Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Acceptability of Home-Assessment PostMedical Abortion and Medical Abortion in aLow-Resource Setting in Rajasthan, India: Secondary Outcome Analysis of a Non-Inferiority Randomized Controlled Trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- & mödrahälsovård och migration/Essén)
Karolinska University Hospital, Stockholm, Sweden.
Karolinska University Hospital, Stockholm, Sweden.
Karolinska University Hospital, Stockholm, Sweden.
Show others and affiliations
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, e0133354Article in journal (Refereed) Published
Abstract [en]

Background

Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education.

Objective

To investigate women’s acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India.

Design

Secondary outcome of a randomised, controlled, non-inferiority trial.

Setting

Outpatient primary health care clinics in rural and urban Rajasthan, India.

Population

Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85mg/l and were below 18 years.

Methods

Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1:1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible.

Main Outcome Measures

Women’s acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups.

Results

731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as compared with 188 (70%) of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001).

Conclusion

Home-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women’s preference should be offered to foster women’s reproductive autonomy.

Place, publisher, year, edition, pages
2015. Vol. 10, no 9, e0133354
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-262580DOI: 10.1371/journal.pone.0133354ISI: 000360437700006OAI: oai:DiVA.org:uu-262580DiVA: diva2:854430
Funder
Swedish Research Council, 2011-3525Sida - Swedish International Development Cooperation Agency
Available from: 2015-09-16 Created: 2015-09-16 Last updated: 2017-12-05
In thesis
1. Simplifying Reproductive Health in Low-Resource Settings: Access to medical abortion and contraceptive choice, the importance of gendered structures in Rajasthan
Open this publication in new window or tab >>Simplifying Reproductive Health in Low-Resource Settings: Access to medical abortion and contraceptive choice, the importance of gendered structures in Rajasthan
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

India introduced family planning in the ‘50s, legalized abortion in the ‘70s, and accomplished a remarkable drop in maternal mortality and fertility since 1990. Nevertheless, abortions account for a large proportion of maternal deaths, and sterilization is the most frequently used contraception. This thesis aims to identify the means to simplify and increase access to reproductive health in low-resource settings, focusing on abortion and contraception in Rajasthan.

A randomized controlled trial compared simplified follow-up, where women assess their abortion outcome at home after early medical abortion, with in-clinic follow-up. Additionally, contraceptive use was compared between study groups post-abortion. In order to explore young women’s opportunities to access reproductive health services in the area, we conducted in-depth interviews with recently-married women.

Women in the home-assessment group preferred home-assessment in the future to a greater extent than the women in the clinic follow-up group, who preferred in-clinic follow-up. Complete abortions were reported in 95% of women in the ‘home-assessment group’ and 93% in the ‘in-clinic group’, suggesting that efficacy of simplified follow-up is non-inferior to in-clinic follow-up. A majority (81%) of women carried out the pregnancy test and found it easy to use. Women (96%) were satisfied with their abortion. There were no differences in contraceptive use between study groups at three months; however, women in the ‘in-clinic group’ were most likely to initiate contraception at two weeks. A majority of women preferred the three-month injection, while only 4% preferred sterilization. The recently-married women considered reversible contraception to be unfeasible due to misconceptions and taboos, yet women wanted effective contraception because their current use of traditional methods resulted in unintended pregnancies. Abortions were common, and were procured from private or informal providers.

Allowing women to take an active role in reproductive health services can enable simplification of, and access to, reproductive services in low-resource settings as well as in other settings. Simplifying medical abortion, providing contraception ‘intra-abortion’, and offering a context-appropriate and effective means of contraception, creates a great potential to increase access to reproductive health services and can result in a more equal society where women, and men, can attain their sexual and reproductive rights.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 144 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1163
Keyword
Medical abortion, Contraception, Access, Simplified, Gender, Sexual and reproductive health and rights, India
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy Obstetrics, Gynecology and Reproductive Medicine
Research subject
International Health
Identifiers
urn:nbn:se:uu:diva-267167 (URN)978-91-554-9414-8 (ISBN)
Public defence
2016-01-11, Gustavianum, Akademigatan 3, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2015-12-14 Created: 2015-11-18 Last updated: 2016-01-13

Open Access in DiVA

fulltext(534 kB)158 downloads
File information
File name FULLTEXT01.pdfFile size 534 kBChecksum SHA-512
339b61ca49abc4cdf404aabe486c275d1b7cac93c342a610dd8f61677534e9b669e4c86825775ae9820aa61003078e23801a1effd5195ff48ea9a9ba39735150
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Search in DiVA

By author/editor
Paul, MandiraEssén, Birgitta
By organisation
Department of Women's and Children's Health
In the same journal
PLoS ONE
Public Health, Global Health, Social Medicine and EpidemiologyObstetrics, Gynecology and Reproductive Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 158 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 641 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf