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Safe Abortion

Clear and compelling evidence demonstrates that access to safe, legal abortion services saves lives and improves women’s health by decreasing unsafe abortion. The safe abortion procedure involves the oral administration of mifepristone followed 24?48 hours later by buccal, sublingual, or vaginal administration of misoprostol. Mifepristone in conjunction with misoprostol is a safe and effective regimen for safe abortion. Where mifepristone is not available, misoprostol only can be used, but with lower success rates. Both mifepristone and misoprostol are in tablet form and stable at room temperature, making them suitable for provision at lower levels of healthcare systems.

Unit of interventionper packet

ContentsOne pill of 200mg mifepristone and four pills of 200mcg misoprostol

For more information about how PSI is increasing access to safe medical abortion to improve health and save lives, visit our website at:
http://www.psi.org/program/medical-abortion/

Model Overview

PSI’s safe abortion impact model is based on the Lives Saved Tool (LiST). LiST is used to estimate the number of deaths averted with complete coverage of safe abortion services in select countries, representing the projected impact of safe abortion. This number of deaths averted at the population level is translated to deaths averted per safe abortion, using parameters such as the number of live births per year and abortion incidence ratio. Once we have deaths averted per misoprostol tablet, we apply data from the 2010 Global Burden of Disease study to estimate the corresponding number of DALYs averted.

Model Outputs (impact metrics)

Estimates of DALYs averted, deaths averted, CYPs provided, and unintended pregnancies averted represent the projected health impact of the intervention. It is projected because it has not been directly measured.

Examples based on provision of safe abortion in Myanmar in 2015 Statement of modeled results, examples:

If 10,000 safe abortions were provided in Myanmar in 2015, an estimated 4 deaths and 207 DALYs would be averted over the effective life of the intervention.

For more details about how PSI models safe abortion impact, see below.

Model Details

Step 1: Running a projection in the Lives Saved Tool (LiST)LiST is a multi-cause mortality model developed by Johns Hopkins Bloomberg School of Public Health that estimates the number of deaths averted (or lives saved) through the scale up of maternal and child health interventions.

PSI begins by running a projection in LiST for select countries. We use “safe abortion services” in LiST as a proxy for our safe abortion intervention. In this projection, safe abortion services are increased from the current, country-specific baseline to 100%. LiST then projects the number of deaths averted among women seeking abortion by this increased level of coverage.

Step 1 Output:
Number of additional deaths averted (or lives saved) if coverage of safe abortion increased from baseline to 100% in select countries

Step 2: Estimating deaths averted per safe abortionPSI uses the step 1 output (deaths averted at 100% coverage of safe abortion) to estimate the number of deaths averted by a single safe abortion. To do this, we divide the number of deaths averted at 100% coverage by the number of safe abortions needed to reach 100% coverage among women seeking abortion.

PSI estimates the number of safe abortions needed to reach 100% coverage using a number of parameters, including baseline coverage of safe abortion access and mortality rates. We also account for wastage of medication for safe abortion in the supply chain, assumed to be 10%.

Step 2 Output:
Deaths averted coefficient for safe abortion

Step 3: Estimating DALYs averted per safe abortion A DALY (or disability adjusted life year) includes two components: years of life lost due to premature death (YLL) and years lived with disability (YLD). DALYs averted are in turn comprised of YLLs averted and YLDs averted or, put simply: death and disability that is prevented by PSI interventions.

To estimate YLLs averted per safe abortion, PSI first estimates the number of years of life lost per death due to unsafe abortion in select countries. This is equal to the life expectancy at the average age of death from unsafe abortion. Age specific life expectancies are taken from the 2010 Global Burden of Disease study (GBD 2010). The number of years of life lost per unsafe abortion death is then multiplied by the number of deaths averted per safe abortion (deaths averted coefficient), calculated in step 2 above for a selected country. This gives us the YLLs averted per safe abortion.

To estimate YLDs averted per safe abortion, we use a YLD/YLL ratio, based on the 2010 GBD. This ratio represents the relative number of years lived with disability for every year lost due to death from unsafe abortion. We apply this ratio to the number of YLLs averted per safe abortion to estimate the number of YLDs averted per safe abortion.

Finally, YLLs averted and YLDs averted are added together to estimate the number of DALYs averted safe abortion.

Step 3 Output:
DALYs averted coefficient for safe abortion