Using telemedicine to improve access to medication abortion in Rwanda
- 2 min. read ▪ Published
In recent years, the African nation of Rwanda has expanded legal grounds for abortion. But the law requires that a doctor authorize the procedure, creating obstacles for women who live in areas with few physicians.
To determine whether a hybrid telemedicine/in-person appointment model could expand access to medication abortions, researchers from UC Berkeley School of Public Health’s Bixby Center for Population, Health, and Sustainability, working with local health care partners and the Rwandan Ministry of Health, launched a pilot program in the predominantly rural Musanze District in Northern Rwanda.
Led by Dr. Ndola Prata—professor of maternal, child and adolescent health, Bixby Center faculty director, and associate director of the University of California Global Health Institute—the researchers tested an intervention that provides first-trimester medication abortion at regional primary health centers, using telemedicine to connect nurses and midwives to doctors in district hospitals for authorization of services. Currently, there are no physicians working in these rural health care centers and health posts, which form the backbone of the nation’s public primary care system. More than 85 % of the population of Rwanda is enrolled in the public system, although those who can afford it can choose private clinics, which are better staffed.
The results of their 15-month prospective study of the hybrid medicine model were published in BMC Public Health online. The authors note that client satisfaction with the services was very high (98%); and the perceived quality of services was also very high (97–99%).
“We conclude that this hybrid telemedicine model for the provision of first-trimester medication abortion is feasible, effective, safe and accepted by clients,” the authors wrote.
The hybrid model worked like this: Nurses and midwives at health centers conducted in-person consultations with women seeking abortion services. These health care providers were remotely connected to medical doctors in hospitals via telephone and video calls for authorization of first-trimester medication abortions using mifepristone and misoprostol, a globally endorsed alternative to surgical abortion.
“Rwanda has a fairly liberal abortion law for Africa,” said Karen Weidert, executive director of the Bixby Center. “But implementation is stuck because doctors work in district hospitals, and the majority of women—especially the most vulnerable women—live in rural areas outside of city centers. We wanted to bring the services closer to home for these women.”
Prata said that since the pilot project was completed, “the Rwandan Ministry of Health has issued recommendations for expansion of services using the tested model, a process that has already started in four additional districts.
“In addition, comprehensive abortion care clinical protocols and guidelines were revised, including roles and responsibilities for mid-level providers and community health workers to support such a program.”
