How Much Medical Supervision Do Women Need to Use Medical Abortion Safely & Effectively in Early Pregnancy? Dhaval S. Patel, PhD, MPH Vice President & Health Systems Director Marie Stopes International (MSI) Marie Stopes International (MSI)

2 The Quick Answer Professionally Speaking and from MSI’s Experience, Women Need “VERY LIMITED to NO” Supervision To Use Medical Abortion

3 MSI Background International Organization in 43 Countries International Organization in 43 Countries Primarily a Service Delivery Provider for Safe Abortion & Family Planning Primarily a Service Delivery Provider for Safe Abortion & Family Planning Multiple Channels for Services, Products, & Information Multiple Channels for Services, Products, & Information Children By Choice, Not Chance Children By Choice, Not Chance

4 Principles for Medical Abortion Quality Quality Choice Choice Access Access Satisfaction Satisfaction

5 Medical Abortion Channels Static Centres Static Centres Outreach Efforts Outreach Efforts Community-Based Activities Community-Based Activities Social Franchisees Social Franchisees Social Marketing Sales Social Marketing Sales

6 Medical Abortion Channels Static Centre Social Marketing Outreach Community-Based Activities Social Franchising More Supervision Less Supervision More Clinical Less Clinical Less Access More Access Direct Follow- Up & Referrals Indirect Follow-Up & Referrals

7 Experience to Date All 43 MSI countries offer medical abortion in their static centres All 43 MSI countries offer medical abortion in their static centres 21 MSI countries in the last 3 years offer it through the other delivery channels with safety and effectiveness with “limited to no” supervision 21 MSI countries in the last 3 years offer it through the other delivery channels with safety and effectiveness with “limited to no” supervision Once medical abortion is introduced outside the MSI static centre, there is no shortage of demand, but product supply can be an issue. Once medical abortion is introduced outside the MSI static centre, there is no shortage of demand, but product supply can be an issue.

8 Experience to Date “Limited to no” supervision implies that quality is paramount in terms of 1) the actually drug, and 2) process of delivery. “Limited to no” supervision implies that quality is paramount in terms of 1) the actually drug, and 2) process of delivery. At a minimum, women must be given 1) information, 2) choice, and 3) ideas for follow-up & referrals in a “limited to no” supervision context. At a minimum, women must be given 1) information, 2) choice, and 3) ideas for follow-up & referrals in a “limited to no” supervision context. MSI global evidence shows that “limited to no supervision” increases access and satisfaction. MSI global evidence shows that “limited to no supervision” increases access and satisfaction.