Publication Cover
Reproductive Health Matters
An international journal on sexual and reproductive health and rights
Volume 22, 2014 - Issue sup44: Expanding access to medical abortion
1,915
Views
14
CrossRef citations to date
0
Altmetric
Original Research Articles

The introduction of first trimester medical abortion in Armenia

, , , , &
 

Abstract

In Armenia, abortion is the main means of fertility regulation; however, before research activities were initiated only surgical methods were available and the quality of services was low in some areas. Our clinical study from 2008–2011 aimed to show that early medical abortion is an acceptable and feasible option. A total of 700 eligible women with pregnancies up to 63 days LMP presenting for abortion were recruited for the study in five locations. Participants took 200 mg mifepristone and 800 μg buccal misoprostol 24–48 hours later. They returned for a follow-up visit two weeks after mifepristone administration. 95% of the women had successful abortions and 95% were satisfied with the method. In 2012–2013, we conducted a follow-up assessment to examine the ongoing provision and quality of medical abortion services at the former research sites. Medical record reviews, interviews and observations were carried out three times approximately six months apart. The assessment found that all five sites had continued providing medical abortion, with about half of eligible women choosing the medical method. Four of the five sites were achieving high success rates. Staff turnover and the lack of trained providers likely contributed to the higher failure rate at the fifth site. These findings provide evidence that first trimester medical abortion is an acceptable and feasible option for Armenian women and providers, and that high quality services are being delivered.

Résumé

En Arménie, l’avortement est le principal moyen de régulation de la fécondité ; néanmoins, avant le début des activités de recherche, seules les méthodes chirurgicales étaient disponibles et la qualité des services était faible dans certaines régions. Notre étude clinique de 2008 à 2011 souhaitait montrer que l’avortement médicamenteux précoce est une option acceptable et faisable. Un total de 700 femmes réunissant les conditions requises, avec une grossesse de moins de 63 jours depuis la DDR, qui s’étaient présentées pour un avortement ont été recrutées pour l’étude dans cinq sites. Les participantes ont pris 200 mg de mifépristone et 800 μg de misoprostol par voie buccale 24–48 heures après. Elles sont revenues pour une visite de suivi deux semaines après l’administration de la mifépristone. 95% des femmes avaient avorté et 95% étaient satisfaites de la méthode. En 2012–2013, nous avons mené une évaluation complémentaire pour examiner la prestation et la qualité des services d’avortement médicamenteux dans les précédents sites de recherche. Un examen des dossiers médicaux, des entretiens et des observations ont été réalisés à trois reprises à environ six mois d’intervalle. L’évaluation a révélé que les cinq sites avaient continué à pratiquer des avortements médicamenteux et que près de la moitié des femmes pouvant y prétendre choisissaient cette méthode. Quatre des cinq sites obtenaient des taux élevés de réussite. Le roulement du personnel et le manque de prestataires formés ont probablement contribué au taux plus élevé d’échec dans le cinquième site. Ces conclusions montrent que l’avortement médicamenteux du premier trimestre est une option acceptable et faisable pour les femmes et les prestataires arméniens et que des services de qualité sont assurés.

Resumen

En Armenia, el aborto es el principal medio para regular la fertilidad; sin embargo, antes de que se iniciaran las actividades de investigación, solo había métodos quirúrgicos disponibles y los servicios eran de baja calidad en algunas regiones. Nuestro estudio clínico realizado de 2008 a 2011 tuvo como objetivo mostrar que el aborto con medicamentos temprano es una opción aceptable y factible. En cinco lugares, se reclutó para el estudio un total de 700 mujeres elegibles con embarazos de hasta 63 días desde la FUM, que acudieron a la unidad de salud para tener un aborto. Las participantes tomaron 200 mg de mifepristona y 800 μg de misoprostol por vía bucal 24 a 48 horas después. Regresaron para una consulta de seguimiento dos semanas después de administrada la mifepristona. El 95% de las mujeres tuvo un aborto completo y el 95% estuvo satisfecha con el método. En 2012–2013, realizamos una evaluación de seguimiento para examinar la prestación continua y calidad de los servicios de aborto con medicamentos en los lugares donde se realizó la investigación. Se llevaron a cabo revisiones de los expedientes médicos, entrevistas y observaciones tres veces, a intervalos de aproximadamente seis meses. La evaluación encontró que los cinco lugares habían continuado prestando servicios de aborto con medicamentos, y que aproximadamente la mitad de las mujeres elegibles eligieron el método con medicamentos. Cuatro de los cinco lugares estaban logrando altas tasas de aborto completo. La rotación de personal y la falta de profesionales de la salud capacitados probablemente contribuyeron a una mayor tasa de aborto fallido en el quinto lugar. Estos hallazgos ofrecen evidencia de que el aborto con medicamentos en el primer trimestre es una opción aceptable y factible para las mujeres y profesionales de la salud en Armenia, y que se están prestando servicios de alta calidad.

Acknowledgements

We acknowledge the technical and financial support of an anonymous donor. We thank our local investigators and coordinators in Armenia, Drs. Ruzanna Abrahamyan, Armine Harutyunyan, Anna Aghajanyan, Aram Avalyan, and Gayane Grigoryan for study implementation and Tatyana Lotarevich from Gynuity Health Projects, New York, for data support.

Notes

* Vanadzor and Gyumri are the next biggest cities in Armenia after Yerevan. VH and GMH are the main providers of abortion in the Lori and Shirak regions, respectively.

a GMH (Gyumri Maternity Hospital, Gyumri)

a Two women were lost to follow up.

b Success defined as abortions completed without surgical intervention at any point during the study period.

c Incomplete abortion defined as having intrauterine debris or retained products of conception.

a Women could choose more than one answer.

a Women who took the drug ± 6 hours of the scheduled time were considered to have taken the drug on time.

b Women were instructed to take the misoprostol 24–48 hours after mifepristone. Women who took the drug ±6 hours of the scheduled time were considered to have taken the drug on time.

a Women could choose more than one answer.

a Women from the capital reported side effects on the home study card.

b Women in the region reported side effects at their exit interview.

c Other reported side effects included headache, dizziness, and joint pain.

a Success is defined as abortions completed without surgical intervention at any point during the study period.

b n = 110 because there were not enough cases in the review period to reach target sample.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.