Medical abortion in Bulgaria: a happy-ending Cinderella story or a Little Match-Seller drama?
Dimitar Cvetkov1, Svetlozar Stoykov2 1Women's Health Hospital Nadezhda, Sofia, Bulgaria, 2Medical University Pleven, Pleven, Bulgaria - firstname.lastname@example.org
Around the world, probably every medicine man possessed an "abortion recipe", and in Bulgaria too, the interruption of an unwanted pregnancy had its common place in traditional medicine. One of famous works of Bulgarian literature, Dimiter Talev's "The Iron Oil Lamp", gives a dramatic description of the terror of a mother who destroyed the life of her daughter by giving her an abortion potion to save her from the shame of unwanted pregnancy. Much has changed in Bulgaria since these times - the country is the sad leader in Europe's statistics on abortion/live birth ratio. When terminating pregnancy up to 12 weeks is in question, the only option regulation allows is surgical abortion. As early as 1994, there were efforts to introduce medical abortion into practice, but no development resulted, due to lack of interest and insecurity on the part of clinicians facing a new method. In 2010, following a symposium on medical abortion, the idea came back to life once more. After an active search for manufacturers and drugs, and even after a period of unregulated import, finally the pharmaceutical companies at last came to see the Bulgarian market as a rightful destination, and shortly after we saw the first registrations. Today, almost 4 years later, the Bulgarian drug market features Exelgyn, Sun Pharma, and Linepharma, in competition for affordable prices and a steady market share. Yet, at the seemingly happy end, we are facing a multitude of questions: regulatory sales regime; minimum age for abortion; reimbursing procedure costs for teenagers; training of clinicians and midwives. If we are not ready to adequately address these challenges and we do not arrive at viable solutions after a discussion among clinicians, the very method may be compromised and rejected, and a happy-ending Cinderella fairy-tale might turn into the Little Match-Seller sad story.