service.

Only 20 Ob&Gyn. doctors available.

Service was to be provided on a show-up, no appointment basis.

Anti-choice activities outside the hospitals.

Friendly fire (inside-outside).

Confusion on choosing the “right” model of care among the different options suggested by NGOs.

Getting Prepared

The law was approved, but there was no budget assigned to the program.

Visits to international models of care.

In-site training for health providers by Ipas.

Competing for surgical room time in hospitals.

Pro-Choice go at last.

Hospitals’ Administrations didn’t acquire enough manual vaccum aspirators.

Initital Steps

Adjusting to the new terminology:

From “Ob&Gyn doctor” to “provider” to “Doctors for Choice”.

Temporary job contracts with no benefits.

Volunteer doctors: Committed with reducing MM.

Worked extra shifts.

A minority within the hospitals.

Teamed to fight for women’s lives.

Doctors for choice.

Problems

Doctors were trained to perform D&C.

Many regimes, different uses.

Follow-ups: 24hr, 48hr, 72hr, 1 week, 2 weeks.

US on Follow-up: Incomplete abortion and ongoing pregnancy.

Complications at home.

Women don’t show up on follow-up visits.

Lack of control on patients.

Medical Abortion with Misoprostol

Medical Abortion with Misoprostol

Gynuity meeting on 2007Gynuity meeting on 2007

Consensus meeting among NGOs on 2007

(sponsored by The Population Council and Gynuity)

Consensus meeting among NGOs on 2007

(sponsored by The Population Council and Gynuity)

Official support by the Minister of Health

(Dr. Manuel Mondragón y Kalb)

Official support by the Minister of Health

(Dr. Manuel Mondragón y Kalb)

Buccal RegimeBuccal Regime

Medical Abortion with Misoprostol

Day 1Misoprostol

800 µg buccal

4 hours afterMisoprostol

800 µg buccal

Day 15Follow-up visit

MA Protocol

AVERAGE MONTHLY PROCEDURESBY TECHNOLOGY

25% 69% 67% 52%

69% 32% 42% 30%

41% 5% 1% 1%

PROCEDURES PER MONTHBY TECHNOLOGY

Total: 37,104February 25, 2010

Medical abortion accounts for 70% of all legal abortions.

The majority of women request a legal abortion before the 9 weeks.

Women are taking misoprostol at home, following the indications given by doctors.

Informational material, call centers and job-aids are key elements to provide the services and address complications.

Medical abortion has had a good impact in women and providers.

The procedure is safer and less traumatic.

Results

MA as a first-line treatment for the majority of women, thus reducing surgical procedures.

The success of the buccal regime in terms of efficacy, comparable to that of WHO sublingual regimes.

Expansion of services to primary care level.

Results

NAF affiliation which speaks of the quality of the services.

NAF affiliation which speaks of the quality of the services.

COFEPRIS approval for a clinical study on Mifepristone-Misoprostol to be conducted jointly by Gynuity Health Projects and Mexico City’s MOH.

Good News

Good News

Sta Catarina Center

BW

New Health Center

New Health Center

New Health Center