Kelly Blanchard1, Naomi Lince-Deroche2, Tamara Fetters3, Jaymala Devjee4, Ilundi Durão de Menezes2, Karen Trueman5, May Sudhinaraset6, Errol Nkonko5, Jack Moodley7. 1. Ibis Reproductive Health, 17 Dunster St, Suite 201, Cambridge, MA 02138, USA. Electronic address: kblanchard@ibisreproductivehealth.org. 2. Ibis Reproductive Health, PO Box 1985, Parklands, 2121, Johannesburg, South Africa. 3. Ipas, 300 Market St., Suite 200, Chapel Hill, NC 27516, USA. 4. Addington Hospital, Obstetrics and Gynecology Department, University of KwaZulu-Natal, Hospital Road, Durban, Republic of South Africa. 5. Ipas, PO Box 2155, Parklands 2121, Johannesburg, South Africa. 6. Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), 50 Beale Street, Suite 1200, Box 1224, San Francisco, CA 94105, USA. 7. Nelson R Mandela School of Medicine, University of KwaZulu-Natal 719 Umbilo Road 4001, Durban, Republic of South Africa.
Abstract
OBJECTIVES: Examine the feasibility of introducing mifepristone-misoprostol medication abortion into existing public sector surgical abortion services in KwaZulu-Natal, South Africa. STUDY DESIGN: Cohort study of women offered medication or surgical abortion in a larger medication abortion introduction study. The sample included 1167 women seeking first-trimester abortion at four public sector facilities; 923 women at ≤9 weeks' gestation were eligible for medication abortion. Women who chose medication abortion took 200 mg of mifepristone orally at the facility and 800 mcg of misoprostol buccally (or vaginally if they anticipated or experienced problems with buccal administration) 48 h later at home, based on international research and global safe abortion guidelines. Women who chose surgical abortion received 600 mg of misoprostol sublingually or vaginally on the day of their procedure followed by manual vacuum aspiration 4 h later. Main outcome measures included proportion of eligible women who chose each method, proportion with complete abortion and proportion reporting adverse events. RESULTS: Ninety-four percent of eligible women chose medication abortion. No adverse events were reported by women who chose surgical abortion; 3% of women in the medication abortion group reported adverse events and 0.4% reported a serious adverse event. Seventy-six percent of women received a family planning method at the facility where their received their abortion, with no difference based on procedure type. Medication abortion patients were significantly more likely to report they would choose this method again (94% vs. 78%, p<.001) and recommend the method to a friend (98% vs. 84%, p<.001). CONCLUSIONS: Medication abortion was successfully introduced with low and acceptable rates of adverse events; most women at study facilities chose this option. IMPLICATIONS: Mifepristone-misoprostol medication abortion was successfully integrated into public sector surgical abortion services in South Africa and was chosen by a large majority of women who were eligible and offered choice of early termination method; access to medication abortion should be expanded in South Africa and other similar settings.
OBJECTIVES: Examine the feasibility of introducing mifepristone-misoprostol medication abortion into existing public sector surgical abortion services in KwaZulu-Natal, South Africa. STUDY DESIGN: Cohort study of women offered medication or surgical abortion in a larger medication abortion introduction study. The sample included 1167 women seeking first-trimester abortion at four public sector facilities; 923 women at ≤9 weeks' gestation were eligible for medication abortion. Women who chose medication abortion took 200 mg of mifepristone orally at the facility and 800 mcg of misoprostol buccally (or vaginally if they anticipated or experienced problems with buccal administration) 48 h later at home, based on international research and global safe abortion guidelines. Women who chose surgical abortion received 600 mg of misoprostol sublingually or vaginally on the day of their procedure followed by manual vacuum aspiration 4 h later. Main outcome measures included proportion of eligible women who chose each method, proportion with complete abortion and proportion reporting adverse events. RESULTS: Ninety-four percent of eligible women chose medication abortion. No adverse events were reported by women who chose surgical abortion; 3% of women in the medication abortion group reported adverse events and 0.4% reported a serious adverse event. Seventy-six percent of women received a family planning method at the facility where their received their abortion, with no difference based on procedure type. Medication abortion patients were significantly more likely to report they would choose this method again (94% vs. 78%, p<.001) and recommend the method to a friend (98% vs. 84%, p<.001). CONCLUSIONS: Medication abortion was successfully introduced with low and acceptable rates of adverse events; most women at study facilities chose this option. IMPLICATIONS: Mifepristone-misoprostol medication abortion was successfully integrated into public sector surgical abortion services in South Africa and was chosen by a large majority of women who were eligible and offered choice of early termination method; access to medication abortion should be expanded in South Africa and other similar settings.