November 2, 2011

Legalization of abortion in the Federal District of Mexico (Mexico City) has been a great achievement, but one important ingredient was missing: mifepristone. However, with Mexico’s recent decision to register mifepristone, women will now benefit from the highly effective combination of mifepristone and misoprostol to end early pregnancy.

Abortion during the first trimester was decriminalized in the Federal District in April 2007, and within 24 hours the Secretaría de Salud del Distrito Federal (SSDF) was providing abortion care. Women with no health insurance who reside in the Federal District could—and still do—receive abortions at no cost to them, while women living outside the Federal District pay on a sliding scale. Demand was overwhelming; women arrived in the middle of the night and slept on the sidewalk to be sure they would receive services when the clinic was open. Early on, procedures were almost always done with dilation and curettage (D&C), but with continual training, manual vacuum aspiration (MVA) has now almost entirely replaced D&C. However, because there weren’t enough doctors or space to offer MVA to all women, those women who were nine weeks pregnant or less and who lived within the Federal District were given medical abortion. Women more than nine weeks pregnant or who lived beyond the Federal District received MVA.

While mifepristone was not registered or available in Mexico, misoprostol was widely available. Therefore, the medical abortion regimen used since 2007 has been sequential doses of misoprostol 800 mcg taken by the buccal route.

Now mifepristone is registered in Mexico. It will soon be available to physicians in private offices and clinics who are registered to administer it, and it will also be stocked in pharmacies to be dispensed as a Class 3 prescription (similar to prescriptions for narcotics that require a physician’s prescription). Mifepristone has also been added to the Essential Drug List in the Federal District so the public hospitals and clinics will be able to work on procurement.

Outside of the Federal District, states in Mexico have laws that restrict induced abortion to limited circumstances, such as rape, risk of death or if the health of the woman is in great danger. However, there may be some indications within those laws for mifepristone/misoprostol use; how mifepristone and misoprostol are used in some states may evolve.

In addition, Gynuity Health Projects and SSDF recently completed a joint study using mifepristone 200 mg combined with misoprostol 800 mcg by the buccal route. One thousand women were recruited for the study and the results were significant: The high success rate of this regimen was virtually identical to the success rates of mifepristone and misoprostol medical abortion published elsewhere, explained Dr. Patricio Sanheuza, SSDF’s coordinator of reproductive health. Sanheuza described the study—as well as the status of mifepristone and plans to integrate it in the public sector—at a meeting organized by SSDF and Gynuity Health Projects in July in Mexico City.

The many organizations and individuals that worked tirelessly to make mifepristone available in Mexico are now hopeful that the results of this joint study, combined with on-going advocacy efforts, will continue to expand women’s access to this highly effective medical abortion drug.

* This story is published as part of the newsletter Medical Abortion Matters, November 2011.