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Reproductive Health Matters
An international journal on sexual and reproductive health and rights
Volume 22, 2014 - Issue sup44: Expanding access to medical abortion
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Original Research Articles

Towards safe abortion access: an exploratory study of medical abortion in Cambodia

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Abstract

In 2010, following its approval by the Ministry of Health, the medical abortion combination pack Medabon (containing mifepristone and misoprostol) was made available at pharmacies and in a restricted number of health facilities in Cambodia. The qualitative study presented in this paper was conducted in 2012 as a follow-up to longer-term ethnographical research related to reproductive health and fertility regulation between 2008 and 2012. Observations were carried out at several clinic and pharmacy sites and in-depth interviews were conducted with a purposive sample of 20 women who attended two MSI Cambodia centres and 10 women identified through social networks; six men (women’s male partners); eight health care providers at the two MSI centres and four pill sellers at private or informal pharmacies (who also provided health care services in private clinics). Although the level of training among the drug sellers and providers varied, their knowledge about medical abortion regimens, correct usage and common side effects was good. Overall, women were satisfied with the services provided. Medical abortion was not always a women-only process in this study as some male partners were also involved in the care process. The study illustrates positive steps forward being taken in making abortion safe and preventing and reducing unsafe abortion practices in Cambodia.

Résumé

En 2010, après son approbation par le Ministère de la Santé, le produit pour l’avortement médicamenteux Medabon, conditionnement qui associe la mifépristone et le misoprostol, a été commercialisé dans les pharmacies et dans un nombre restreint de centres de santé au Cambodge. L’étude qualitative présentée dans cet article s’est déroulée en 2012, comme prolongement d’une recherche ethnographique à plus long terme relative à la santé génésique et la régulation de la fécondité entre 2008 et 2012. Les observations ont été réalisées dans plusieurs dispensaires et pharmacies. Des entretiens approfondis ont été menés avec un échantillon raisonné de 20 femmes qui s’étaient rendues dans deux centres MSI Cambodge et dix femmes identifiées par les réseaux sociaux ; six hommes (des partenaires des femmes) ; huit prestataires de soins de santé dans les deux centres MSI et quatre vendeurs de comprimés dans des pharmacies privées ou informelles (qui assuraient également des soins de santé dans des dispensaires privés). Le niveau de formation des vendeurs de comprimés et des prestataires était divers, mais leur connaissance des schémas d’avortement médicamenteux, de leur utilisation correcte et des effets secondaires fréquents était bonne. Dans l’ensemble, les femmes étaient satisfaites des services fournis. L’avortement médicamenteux n’était pas toujours une « affaire de femmes » dans cette étude puisque certains partenaires masculins participaient également au processus. L’étude illustre les progrès accomplis pour rendre les avortements plus sûrs, tout en prévenant et réduisant les pratiques abortives à risque au Cambodge.

Resumen

En el año 2010, después de ser aprobado por el Ministerio de Salud, el paquete combinación para el aborto con medicamentos Medabon (que contiene mifepristona y misoprostol) se hizo disponible en farmacias y en un número limitado de unidades de salud en Camboya. El estudio cualitativo presentado en este artículo fue realizado en 2012 como seguimiento a investigaciones etnográficas más extensas relacionadas con la salud reproductiva y la regulación de la fertilidad del 2008 al 2012. Se realizaron observaciones en varias clínicas y farmacias, así como entrevistas a profundidad con una muestra intencional de 20 mujeres que asistieron a dos centros de MSI Camboya y 10 mujeres identificadas por medio de redes sociales; seis hombres (parejas de mujeres); ocho profesionales de la salud en los dos centros de MSI y cuatro vendedores de píldoras en farmacias privadas o informales (que también prestaban servicios de salud en clínicas privadas). Aunque el nivel de capacitación entre los vendedores de medicamentos y profesionales de la salud varió, tenían buenos conocimientos acerca de los regímenes de aborto con medicamentos, uso correcto y efectos secundarios comunes. En general, las mujeres estaban satisfechas con los servicios que recibieron. En este estudio, el aborto con medicamentos no siempre fue un proceso solo para mujeres, ya que algunas parejas de sexo masculino también participaron en el proceso de brindar cuidados. El estudio ilustra los pasos positivos hacia adelante que se están realizando para lograr que el aborto sea más seguro y para prevenir y reducir las prácticas de aborto inseguro en Camboya.

Acknowledgements

This research was made possible through three project/study grants: (1) “Transmission of HIV, HBV and HCV in health care settings: the cultural dimension of hygiene in health settings in Cambodia” (ANRS 12102 and Sidaction); (2) “Women reproductive health and care issues in the ANRS 12095 CIPRA KH001 CAMELIA Clinical Trial: an anthropological approach” (ANRS 12268 and Sidaction); and (3) “Women, men and the abortion pill: an anthropological approach to reproductive health issues in Cambodia” (European Society for Contraception and Reproductive Health), which raises specific issues on Medabon. We would like to thank the MSI Cambodia team in Phnom Penh who authorized the authors to conduct data collection in two MSI clinical centres and the MSI headquarters for their comments and suggestions on a previous version of this article. The information and views in this article are those of the authors and do not necessarily reflect the opinions of MSI.

Notes

* Medabon was developed by the Concept Foundation under an agreement with the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. It is licensed to and produced by Sun Pharmaceutical Industries Ltd, Mumbai, India.

† WHO. Safe Abortion: Technical and Policy Guidance for Health Systems. 2nd ed. Geneva; 2012.

* Ministry of Health, Options. The Comprehensive Abortion Care National Trainer’s Guide. Phnom Penh; 2010.

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