Achievements of the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences in South‐Southeast Asia

Abstract

Since 2008, the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences has contributed to ensuring the substitution of sharp curettage by manual vacuum aspiration (MVA) and medical abortion in selected hospitals in participating countries of South-Southeast Asia. This initiative facilitated the registration of misoprostol in Pakistan and Bangladesh, and the approval of mifepristone for "menstrual regulation" in Bangladesh. The Pakistan Nursing Council agreed to include MVA and medical abortion in the midwifery curriculum. The Bangladesh Government has approved the training of nurses and paramedics in the use of MVA to treat incomplete abortion in selected cases. The Sri Lanka College of Obstetricians and Gynaecologists, in collaboration with partners, has presented a draft petition to the relevant authorities appealing for them to liberalize the abortion law in cases of rape and incest or when lethal congenital abnormalities are present. Significantly, the initiative has introduced or strengthened the provision of postabortion contraception.

Abortion and fertility control in Pakistan: the role of misoprostol

“…These numbers are surprising, given that abortion in Pakistan occupies an ambiguous legal, religious and social position. Since 1997, Pakistani law has permitted abortion to save a woman's life and to provide ‘necessary treatment’ 2 3. However, no details are given as to whether saving the mother's life also extends to her mental and social wellbeing, and the term ‘necessary treatment’ is not clarified.…”

“…Given these circumstances, women have traditionally sought clandestine services 3 6. While these services offer women a greater degree of confidentiality and some protection from punitive measures,3 they are typically administered by poorly trained providers lacking the appropriate equipment and medical training needed to safely perform the procedure 6 7.…”

“…While these services offer women a greater degree of confidentiality and some protection from punitive measures,3 they are typically administered by poorly trained providers lacking the appropriate equipment and medical training needed to safely perform the procedure 6 7. Risks of acute and long-term complications such as damage to reproductive organs and secondary infertility are elevated in such unsafe settings 8.…”

Access to services: advocacy for abortion

“…There are numerous international initiatives for collaboration between countries to share experiences to improve abortion care 12. The World Health Organization has produced excellent guidance for the provision of abortion services13 but ideally this should be complemented by national guidelines on specific issues, as exemplified by the clarification of roles and responsibilities by the UK Department of Health on 23 May 2014 14…”

“…In Bangladesh, for example, abortion is illegal, except to save the life of a woman, but ‘menstrual regulation’ is widely accessible through a legal arrangement whereby this intervention can be done in the absence of confirmation of pregnancy 12. As induced abortions can be carried out with the same equipment that is used for the evacuation of retained products of conception following incomplete miscarriage, the clinical provision of services is facilitated.…”