Establishing second trimester abortion services: experiences in Nepal, Viet Nam and South Africa.

This paper describes experiences and lessons learned about how to establish safe second trimester abortion services in low-resource settings in the public health sector in three countries: Nepal, Viet Nam and South Africa. The key steps involved include securing the necessary approvals, selecting abortion methods, organising facilities, obtaining necessary equipment and supplies, training staff, setting up and managing services, and ensuring quality. It may take a number of months to gain the necessary approvals to introduce or expand second trimester services.

Clarifying values and transforming attitudes to improve access to second trimester abortion.

Access to safe second trimester abortion services is poor in many countries, sometimes despite liberal laws and policies. Addressing the myriad factors hindering access to safe abortion care requires a multi-pronged strategy. Workshops aimed at clarifying values are useful for addressing barriers to access stemming from misinformation, stigmatization of women and providers, and negative attitudes and obstructionist behaviours.

Introduction of the dilation and evacuation procedure for second-trimester abortion in Vietnam using manual vacuum aspiration and buccal misoprostol.

Background: The dilation and evacuation (D&E) procedure was modified for use in a low-resource setting where access to electric vacuum aspiration is limited.

Method: In this demonstration project, buccal misoprostol is used for cervical preparation, followed by evacuation using manual vacuum aspiration (MVA) and forceps. Senior physicians at the Hanoi Obstetrics and Gynecology Hospital were trained in D&E and subsequently conducted 439 D&E procedures.