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September 28, 2017
 
Greetings from New York,
We join friends and colleagues around the world to mark September 28th, International Safe Abortion Day. Abortion-related morbidity and mortality remain high due to restricted access, stigma, misinformation and lack of good services. Our work to improve access to safe abortion remains a top priority for Gynuity starting with involvement in seminal early research leading to mifepristone's approval in the U.S. We have decades of experience bringing medical abortion technology to women in many other countries, including technical input to international and national clinical guidelines. Our ongoing work includes service delivery innovations and support to governments and health systems to make evidence-based care available and within reach of all women. Our  "Spotlight on..." feature focuses on second trimester abortion services which are often highly stigmatized and challenging for health systems. In addition to recognition of International Safe Abortion Day, we hope you will join us to celebrate the 17th anniversary of mifepristone registration in the United States. We appreciate your interest in our work and look forward to sharing more news in the months ahead.





Very best wishes,
   
Beverly 
 
NEW AND NOTEWORTHY
New Grant from OCs OTC Working Group  
In June 2017, Gynuity staff member Tara Shochet was awarded one of six grants from the OCs OTC Working Group to conduct research to support the effort to make an over-the-counter oral contraceptive a reality in the US. Gynuity's project will assess the impact of such a status change on low-income women living in rural Iowa.
MATERIALS
How to Use Multi-level Pregnancy Tests
Gynuity recently developed an instructional video to assist women using multi-level urine pregnancy tests to determine on their own whether or not their abortion is complete after using Medical Abortion Regimens. The video is 2-3 minutes long and is available in English, Spanish and Russian.  

Learn more about our work using multi-level pregnancy tests here.

GYNUITY-HOSTED WEBINARS
Improving Second Trimester Abortion Care, July 12th, 2017
In collaboration with the Abortion and Postabortion Care Consortium (APACC), Gynuity organized a webinar on Improving Second Trimester Abortion Care. 
Moderator:  Dr. Nathalie Kapp, Senior Medical Scientist,  Ipas
  • "New evidence, guidance, and innovations in second trimester abortion", Dr. Monica Dragoman, Medical Associate, Gynuity/ Associate Medical Director, PPNY
  • "Self-induction in pregnancies more than 13 weeks: Data from Indonesia & Argentina". Dr. Caitlin Gerdts, Vice President for Research, Ibis Reproductive Health
  • "Expanding and improving second trimester abortion programs: Lessons learned from West and North Africa". Dr. Selma Hajri, General Secretary, Groupe Tawhida Ben Cheikh
Remote Provision of Medical Abortion: Clinical Issues in Treating Women from a Distance, August 21st, 2017
Gynuity co-hosted, with Stanford University and the National Abortion Federation, a webinar entitled "Remote Provision of Medical Abortion: No Walls for Us; Clinical Issues in Treating Women from a Distance." 
Moderator: Jennifer Blum, Vice President, Gynuity Health Projects
  • "How to make sure the pregnancy is not too late?" Dr. Monica Dragoman, Medical Associate, Gynuity Health Projects/Associate Medical Director, PPNYC
  • "What about pregnancies that aren't seen on ultrasound?" Dr. Matthew Reeves, Medical Director, National Abortion Federation
  • "Do we need follow-up?" Dr. Paul Blumenthal, Professor of Obstetrics and Gynecology, Stanford University
The session was well attended with 200 people participating. The activity was approved for 1.5 AMA PRA Category 1 Credits™. A commentary summarizing the webinar content is forthcoming.
MEETINGS
General Membership Meeting of the Reproductive Health Supplies Coalition (RHSC), Dakar, Senegal, 23-27 October, 2017
Our team organized a panel on Increasing Access to Abortion Commodities in Countries with Limited Legal Indications for Induced Abortion: Barriers and opportunities 
26 October (time and location to be confirmed)
Moderator: Jennifer Blum, Gynuity Health Projects
  • "The Impact of policy and social attitudes on efforts to increase access to abortion medicines in Latin America". Agustina Ramón Michel, Law professor, researcher adjunct at Centro de Estudios de Estado y Sociedad - CEDES, and member of CLACAI
  • "From registration to availability: Lessons from IPPF's experience bring medical abortion pills to Francophone Africa". Manuelle Hurwitz, IPPF, London
  • "Development of additional maternal health uses of mifepristone and misoprostol as a strategy to facilitate registration of these medicines globally". Jennifer Blum, Gynuity Health Projects, New York
At the upcoming regional FLASOG Congress, jointly organized with FEMECOG, Gynuity and colleagues are participating in the following sessions and activities.

5 November -  Curso Pre-congreso Derechos Sexuales y Reproductivos en Latinoamérica 
11:10 - 11:40  
Optimizando roles de los prestadores de atención en salud materna y salud reproductiva, D r. Joao Paulo Souza, Organización Mundial de Salud
12:40 - 13:10 
Las ventajas de usar la mifepristona con el misoprostol para la evacuación uterina, Dra. Beverly Winikoff, Presidenta, Gynuity Health Projects

6 November -  Simposio Derechos Sexuales y Reproductivos en Latinoamérica
9:55-10:15  
Optimizando roles de los prestadores de atención en salud materna y salud reproductiva. Dr. Joao Paulo Souza, Organización Mundial de Salud

7 November -  Panel jointly organized by Gynuity and FIGO
9:30-11:00 am 
Perspectivas nuevas sobre la hemorragia postparto (HPP) y su manejo.
Moderator: Dr. Ernesto Castelazo
  • Más allá de la prevención: Nuevas estrategias usando el misoprostol para el manejo de hemorragia postparto. Jill Durocher, Gynuity Health Projects, Nueva York, EEUU
  • ¿Qué tan importante es la vía de administración de oxitocina para reducir el sangrado postparto? Dr. Guillermo Carroli, CREP, Rosario, Argentina 
  • (Re)definiendo HPP: Nueva evidencia sobre el índice de shock como un indicador nuevo para evaluar la severidad de la HPP. Dra. Elba Mirta Morales, Hospital JR Vidal, Corrientes, Argentina
  • Intervenciones terapéuticas prometedoras para controlar la hemorragia severa: Nueva evidencia, resultados claves, y novedades sobre tratamientos recomendados (Dr. Joao Paulo Souza, Organización Mundial de Salud, Geneva, Switzerland)
Symposium on Innovations in Abortion and Postabortion Care, Hammamet, Tunisia, 8-9 May, 2017
Gynuity, in collaboration with the Tunisian National Family Planning Board (ONFP) and Group Tawhida Ben Cheikh (a regional SRH NGO), hosted a regional symposium in Tunisia with representation from over 15 francophone countries from West and North Africa. This meeting of expert clinicians, advocates, and researchers featured sharing and discussion of new clinical and programmatic evidence and innovations in the provision of early and later medical abortion and post abortion care. The symposium included interactive group work around new international guidelines, including those of the WHO. Country teams worked together to evaluate the potential for task-sharing in their respective settings and put together a work plan of potential regional strategies. Participants had the opportunity to visits local ONFP primary care clinics where a range of reproductive health care services including medical abortion are offered by midwives. This encounter provided a rare opportunity to bring together trailblazers from the region and contributed to the efforts to increase access and availability to high quality MA and PAC services in the region.
International Confederation of Midwives (ICM) World Congress, Toronto, Canada, 18-22 June, 2017
In collaboration with FIGO, Gynuity hosted a plenary panel on "New task-sharing models and technologies for facilitating access to timely management of PPH at all levels of care." The panel was moderated by Dr. Beverly Winikoff and featured presentations on new evidence and their implications for improving the diagnosis and management of PPH by a range of providers, including midwives. A second plenary panel on task sharing in abortion and postabortion care presented Gynuity's work, regional experiences, and models for streamlining and improving access to abortion care globally. Gynuity, as a member of the Abortion and Postabortion Consortium (APACC), co-organized with APACC and Pathfinder International a breakfast workshop that focused on case studies in abortion care to facilitate an interactive update of ICM Competency 7 (provision of abortion care).
FOGSI International Congress, Hyderabad, India, 6 August 2017
At the FOGSI International Congress on Clinical Challenges in Obstetrics & Gynaecology, a panel co-organized by Gynuity and FIGO shared evidence about new technologies and program innovations for the management of preeclampsia and postpartum hemorrhage, the two leading causes of maternal mortality. We presented completed and ongoing research from Africa, Latin America, South Asia, and Central Asia, with a focus on low-resource settings and lower levels of healthcare systems, where options remain limited.
Technical Seminar on "Use of mifepristone and misoprostol in gynecology and obstetrics", Santiago, Chile, 24 August, 2017
The Constitutional Court of Chile ruled in favor of the decriminalization of abortion in cases of risk to a woman's life, non-viable fetus, and rape on August 21st, 2017. That same week, Gynuity Health Projects led a technical meeting on medical abortion in Santiago, Chile, in partnership with a local advocacy organization, Corporación Miles, and colleagues from the National Abortion Federation (NAF). Meeting participants came from Santiago and other regions throughout the country and included midwives, representatives from hospitals, universities, and NGOs. The court decision generated significant enthusiasm and interest among meeting participants to receive the latest evidence and recommendations for use of abortion medications and strategies for integration of medical abortion into services to ensure high quality services for women.
2nd Regional National Abortion Federation (NAF) Congress, Mexico City, Mexico, 7-8 September 2017
Gynuity participated at NAF's Latin American regional conference, which convened nearly 600 people and addressed different aspects of abortion care. Gynuity staff were on the conference organizing committee, prepared two panels, and gave several presentations of new evidence in first and second trimester medical abortion care. 
RECENT STAFF PUBLICATIONS
Shochet, T., Comstock, I.A., Ngoc, N.T.N., Westphal, L.M., Sheldon, W.R., Loc, L.T., Blum, J., Winikoff, B., Blumenthal, P.D. Results of a pilot study in the U.S. and Vietnam to assess the utility and acceptability of a multi-level pregnancy test (MLPT) for home monitoring of hCG trends after assisted reproduction. BMC Women's Health. 2017;17:67.

Mundle, S., Bracken, H., Khedikar, V., Mulik, J., Faragher, B., Easterling, T., Leigh, S., Granby, P., Haycox, A., Turner, M.A., Alfirevic, Z., Winikoff, B., Weeks, A.D.  Foley catheterisation versus oral misoprostol for induction of labour in hypertensive women in India (INFORM): A multicentre, open-label, randomised controlled trial. The Lancet. 2017 Aug 12;390(10095):669-680.  Read a blog post about this article posted on the Maternal Health Task Force blog here .

Morris, J.L., Winikoff, B., Dabash, R., Weeks, A., Faundes, A., Gemzell-Danielsson, K., Kapp, N., Castleman, L., Kim, C., Ho, P,C., Visser, G,H,A. FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics. International Journal of Gynecology & Obstetrics. 2017;138: 363-366.

Rajbhandari, S.P., Aryal, K., Sheldon, W.R., Ban, B., Upreti, S.R., Regmi, K., Aryal, S., Winikoff, B. Postpartum hemorrhage prevention in Nepal: A program assessment. BMC Pregnancy and Childbirth. 2017 Jun 5;17(1):169.  Read a summary of this article here.
SPOTLIGHT ON...Spotlight
Second Trimester Abortion Care

Over the past decade, Gynuity has implemented several research projects exploring the role of medical abortion in the second trimester. These efforts have evaluated combined regimens of mifepristone and misoprostol versus misoprostol alone, documented the potential of home use of mifepristone, compared sublingual and buccal routes for misoprostol, considered shortening the interval between mifepristone and misoprostol dosing, and explored the efficacy and safety of using more than the previous standard maximum of 5 doses of misoprostol. Gynuity has also been exploring the potential for medical management of intrauterine fetal death (IUFD) in the second trimester using mifepristone-misoprostol and misoprostol alone. 
 
New information on medical management of second trimester abortion has been adopted unevenly. As a result, second trimester medical abortion management practices vary widely, are often driven by provider preferences and are not reflective of the best evidence. Gynuity is currently co-chairing the research stream of SERAH (Supporting Expanded Roles for Safe Abortion Care by Health Workers), an advisory group that aims to fill information gaps identified in the WHO's abortion task-sharing 2015 guidance and to disseminate the findings.

Gynuity collaborates with international organizations, such as FIGO and WHO, to provide technical assistance in the revision of international guidelines, such as FIGO's 2017 misoprostol guidelines that no longer recommend a maximum number of doses of misoprostol for second trimester abortions.
Tel: 1+212.448.1230