In Armenia, abortion is widely available, but women continue to undergo riskier means of terminating unwanted pregnancies. A major problem is that a well-established alternative method, which is recommended by the international medical community, is underutilized.
There are two methods of abortion available in Armenia. The most commonly known method is a surgical procedure performed in a clinic or a hospital. But this option carries some risk for women. In Armenia, most surgical procedures are performed using outdated protocols and older model aspirators. Women are also administered general anesthesia, and providers are not trained in current cervical priming techniques appropriate for later first- and second- trimester abortions
Another option is medical abortion, using two drugs, mifepristone and misoprostol, to terminate unwanted pregnancy. This method has been proven to be safe and acceptable. The combination of these two drugs produces an effectiveness rate of up to 98 percent for abortions occurring up to nine weeks after the most recent menstrual period, according to a World Health Organization (WHO) technical and policy guidance published in 2012.
In countries where mifepristone is not available, women have been using misoprostol alone to induce abortions since it first became available for the treatment of peptic ulcers in the 1980s. The first documented case study was conducted in Brazil, where in the late 1980s and 90s women seeking abortions were able to purchase misoprostol at pharmacies without restrictions. Today, in many Latin America countries, where stringent anti-abortion laws restrict women’s access to abortion in a clinic, misoprostol is a widely available option for women who otherwise would be forced to seek more risky abortions. Although misoprostol alone is not as effective when used without mifepristone, it is still from 75 percent to 90 percent effective in terminating pregnancy.
In late October, EurasiaNet.org reported that a significant number of Armenian women appear to be turning to pharmacies for misoprostol in order to conduct ‘do-it-yourself’ procedures. There is no evidence that shows women are unable to abort at home safely. Research conducted by Gynuity Health Projects has shown that women are able to follow instructions, and prefer medical abortion in the home for reasons of privacy and comfort.
The WHO and the government of Armenia have endorsed the home use of misoprostol in their official guidelines. In 2010, the Republic of Armenia’s Ministry of Health issued abortion guidelines, titled “Clinical Guideline on Organizing and Providing Health Care on Medical Abortion,” which recommend a mifepristone and misoprostol regimen for first trimester abortion, and includes home use of misoprostol. If substantial numbers of Armenian women are truly attempting to end their pregnancies without consulting a doctor (as the EurasiaNet article notes - no official data exists), then efforts need to be made to educate women and pharmacists about the correct regimen, and the importance of consulting a doctor before taking action.
A recent survey on abortion practices in Armenia indicates that some health-care providers were aware of medical methods of abortion and were making mifepristone and misoprostol available to women before abortion pills were officially available. Medical abortion using the two-drug regimen became available in Armenia in 2007. Unfortunately, access to this method today is not as wide as it could be, and there are no comprehensive national education campaigns in Armenia to inform women about medical abortion using mifepristone and misoprostol.
Medical abortion is a safe, alternative method to surgical abortion regardless of whether a woman administers pills at home, or in a hospital. It is important that providers are trained in evidence-based clinical guidelines and that they are able to provide abortion services that respect women’s dignity, privacy, and choice.
Ingrida Platais is Research Program Coordinator at Gynuity Health Projects.