# Strengthening regional commitment to ensuring access to medical abortion medicines in WHO’s South-East Asia region: report of a participatory assessment and workshop

## TL;DR

This paper assesses access to medical abortion medicines in WHO's South-East Asia region and recommends actions to improve availability and safety.

## Contribution

The study provides a participatory assessment and workshop-based recommendations for improving access to medical abortion medicines in the region.

## Key findings

- Most countries in the region include misoprostol in their essential medicines lists, but not all.
- Only a few countries have national policies for safe abortion care.
- Private and NGO sectors support access to medical abortion in legal abortion countries.

## Abstract

In 2019, the World Health Organization identified improving access to safe abortion as an important priority toward improving sexual and reproductive health and rights and achieving Sustainable Development Goals. One strategy for addressing this priority is strengthening access to medicines for medical abortion. All 11 countries in the South-East Asia Region have some indications for legal abortion and permit post-abortion care. Therefore, strengthening access to medical abortion medicines is a reasonable strategy for improving access to safe abortion for the Region.

We applied an adapted version of an existing World Health Organization landscape assessment protocol for the availability of medical abortion medicines at the country-level in the South-East Asia Region. We collected publicly available data on the existence of national health laws, policies, and standard treatment guidelines; inclusion of medical abortion medicines in the national essential medicines list; and marketing authorization status for medical abortion medicines for each country and verified by Ministries of health. The findings were once more presented, discussed and recommendations were formulated during regional technical consultation workshop. Each country teams participated in the process, and subsequently, the suggestions were validated by representatives from Ministries of Health..

Few countries in the Region currently have national policies and guidelines for comprehensive safe abortion. However, either mifepristone-misoprostol in combination or misoprostol alone (for other indications) is included in national essential medicines lists in all countries except Indonesia and Sri Lanka. Few countries earmark specific public funds for procuring and distributing medical abortion commodities. In countries where abortion is legal, the private sector and NGOs support access to medical abortion information and medicines. Several countries only allow registered medical practitioners or specialists to administer medical abortion.

Following this rapid participatory assessment and technical consultation workshop, the World Health Organization South-East Asia Regional Technical Advisory and Sexual and Reproductive Health and Rights technical committee recommended priority actions for policy and advocacy, service delivery, and monitoring and evaluation, and indicated areas for support.

The World Health Organization suggests improving access to safe abortion to reduce maternal deaths. All 11 countries in the Region permit abortion for some indication. A safe and effective way to end a pregnancy is medical management of abortion with mifepristone and misoprostol pills, or just misoprostol. We reviewed global, regional, and national policy documents, guidelines, training materials and data about the use of medical abortion medicines in South-East Asia and then confirmed the results in a technical consultation workshop with key stakeholders from each country in the Region. We found that about half of the countries had national policies and guidelines related to safe abortion care. Misoprostol is included in the national Essential Medicines Lists in all countries except Indonesia and Sri Lanka. There is no standardized forecasting of resources needed for medical abortion medicines within health budgets in any of the countries except India and Nepal. Most countries only allow registered medical practitioners or specialists to provide medicines for medical abortion. To improve access the medical abortion medicines in the Region the World Health Organization recommended specific actions that should take priority.