Medical Abortion Since late 2007 Gynuity has been working closely with the Secretariat of Health of Mexico City (SSDF), where abortion was legalized in April of the same year, to equip affiliated clinical providers with the evidence base they need to provide safe and effective abortion services. Gynuity supported and guided the heads of the legal pregnancy termination program in SSDF hospitals throughout the Federal District in their definition and adoption of an evidence-based medical abortion protocol that has been incorporated in the program procedures manual. Gynuity also helped to introduce mifepristone-misoprostol services, the gold standard for medical abortion. We remain involved in capacity-building activities as the SSDF implements a planned program expansion to the primary care level. Misoprostol for Postabortion Care At the request of the SSDF, Gynuity also trained multidisciplinary clinical and support staff of secondary and tertiary level hospitals to integrate misoprostol as a first line treatment for incomplete abortion in emergency room settings. The aim of the introduction is to reduce reliance on surgical procedures, use of general anesthesia, and hospitalization of women for this common women's health concern. Gynuity provides technical support to the SSDF to monitor and evaluate this service. Since 2010, Gynuity has also been working to expand the use of misoprostol for treatment of incomplete abortion in Mexican states. Initial states and specific hospitals were chosen in collaboration with the Mexican Ministry of Health and state-level Secretariats; local partners work in hospitals with a high PAC caseload and where D&C with hospitalization is the standard of care. The project involves disseminating the national guidelines on obstetric hemorrhage that indicate its use for this indication; training of clinical care providers on evidence-based regimens; documenting women treated with the new protocol, providing technical assistance on service delivery issues, and disseminating materials and resources to project hospitals, Secretariats and other NGOs and women's health organizations in each state.
Additional activities include: * Supporting the introduction of a mifepristone-misoprostol regimen through clinical studies in hospitals and primary health care centers and documenting efficacy, safety, and acceptability in these settings. * Training primary health care centers in use of available medical abortion regimens for early termination of pregnancy. * Training and technical support on the use of misoprostol for treatment of incomplete abortion. * Development of tools to document service delivery procedures and outcomes. * Clinical studies related to medical abortion service delivery improvements, and the use of progestin-based contraceptives after medical abortion.