From research to reality: the challenges of introducing medical abortion into service delivery in Vietnam.

Following the inclusion of mifepristone + misoprostol for early pregnancy termination into the Vietnam National Reproductive Health Guidelines in 2002, a team from the Ministry of Health, World Health Organization and Ipas assessed how best to move from clinical research to widespread public sector availability. After field visits to hospitals and discussions with stakeholders, the team endorsed the phased introduction of medical abortion alongside vacuum aspiration services to expand choice. They stressed the importance of patient-oriented information on what to expect as the abortion process takes place and the need for follow-up, also crucial in training of providers. Routine use of ultrasound to detect ectopic pregnancies or determine that abortion was complete was considered unnecessary The mandated four-hour observation period following misoprostol administration could be reduced. The National Guidelines, appropriately conservative at the start of the programme, should be amenable to modification as experience grows. Introduction is not possible without a steady supply of drugs at affordable prices. Ways to reduce the high price of mifepristone and deal with provider expectations of extra allowances, as with surgical abortion, are needed. Making medical abortion a viable option for most Vietnamese women will require provision at commune-level clinics through mid-level providers, and with home use an option. Other challenges include use of misoprostol alone and regulating provision in the private sector.