Providers' Knowledge of Medication Abortion Is Lacking in Guatemala
Ramashwar, S., International Perspectives on Sexual and Reproductive Health
Awareness of medication abortion is almost universal among obstetrician-gynecologists in Guatemala, but far smaller proportions know the recommended regimens or have adequate knowledge of the country's abortion laws. (1) More than 90% of the obstetrician-gynecologists who participated in a national study had heard of misoprostol, but just 22-35% knew the dosages required to induce abortion at particular gestational ages. Moreover, although 73% knew that abortion is legal in Guatemala when a woman's life is in danger, 24-28% mistakenly believed that it is also permitted when a woman's health is at risk or in cases of fetal anomaly.
Because of Guatemala's restrictive abortion law-pregnancy termination is legal only to save a svoman's life-as well as the stigma surrounding the procedure, women trying to obtain an abortion often use illegal providers, and unsafe abortion has been the country's fourth leading cause of maternal death for the past decade. Moreover, one of the two drugs typically used for medication abortion (mifepristone) is unavailable in Guatemala, and the other (misoprostol) is not officially indicated for abortion. Obstetrician-gynecologists have played a key role in introducing and expanding the use of reproductive health services in other countries; to explore whether practitioners are in a position to play a similar role in Guatemala, the current study examined providers' knowledge of and attitudes toward medication abortion.
All members of the Guatemalan Society of Gynecologists and Obstetricians who worked in private practice were recruited for the survey from February to August 2010; nonmember colleagues working at the same sites were also invited to participate. Participants completed a multiple-choice questionnaire that asked about their social, demographic and professional characteristics and assessed their knowledge of medication abortion and its legality; the survey also included questions about their approval of this type of abortion under certain circumstances, such as anembryonic pregnancy (a pregnancy in which the fertilized egg does not develop), severe eclarnpsia, or fetal anomaly or death. The response rate was 71%. In addition to calculating descriptive statistics, the researchers conducted a multivariate regression analysis to identify provider characteristics associated with approval of certain uses of medication abortion.
Most of the 172 respondents were male (82%) and married (81%), and about half had at least three children and were aged 50 or older (47% each). Three-fifths had at least 20 years of medical experience (61%).
Almost all of the obstetrician-gynecologists knew of misoprostol (92%). However, only small proportions knew what dosages were recommended for abortions administered at less than nine weeks' gestation (22%) or less than 12 weeks' gestation (35%), and just one-quarter (25%) had heard of rni fepris tone. …