Elsevier

Contraception

Volume 74, Issue 1, July 2006, Pages 11-15
Contraception

Review article
Women's perceptions on medical abortion

https://doi.org/10.1016/j.contraception.2006.02.012Get rights and content

Abstract

The reasons why women choose medical abortion vary in different countries. In most countries, the most common reasons for choosing medical abortion are as follows: (a) avoidance of surgery or general anesthesia; (b) perception that it is safer; and (c) perception that it is more natural than a surgical procedure. In most studies, over 80% of women who chose medical abortion found it acceptable and would choose the same method again if they needed another abortion in the future. They would also recommend this procedure to other women who need an abortion. In selected women, the administration of misoprostol at home was also acceptable. The acceptability of medical abortion may decrease with increasing gestational age of pregnancy, failure of medical abortion, prolonged bleeding and high levels of discomfort and anxiety during the abortion procedure. There was no significant difference in the emotional responses or incidences of psychiatric morbidity between women undergoing medical and women undergoing surgical abortion.

Introduction

The combination of mifepristone and misoprostol is now a well-established method for medical abortion in many countries. It has been shown by various studies to be a safe and effective method for the termination of pregnancy. However, to be widely used, it must also be acceptable to women, especially since there is an alternative (vacuum aspiration) that is also a safe and effective method for the termination of pregnancy. Therefore, it is necessary to assess the acceptability of the method and to understand the perspectives of women and how they perceive the different methods. Since the introduction of medical abortion, many studies have been performed to assess its acceptability. In this paper, the reasons for choosing medical abortion, the acceptability of medical abortion and women's perceptions of medical abortion will be reviewed and discussed.

Section snippets

Why do women choose medical abortion?

This issue was explored in a number of studies on medical abortion [1], [2], [3], [4], [5], [6], [7]. Before the abortion procedure, women were asked why they chose medical abortion. While there are some differences among studies, the most commonly given reasons for choosing medical abortion are as follows: (a) fear of surgery or general anesthesia, which women want to avoid with medical abortion; (b) perception that medical abortion is safer than surgical abortion; and (c) perception that

Acceptability of medical abortion

The most common way of assessing the acceptability of medical abortion was to ask women after the procedure whether they were satisfied with the procedure, whether they would choose medical abortion again if they needed an abortion in the future and whether they would recommend medical abortion to a friend. The results of the studies are summarized in Table 1 [1], [2], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. The studies were conducted in many countries

Women's views on the features of medical abortion

In a multicenter study involving women in China, Cuba and India [5], women were asked to name the best and the worst features of medical abortion. Most of the women thought that the advantages of medical abortion were: avoidance of surgery and general anesthesia, less pain, safety, ease of use and compatibility with everyday responsibilities. Freedom from pain was especially important in China, where relief from the pain of surgical abortion during the procedure was apparently minimal. Bleeding

Factors affecting the acceptability of medical abortion

As indicated by Henshaw et al. [3], one of the most important factors affecting the acceptability of a method is the ability of women to choose the method. Therefore, where facilities are available, both surgical and medical abortions should be offered as alternative methods. The acceptability of medical abortion was found to decrease with increasing gestational age of pregnancy in some studies [3], [7], but not in others [12], [18]. The acceptability of medical abortion is adversely affected

Psychological response of women undergoing medical abortion

Using a standardized questionnaire to screen for anxiety and depression, Urquhart and Templeton [10] compared the psychiatric morbidity before and the psychiatric morbidity after surgical and medical abortions. Before abortion, 60% in both groups had high scores (compatible with psychiatric morbidity), but after abortion, there was a significant and equal fall in scores so that, by 1 month, <10% of either group had high scores. There was no significant difference between the two groups. Another

Conclusion

Medical abortion was well accepted by women who chose the method. The acceptability of medical abortion may decrease with increasing gestational age of pregnancy, failure of the method and prolonged bleeding. There was no difference in emotional responses or incidences of psychiatric morbidity between women who underwent medical abortion and women who underwent surgical abortion.

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