Evaluation of a harm-reduction model of service delivery for women with unintended pregnancies in Peru

Unsafe abortion contributes substantially to maternal morbidity and mortality in South America, and a harm-reduction approach aimed at decreasing the negative health effects of unsafe abortion has shown promise. Use of misoprostol to induce an abortion is a safer and more effective alternative to other forms of abortion self-induction and studies have documented widespread availability of the drug in Latin America. Instituto Peruano de Paternidad Responsable (INPPARES) provides harm-reduction counseling to women who present with an unintended pregnancy. Providing women with guidance regarding the full range of options when confronted with unintended pregnancy, including information about safe and effective misoprostol regimens should a woman decide to terminate the pregnancy, has the potential to decrease abortion-related morbidity and mortality in Peru.

This project documents women’s experiences with and acceptability of the harm-reduction model of service provision as implemented in the INPPARES clinics in Peru (including whether and how they choose to take misoprostol). The project also determines effectiveness, safety, and acceptability of telephone follow-up as compared to in-person follow-up. These factors were measured through telephone questionnaires with 253 women who agreed to participate in this study, as well as in-depth interviews with 22 study participants. We also gathered clinical data from participants to assess their clinical outcomes and the safety of the harm-reduction model. Results suggest that the majority of women terminate their pregnancy using misoprostol without complications and that women are equally satisfied with both forms of follow-up. Results have been presented to stakeholders in Peru and at regional and US-based conferences.