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Awareness Raising on Sexual and Reproductive Health and Rights

To protect women's sexual and reproductive health and rights Women's Rights Center (WRC) works in the following directions:

  

Awareness Raising on Sexual and

Reproductive Health and Rights

WRC uses every opportunity to spread information on medical abortion, the perspectives and advantages of the safe abortion method that became available in the country.

Activities on raising public awareness were considered necessary to carry out not only in Yerevan, but in the regions as well. A significant importance was given to informing women on safe abortion, on possibilities to acquire knowledgeable consultation of drug usage.

 

Informative Booklets on Medical Abortion have been elaborated and disseminated during the trainings by the doctors-participants (obstetricians - gynecologists) to women during their visits to relevant institutions.The maternal homes and clinics happened to be provided with the large amount of booklets for informational dissemination among the patients as well.

To get acquainted to the booklet please follow the link:  http://wrcorg.am/en/publications.htm 

Means of mass media are also engaged in promotion of the method as well.

 

  
  Series of TV programs devoted to women’s sexual and reproductive health and rights

 

Women’s Rights Center organized series of television programs in different regions of Armenia: Gegharkunik, Lori and Kotayk. The first TV program took place on September 28, 2015, which is the International Day of Action for Access to Safe and Legal Abortion and is aimed to disseminate information on safe abortion method worldwide. The programs were in Q&A format and hosted Dr. G. Avagyan, the Head of Maternal and Reproductive Health Department of RA Ministry of Health, Dr. V. Hovhannisyan, the Head of the Department of Gynecology & Obstetrics of Maternity Hospital of Gegharkunik region, Dr. A. Avalyan, the Head of the Department of Gynecology & Obstetrics of Maternity Hospital of Lori region and Dr. V. Adamyan from the Department of Postpartum Care of Maternity Hospital of Kotayk marz. This series of programs was one more opportunity to shed light on the issue of women’s sexual and reproductive health and rights. During the programs current situation on abortions in different regions and in Armenia in whole was introduced and advantages of medical abortion comparing to other methods of pregnancy termination were accessed. The lack of awareness and knowledge of population on the issue of sexual and reproductive health and rights was underlined by all guests. The new Clinical Guideline on provision of medical abortion in the first and second trimesters was presented during the TV programs and Dr. Avagyan mentioned that it would be provided to the Maternity Hospitals of Armenia to make the process of safe termination of pregnancy guaranteed. The TV programs were concluded with encouraging women to have a lot of children and in case of unwanted pregnancies to choose safe abortion method of pregnancy termination.

 

Revised Clinical Standard on Organization and Delivery of Medical Aid in Medical Abortion

Within the framework of the research study on the 2nd trimester of unwanted pregnancy medical abortion implemented at the Republican Institute of Reproductive Health, Perinatology, Obstetrics and Gynecology the Working Group revised the already published Clinical Standard (2010). The aim of the republished Clinical Guideline is to assist doctors in using evidence-based practice when providing comprehensive medical aid in terminating unwanted pregnancy. It suggests medical abortion as an alternative way of terminating unwanted pregnancy. The Guideline includes general information on pregnancy termination in Armenia, organization and performance of medical abortion in the first and second trimester, drugs and prescription terms for medical abortion, indications, contraindications and precautions of medical abortion, getting rid of side effects and treatment of complications. 

 

Evaluation and monitoring research study in Yerevan, Gyumri and Vanadzor

Women’s Rights Center (WRC) has continued its activities to raise awareness on medical abortion method, promote access to medical abortion focusing on the needs of women in Armenia.
A monitoring and evaluation research study dating from the period of April, 2013 - 30 September, 2013 was held in 5 hospitals in Yerevan, Gyumri and Vanadzor, namely, Republican Institute of Perinatology, Obstetrics, Gynecology and Reproductive Health, Yerevan State Medical University, Centre of Family Planning and Sexual Health, Gyumri Maternity Hospital, Vanadzor Medical Center. The research is aimed at following up as how the abortion in the above mentioned 5 research sites was done during the mentioned period, whether doctors inform patients about medical abortion, its benefits, as well as side effects or not, whether the practice of medical abortion has been increased ever since it has been practiced in Armenia, etc.
About 250 women in the clinics who have had a medical abortion were investigated. The results of the research study showed that all the cases of women under examination were engaged successfully.

 

Dissemination Meeting on Medical Abortion in Gyumri and

Training on MA in Yerevan

Two meetings on medical abortion in Armenia were held on April 16 - 17, 2012. Co-principal investigator and study monitor from Georgia and New York organized a dissemination meeting in Gyumri followed by the training on medical abortion in Yerevan. These meetings were intended to present findings of medical abortion studies in Yerevan, Gyumri and Vanadzor, mechanism of mifepristone-misoprostol application in medical abortion, its indications and contraindications, as well as provision of medical assistance according to the guideline recommendations.

During dissemination meeting in Gyumri doctors from Yerevan and different regions of Armenia shared their experience on medical abortion providing facts, statistics and other information. According to the statistics provided by F. Grigoryan (obstetrician-gynecologist of Gyumri Maternity Home) medical abortion is practiced in the region for 1-1,5 years. Since, during 5-10 weeks more than 100 women applied for medical abortion, and 96 out of 100 women were performed successfully. According to G. Grigoryan, the principle investigator from Gyumri Maternity Home, and A. Avalyan, the principle investigator from Vanadzor Maternity Home, this fact is indicative of the increase in the number of women applying for medical abortion which in its turn promotes development of family planning as well as protection of women’s sexual and reproductive health.   
 
 
During the training on April 17 G. Avagyan, the representative from RA Ministry of Health, introduced her presentation on medical abortion in Armenia followed by the practical work including discussion of various medical abortion cases. In the result of these meetings it became evident that medical abortion in Armenia is safer and more applicable method which increase acceptability of abortion services in Armenia.

 

 Press conference on Medical Abortion 

On January 23, 2012 a press conference on medical abortion was convened by Women's Rights Center to discuss this modern, safe and effective method of unwanted pregnancy interruption. The press conference was welcomed and moderated by Susanna Vardanyan. She highlighted that since 2007 Women's Rights Center has been working in the field of protection of women's sexual and reproductive health and rights.

According to S. Vardanyan women frequently go to pharmacies, buy random pills, and terminate pregnancy without consulting with the doctors, usually using only one medicine instead of two. The latter can have a detrimental effect on women's health. During the press conference the doctors highlighted the fact they did not encourage abortions in any case; however, in case of unwanted pregnancy termination, women should apply to medical abortion under the supervision of a doctor.

The other advantage of medical abortion is that it is safer and more painless, and its cost is almost the same as for the surgical one. S. Vardanyan paid attention to the correct usage of the medicines, as in other case it could have unfavorable consequences for a woman. Dr. Harutyunyan mentioned that sometimes women use only one medicine instead of two because of the price and lack of knowledge; however, for their safety women should apply to doctors in order to eliminate further difficulties.

 

                             Round table discussion on Medical Abortion  

On July 15, 2011 a round table discussion on medical abortion was organized by Women's Rights Center. Representatives from the Ministry of Health of Armenia, doctors and principal investigators from Gyumri and Vanadzor, thirty-three participants - obstetrician/gynecologists from different medical institutions, as well as 6 different mass media representatives were present at the discussion.

Dr. R. Abrahamyan introduced their experience and good practice on medical abortion method and medications - mifepristone and misoprostol, its regimens, dosage, the achieved results and the effectiveness of the medications (i.e. no life threat, female fertility restoration, etc.). The round table participants made suggestions, particularly everybody agreed that drugs for medical abortion should be sold only by doctor's prescription. Otherwise, women unaware of the medication regimens could freely buy the medication and use without doctor's control. This could lead to many dangerous problems, even lethal ones.

Another important issue of raising awareness among women to prevent the usage of the medications without doctor's prescription was raised by S. Vardanyan. According to her various awareness-raising campaigns should be organized. For example, TV shows where discussion on medical abortion service should be launched.

                           

Methodological Trainings on Medical Abortion

One of major significance in the process of providing professional information on the methods and mechanisms of medical abortion in Armenia is considered the organization of trainings conducted for gynecologists-obstetricians both in Yerevan city and the regions of Armenia. WRC educates health professionals to use medical abortion as a new method of reproductive health technologies and train them in research methodology to document the use and acceptability of the method. Trainings also serve to help providers to examine and find out potential barriers to service provision.

On the 29th of November, 2012 Women's Rights Center provided training on the 2nd trimester medical abortion in Ani Plaza Hotel. Doctors and nurses from the Republican Institute of Reproductive Health, Perinatology, Obstetrics and Gynecology in Yerevan (RIRHPOG) and #2 Department of Obstetrics and Gynecology (Yerevan State Medical University) participated in the training. During the training they briefly presented the situation on the 2nd trimester abortion in Armenia, reasons for abortion, regimens mostly used for medical abortion in the 2nd trimester, technologies for abortion, as well as contraindications, statistics on both surgical and medical abortion, etc. The 2nd trimester abortion protocol was presented to the doctors, discussed and explained in details. 

Two-day training was organized in Vanadzor region on 01 and 02 December, 2010 after thoroughly investigation of maternity hospitals and clinics of Obstetrics and Gynecology within Lori region. During the training the schemes, types and various methods of application of medicaments (mifepristone and misoprostol) were presented to the participants. The relevant materials on medical abortion, including information booklet about the company, research study and program summaries, as well as booklet on Medical Abortion were disseminated as well.

In October, 2009 two-day training on Medical Abortion was held in Gyumri. The target audience was gynecologists-obstetricians from maternity hospitals in Gyumri and other cities of Shirak region. The participants welcomed the efforts to improve the sphere on reproductive health and expressed their willingness to contribute to the mission.

On July 10, 2009 at Congress Hotel training on Medical Abortion for doctors of maternity hospitals and clinics of Yerevan was organized for 30 physicians from different medical institutions and maternity hospitals. During the training the research introduction and study results carried out in Armenia (2007) in three clinics – the Republican Institute of Reproductive Health, Perinatology, Obstetrics and Gynecology, the Center for Family Planning and Sexual Health and Department of Perinatology, Gynecology and Women’s Reproductive Health of the State Medical University - with 450 pregnant women was introduced. The training was aimed at spreading information on the medical abortion methods used in different countries as well as providing information on medical abortion study carried out in three clinics of Yerevan.

A package of relevant materials on medical abortion, including the list of studies, information booklet about the company, research and program summaries, booklet on “Medical Abortion” and other booklets were disseminated among the participants.

 

  The Elaboration of Methodological Guideline on Medical Abortion

 

As a result of consistent work of Women's Rights Center, RA Ministry of Health confirmed elaboration and implementation of clinical guideline for obstetrician - gynecologists on Medical Abortion due to the decree made on June 15, 2010.

With the aim of elaboration of guideline a Working Group has been formed under the supervision of Dr. Gayane Avagyan, (Maternal and Child Health Care Department of the RA Ministry of Health). The Guideline has been prepared with joint efforts of doctor-investigators: Dr. Ruzanna Abrahamyan (Institute of Perinatology, Obstetrics and Gynecology), Dr. Astghik Zargaryan (Center of Family Planning and Sexual Health) and Dr. Armine Harutyunyan (State Medical University and Polyclinic N. 8). 

The core of the guideline is providing the general information on how to prepare the pregnant women to Medical Abortion procedures, the methods of consultations on use of contraceptives, the preferences of doctors to use certain methods, etc. In the guideline also presented the detailed demonstration of organization and implementation of Medial Abortion including the regimes, dozes, types, the timelines for applying, the schedule of visits to clinics and follow up control in case the side effects or complications appeared during the abortion implementation. Introduction of present situation of artificial abortion in Armenia is also included in the guideline.

     

 Travel to research sites

On May 24, 2011 during the travel to research sites Vanadzor Hospital N 1 and Gyumri Maternity Home were visited. The project coordinator Susanna Vardanyan examined all completed cases in Vanadzor. Some of the questions concerning the research were discussed, such as:

 

- if there has been double usage of medical abortion,

 

- if any surgical interventions have occurred during the monitoring period,

 

- prolongation of the project,

 

- passing medical investigation with women with 8-12 weeks pregnancy and so on.

 

The doctors mentioned that women-patients were satisfied with medical abortion very much. But they also raised an issue of women using medicaments at home without previous consultations with doctors and often returning to the hospital with profuse bleeding. The doctors also offered to discuss the issue at the RA Ministry of Health in order to sell the medicament only by doctor's prescription.

In Gyumri S. Vardanyan examined all completed cases. According to the results women preferred medical abortion to surgical. However, there were also some cases when after usage of medicaments women had severe pain, fever or unpleasant feelings while the medicament was resolving (nearly 30 minutes). 

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