The three components
of feasibility are drugapproval, drug access and appropriate drug
use. Research is required as initial step to be followed by approval,
access and feasibility. There are six strategies that can be adopted
to make medical abortion feasible in India.
Continue Clinical / Acceptability
Studies
This will allow the providers to gain expertise and to know that
women like the method. A number of linicalinnovations need to be
assessed which may help increase feasibility e.g. decreasing the
drug cost to increase acceptability, promote home use of misoprostol,
decrease the need for follow-up visit and increase the efficacy
of drug (sublingual misoprostol under research).
Conduct Non-Clinical Studies
It is important to move beyond clinical research. Qualitative research
should document women’s experience and assess provider’s
knowledge, concerns, expectations and experiences. Operations research
is needed to obtain data from private and public sectors. KAP (knowledge,
attitude and practice) surveys of FOGSI and IMA members are required.
Novel services delivery options need to be examined and changing
profile of complications due to abortion at referral – level
facilities, need to be documented.
Table
1.3.1
Framwork for providing medical abortion |
Increase Provider Knowledge
Healthcare providers should be trained at clinic level and should
participate in organized training seminars. Medical abortion/MVA training
centres should be established or training for medical abortion be
incorporated in existing surgical MTP training courses. Relationship
should be developed with experienced providers who can offer feedback
as needed. Sessions on medical abortion should be set in professional
and advocacy meetings and flexibility to be incorporated in national
guidelines to facilitate adoption of evidencebased regimens. Inform
greater RH community about medical abortion and move beyond DGOs to
MBBS, GPs, and midlevel providers to even chemists.
Increase Client Knowledge
Client’s knowledge can be increased by appropriate media outlets
i.e.women’s magazines, talk/radio shows and school health talks.
Client material should be created in Hindi and regional languages.
The use of medical abortion facility in early pregnancy should be
stressed and the knowledge regarding serious adverse events should
be increased.
Document
Serious Adverse Events
Serious adverse events should be added to monthly MTP reporting
by registered providers or an alternative system needs to be evolved
for reporting all serious adverse events. Pharmaceutical companies
should be lobbied to establish monitoring system. It is essential
to assess the accuracy of media reports regarding the adverse events.
Debate Legislative Framework :
• Debate is required to discuss issues like:
- Should medical abortion fall under MTP Act?
- Can provision be made for midlevel providers?
- Can introduction of medical abortion be used as an issue
to reconsider MTP Act?
Safe, effective and acceptable use of medical abortion
is feasible in India. Several right steps need to be taken to move
from research to successful clinical practice. Physicians, clinical
researchers, social scientists, women’s health advocates and
trainers, all, have an important role to play to make medical abortion
feasible in India. |
