Community-based distribution of misoprostol for early abortion: evaluation of a program along the Thailand-Burma border.

Background: Although abortion is legal in Thailand for a number of indications, women from Burma residing in Thailand are rarely able to access safe services. We evaluated the outcomes of a community-based distribution program that provides migrant, refugee, and cross-border women from Burma with evidence-based information about and access to misoprostol for early pregnancy termination.

Methods: After determination of eligibility based on self-report and counseling, trained Network members instructed women to vaginally administer two 800-mcg doses of misoprostol 24 h apart and a third dose one week later, if needed. We systematically reviewed data from monitoring logbooks recorded over a three-year period to examine pregnancy outcomes. We also conducted in-depth open-ended interviews with the three leaders of the two Networks to understand better their perceptions and experiences as providers and counselors. We analyzed logbook data using descriptive statistics and interviews for content and themes using both deductive and inductive techniques.

Results: From January 2012 through December 2014, 918 women received early abortion care using misoprostol through the community-based distribution program. Of these, 885 women (96.4%) were not pregnant at follow-up, 29 were pregnant at follow-up (3.2%), and four women were lost to follow-up (0.4%). Our interviews revealed that providers are motivated to participate due to concerns surrounding unsafe abortion in the community and frame their work as a public health intervention.

Conclusions: The documented outcomes from this initiative may be valuable for those working to reduce harm from unsafe abortion in other legally restricted, low-resource, and/or conflict-affected settings.

Implications: Our findings demonstrate that community-based distribution of misoprostol can be a safe and effective strategy for increasing access to safe abortion, even in a legally restricted, low-resource setting. Determining if similar strategies can be successfully employed in other contexts appears warranted.