Improving Access to Safe Abortion Services in Kyrgyzstan

In Kyrgyzstan, abortion is legal. The law allows people to end a pregnancy on request up to 12 weeks, and then for ‘social reasons’ as agreed with health professionals, up to 22 weeks. Abortion is allowed at any time in cases of medical necessity. So, the law is liberal compared to many other countries, but unfortunately women seeking abortions still face barriers. Firstly, primary health care does not provide abortion services, requiring women to seek abortions at specialized hospitals, often located in large cities. Long travel times and the cost of transportation can be a significant barrier, especially for vulnerable women, where such costs can be prohibitive.

Initiatives for Updating National Clinical Guidelines

The Kyrgyz Family Planning Alliance (KFPA) has been working for many years to promote access to safe abortion for women in Kyrgyzstan. This year, with funding from SAAF, we launched an important initiative to update our national clinical guidelines for safe abortion. The most recent updates were made in 2020. This new effort includes incorporating the latest World Health Organization (WHO) recommendations on abortion care, and adding a new section on telemedicine. Previously, we supported the revision of requirements for termination of pregnancy during the COVID-19 pandemic to ensure safety and accessibility of services in the country.

The Role and Impact of Telemedicine

The pandemic showed the importance of being able to access abortion medications remotely. We know that abortion by telemedicine is effective. KFPA believes that telemedicine will enable health workers to provide services at a distance, which will be convenient for women in remote or hard-to-reach areas. It will also ensure continuity of care during emergencies and provide a private and confidential environment, which can reduce stigma and encourage women to seek necessary medical care.

Evidence of this convenience is reflected in the following testimonials:

• 44 years old, Bishkek: “You get counseling from the comfort of your own home, medical abortion pills delivered by courier and can terminate a pregnancy with no additional cost – don’t have to take time off work, you don’t have to find a babysitter, it’s very convenient”
• 29 years old, Djalal-Abad: “It is very convenient especially with my physical disabilities, also liked that I received the service confidentially”

Pilot Study Data and Results

In 2023, we conducted a pilot study of telemedicine with fellow SAAF grantee partner Reproductive Health Training Center of the Republic of Moldova (RHTC). The results were very positive and are summarized below:

• Participants: 100 women who received abortion through telemedicine in Bishkek and Osh.
• Preference: 95 women said they prefer telemedicine to in-clinic visits.
• Recommendation: 99% said they would recommend the service to others.

Our study highlights the potential of telemedicine to reach vulnerable populations, especially during emergencies.

Legislative Progress and Future Implementation

In October 2023, the law to allow for provision of telemedicine services was approved. The Ministry of Health of Kyrgyzstan recognizes the importance of telemedicine and is taking steps to implement it. To support this, KFPA is planning work to organise supervisory visits on the implementation of clinical guidelines this year that will also include training seminars with health workers on telemedicine and safe abortion. We are pleased to see that with the introduction of telemedicine abortion the country is advancing reproductive health and overcoming barriers to essential services. Through collaboration and evidence-based decision-making, KFPA is working towards a more inclusive health system in Kyrgyzstan. Our efforts are aimed at ensuring that all women, regardless of location and socio-economic status, have access to safe and dignified abortion services and post-abortion care.