Debate: How much medical supervision do women need to use medical abortion? Galina Maistruk, MD Coordinator, East European Alliance for Reproductive Choice

Regional perspective on medical supervision: 1. Legislation framework: In most countries in the region, abortion is legal Only doctors (Ob/Gyn) can be providers of abortion, including medical one Can only be provided in the hospital settings

2. Level of education of health care providers: Ob/Gyn: Basic education in medical university Post-graduate training (including practical skills development) Other physicians: low knowledge, no practical skills, no possibilities for training Other health care providers (midwifes, nurses): not a part of their responsibility and training

3. Pre- and post-abortion counseling Quality of the counseling is a key point for the success of medical abortion At the moment, Ob/Gyn has the best knowledge and skills in counseling, including post-abortion contraception.

4. Second trimester abortion Usually, Ob/Gyn Council is the final approval body of indications for termination of pregnancy in second trimester and Ob/Gyn are the only possible providers for second trimester abortion

5. Management of complications and incomplete abortion Referrals to other health care providers and health care facilities are not needed  Ob/Gyns may timely determine and manage complications.  Saves time to receive help in the same hospital  Reduces possible blaming of women Needed skills and equipment are available for other methods to terminate the pregnancy

Opportunities for the future: Strategic Assessment in the countries Development and implementation of comprehensive care for unwanted pregnancies programs Inclusion of other health care professionals into counseling and referral.

Thank you for your attention