Reproductive Health/Reproductive Medicine – Kristina Gemzell Danielsson's research group

The research conducted at the WHO center including the development of medical abortion, misoprostol for use in obstetrics and gynaecology and new contraceptive methods such as emergency contraception, and intrauterine contraception has had a major impact on women's heath in Sweden and globally. A translational approach from experimental research to clinical trials and public health implementation. Unsafe abortion is a major contributor to maternal mortality. Therefore, effective methods for contraception and safe and acceptable methods for termination of unwanted pregnancies and treatment of incomplete abortion are prerequisites for reproductive health.

Medical abortion that was first invented by our research group and developed in collaboration with WHO is now increasingly used worldwide with major impact on women, their families and society. A simplified medical abortion procedure may include possibility for (i) home administration of misoprostol by the woman herself and; (ii) abortion care (including the examination and ultrasound) conducted by midwives; (Task shifting) (iii) self-assessment of the outcome of treatment (iv) medical abortion carried out by women themselves using telemedicine. Our research has led to the use of misoprostol on several indications (incl. postpartum hemorrhage, post-abortion care and labor induction) to reduce maternal mortality.

Our research also focuses on the development of new contraceptive methods containing new compounds such as progesterone receptor modulator, and on male hormonal contraception. In collaboration with WHO new methods for Emergency Contraception (EC) has been developed. However, the current EC Pills are only limited effective. Therefore an important part of the research programme is to develop highly effective Emergency contraceptive methods that can be used on demand and for dual protection as well as developing and promoting long acting reversible contraception (LARCs = implants and intrauterine contraception).

Although medical abortion is increasing world-wide with major impact on society a serious limitation with mifepristone is that it is only available in about 60 countries and frequently at a high cost. Therefore, misoprostol-alone regimens (although slightly less effective than the combined method and with more side effects) are used for medical abortion where mifepristone is not available.

The implementation of misoprostol has led to reduced maternal mortality and morbidity through treatment and prevention of post-partum haemorrhage, labor induction, treatment of incomplete abortion, and making legal abortion safer and more effective and illegal abortions less dangerous. Misoprostol is safe, easy to use and can be handled by nurse/midwives or women themselves. Read more at misoprostol.org

This research focuses on the development of safe, effective and accepted methods for contraception, abortion and task shifting/sharing in relation to post abortion care (PAC). In ongoing projects, experiences and access to abortion and contraceptive counseling among immigrants in Sweden are studied. Access to contraception and safe abortion care in humanitarian settings is evaluated in another project. This research takes place at the intersection of healthcare research, public health/global health and reproductive medicine/reproductive health. By integrating policy, intervention and implementation into clinical practice, we strive to increase access to evidence-based abortion care. In addition to individual significance, the research also has health economic effects.