Improving Access to Safe Abortion Services and Telemedicine Initiatives

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.

Barriers to Care and National Initiatives

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. To address this, Kyrgyz Family Planning Alliance 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. This includes incorporating the latest World Health Organization (WHO) recommendations on abortion care, and adding a new section on telemedicine.

The Role and Effectiveness of Telemedicine

The pandemic showed the importance of being able to access abortion medications remotely. We know that abortion by telemedicine is effective. 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. 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.

Regarding the data collected from the pilot study in Bishkek and Osh:

• Total women who received abortion through telemedicine: 100
• Women who prefer telemedicine to in-clinic visits: 95
• Participants who would recommend the service to others: 99%

As one patient from Djalal-Abad shared: “It is very convenient especially with my physical disabilities, also liked that I received the service confidentially.” Another participant noted: “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.”

Policy Development and Global Context

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. 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.

While Kyrgyzstan advances, other regions face new challenges. The US Circuit Court of Appeals restricted the prescription of abortion pills, following action from several anti-abortion groups. The court decision banned telemedicine prescriptions and mail orders of the drug, which will take effect upon Supreme Court review. The US Food and Drug Administration (FDA) first approved mifepristone in 2000, under its brand name Mifeprex. This contrast highlights that through collaboration and evidence-based decision-making, KFPA is working towards a more inclusive health system in Kyrgyzstan to ensure all women have access to safe and dignified abortion services.