June 25, 2002
Volume 4/ Number 14
One of the most common methods of abortion in the developing world is Manual Vacuum Aspiration (MVA). Not only is this method of abortion immoral, it is extremely unsafe for women. Today, the international abortion movement seeks to expand the number of abortions performed worldwide under the guise MVA “care for miscarriage.” But, as medical evidence shows, MVA—even when used for legitimate miscarriage care—is so substandard that it presents life-threatening risks to women. All governments concerned about promoting women’s health should reject MVA for any purpose. This would be a major setback for the abortion movement, but a major step forward for women’s health.
Steven W. Mosher
The Dangers of Manual Vacuum Aspiration
The international population control movement is seeking to increase the number of abortions overseas under the guise of women’s health.
With a device called the Manual Vacuum Aspirator (MVA), abortions may be performed under the guise of “miscarriage treatment” or “uterine evacuation” in countries where abortion is illegal, and in circumvention and violation of international norms and standards which prohibit abortion.
The MVA is a hand-held vacuum syringe with flexible plastic cannulae used to “evacuate the contents of the uterus.” The MVA is recognized by the World Health Organization (WHO) as a “uterine evacuation technique” through “12 weeks” gestation. (1)
PRI photographed an MVA, supplied by the U.N. Population Fund (UNFPA), in 1999 in Macedonia, during the height of the Kosovar refugee crisis. UNFPA claimed its MVA was used for “menstrual regulation”—a procedure which medical experts recognize as a euphemism for abortion. However, the Planned Parenthood affiliate in the Kosovo region informed PRI that midwives were being trained to use MVAs explicitly for abortion. (2)
For miscarriage complications, the MVA is not widely used in the United States, if at all, because less dangerous non-manual methods (namely, vacuum aspiration, or VA) in fully equipped and safe medical environments are available. To use MVAs for any procedure is so substandard that it presents extreme risks to women.
In clinical trials of MVAs, women required surgical treatment because of incomplete evacuation and endometritis. (3) Other sources note that uterine perforation is a risk of MVA procedures.(4)
MVAs are not widely used in the U.S. for any purpose, if at all. The proposal of using MVAs for abortion completion was rejected by the FDA, even during hearings which ultimately lead to RU-486 abortion approval. Using MVAs to complete RU-486 abortions was described as “treading on very dangerous ground” and “dictat[ing] medical practice.” (5)
The standard method of abortion in the U.S. is non-manual “vacuum aspiration [VA]…. Most of these operations are performed in [a surgical procedure room or] operating theater using suction curettage and an electric vacuum pump.” (6)
Because of risks, certain pre-conditions for abortion by VA have been
“At a minimum, providers need arrangements for laboratory services for hemoglobin and Rho (D) antigen determination. Ultrasonographic capability, preferably with a transvaginal probe… should be available for difficult cases. Finally, clinicians offering surgical abortion should have basic emergency equipment and supplies in place.” (7)
In order to safely perform abortions with the manual suction device (MVA), the pro-abortion Allan Guttmacher Institute (AGI) has noted similar pre-conditions determining gestation, and ultrasound. (8) Unfortunately, AGI promotes MVA as a safe method of abortion for up to twelve weeks gestation. (9) Common medical opinion, however, notes that MVA—for either abortion of miscarriage care—can be problematic beyond 8 weeks gestation, because of the potential for retained products of conception and hemorrhage, and because of inadequate suction on the manual device.
Despite these risks, MVA, without adequate medical pre-conditions, is the most common method of abortion in many developing countries. For example, in Nigeria, it is estimated that 75% of all abortion providers use MVAs for abortion. (10)
The high maternal death rate in the developing world because of MVA abortions, clearly indicates that promoting MVA in the name of women’s health is misleading. And because MVAs are promoted in the developing world by the international abortion movement allegedly not for abortion, but for “the safe completion of incomplete unsafe abortion” or “miscarriage completion,” there are even greater concerns that abortion is being conducted behind a false front.
In underdeveloped settings, such as impoverished regions and refugee settings, MVAs have been promoted globally by the World Health Organization, and are provided—along with morning-after pills (MAPS)—by the United Nations Population Fund (UNFPA).
Complications following the ingestion of morning-after pills (MAPs) are common. WHO and UNFPA promote MAPs and MVAs throughout the developing world. To use MVAs to “complete miscarriages” or for “menstrual regulation” after the ingestion of MAPs acting with a post-fertilization effect is highly misleading. This is not “care for miscarriage.” This is unsafe abortion.
In countries where abortion is illegal, like Peru, the abortion movement is lobbying fiercely for greater acceptance of MVA, under the guise of care for miscarriage. (11)
Since the safest policy for legitimate miscarriage care, where such care is needed, should be designed to prevent maternal death and promote maternal health, MVA should be rejected. Only non-manual vacuum aspiration (VA), with all the medical pre-conditions necessary to ensure safety for women, should be approved for legitimate miscarriage care.
In developing countries where abortion is legal, unsafe abortion by MVA has been promoted by MVA maker, International Projects Assistance Service (IPAS), throughout the developing world – in Ecuador, Mexico, Nicaragua, Nigeria, Turkey, Zaire and Zambia – for years.(12)
In the name of women’s health, and for the purpose of preventing maternal death, MVA should be rejected as unsafe for miscarriage care, and unsafe for abortion, even in those nations where abortion is legal.
1. World Health Organization, “Clinical management of abortion
complications: a practical guide;” Annex. 11, “Manual Vacuum Aspiration,”
2. PRI Review, “Kosovar Women Just Say ‘No’…” June/July 1999, p. 1.
3. “Manual vacuum aspiration,” Hemlin J – Acta Obstet Gynecol Scand – 01-Jun-2001; 80(6): 563-7.
4. “Assessment of the manual vacuum aspiration (MVA) equipment in the management of incomplete abortion,” Kizza AP – East Africa Medical Journal – 01-Nov-1990; 67(11): 812-22.
5. U.S. Food and Drug Administration, www.fda.gov/ohrms/dockets/ac/96/transcpt /3198t1d.pdf, p 320.)
6. “Manual vacuum aspiration,” Hemlin J – Acta Obstet Gynecol Scand – 01-Jun-2001; 80(6): 563-7.
7. “Early surgical abortion: An alternative to and backup for medical abortion,” Laura MacIsaac MD, Philip Darney MD, MSc, American Journal of Obstetrics and Gynecology Volume 183, Number 2, August 2000.)
8. “The Political Challenges And Educational Opportunities Around Very Early Abortion,” By Rebekah Saul, The Guttmacher Report on Public Policy, Volume 2, No. 1, February 1999.
10. “The Incidence of Induced Abortion in Nigeria,” By Stanley K. Henshaw, Susheela Singh, Boniface A. Oye-Adeniran, Isaac F. Adewole, Ngozi Iwere and Yvette P. Cuca, Family Planning Perspectives (AGI), Volume 24, No. 4, December 1998.
11. Letter to Dr. Fernando Carbone, Peruvian Minister of Health, May 17th, 2002, co-signed Pathfinder, USAID employee et al.
12. PRI Review, “IPAS Worldwide Abortions Illegal?,” January/February 1991, p. 11.