Introducing MTP in lower and middle income countries

Introducing MTP in lower
and middle income countries
Helena von Hertzen, MD, DDS
Senior Medical Officer
Concept Foundation
Geneva
Product introduction = integrated set of
activities that prepares health systems to
use new health technologies, i.e.
how to best bring the services/technologies
to people who need them
Situation analysis
• Participatory by all stakeholders (public, private)
- current situation with VA – MA - user needs
- legal and policy requirements
- clients’ awareness about the situation
- service and health system capabilities (staffing,
financial resources, etc. )
- the prevalence of unsafe abortion and abortion-related
morbidity and mortality are often unknown in countries
that lack safe abortion services
Steps forward
• Build support for safe MTP care and introduction of
medicines at all appropriate levels
• Review evidence-based information – choose the best
drug regimen!
• Ensure that the product can be made available
- product registration, identify a local distributer
• Develop a distribution plan
- price; only in special hospitals or clinics by trained
providers; Pharmacies?
Introduction of MTP
• Design a pilot study and undertake it in selected
healthcare facilities.
• Disseminate the results of pilot introduction
• Train providers
• Scale up
Train providers – inform
women
• Meet information needs of providers
- national guidelines to be developed
• Meet information needs of women
- indications for MTP
- where to get safe services
- counseling about the procedure
Medabon® for MTP
Mifepristone (1x200mg tablet)
&
misoprostol (4x200μg tablets)
Concept Foundation
collaborates with
Sun Pharma, Mumbai, India.
Regimen recommended by
WHO and FIGO and RCOG
Effects of mifepristone and
misoprostol
• Mifepristone blocks progesterone receptors:
-> changes in the endometrial lining, decreasing
support to pregnancy, softening and dilation of the
cervix, and increased uterine sensitivity to prostaglandins
(such as misoprostol).
• Misoprostol contracts the uterus:
-> contractions expel the pregnancy.
MTP very similar to spontaneous miscarriage
Medical abortion regimen
up to 63 days
Day 1
0800
2000
Day 2
0800
24h
Day 3
0800
48h
Mifepristone 200 mg orally
and 24-48 hours later
800 µg misoprostol either vaginally or sublingually
Medabon registration in 23 countries
Registration submissions
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United Kingdom
Netherlands
Norway
Sweden
Finland
Denmark
Iceland
Hungary
Romania
Czech Republic
Estonia
Latvia
Bulgaria
Slovakia
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India
Nepal
Cambodia
Ghana
Mozambique
Zambia
Kenya
Ethiopia
Tunisia
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Belarus
Ukraine
Kazakhstan
Moldova
Serbia
Thailand
Mexico City
Malaysia
Viet Nam
Hong Kong
Mongolia
South Africa
Zimbabwe
Burkina Faso
Turkey
Colombia
etc.
Efficacy of Medabon
Registered up to 63 days’ gestation
In various studies
- the rate of complete abortion from 97%-99.2%
- the highest failure rate (continuing pregnancies)
has been 0.5%
- very few complications, such as heavy bleeding
The high efficay may be due to misoprostol in
Medabon, which dissolves better than e.g. Cytotec
Advantages of medical abortion
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When given the choice between aspiration and medical abortion,
most women and providers choose medical abortion - more
natural to women and easier to providers
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Introduction of medical abortion: unsafe abortion becomes rare:
abortion related morbidity and mortality decrease (e.g. in Nepal,
Cambodia, Ethiopia, Zambia)
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Abortions usually at 5-7 weeks; late abortions become rare
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Provision of post-abortion family planning – unwanted
pregnancies likely to decrease
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Easy to provide: trained mid-level providers, even pharmacists
The need for information
PATH, Ipas and Concept have produced
materials for health care providers,
programme managers, policy makers and
the media. They include:
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Medabon®: Medical & Service Delivery
Guidelines
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Medabon®: A Framework for
Introduction
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Medabon®: Frequently Asked
Questions (FAQ)
Medabon®: What You Need to Know
(sample patient brochure)
Medabon®: Background for Providers
of Emergency Care
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See www.medabon.info
Documents in English, French, Khmer, Nepali, Portuguese, Russian, Spanish, Thai,
Vietnamese
THANK YOU
plants that have been used when trying to terminate pregancies

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