Home use of misoprostol for early medical abortion in a low-resource setting in India

by Kirti Iyengar, Marie Klingberg-Allvin, Sharad D Iyengar, Kristina Gemzell-Danielsson

Acta Obstetricia et Gynecologica Scandinavica 2015;95(2)  DOI: 10.1111/aogs.12815


Introduction: Although home use of misoprostol for early medical abortion is considered to be safe, effective and feasible, it has not become standard service delivery practice [in India]. The aim of this study was to compare the efficacy, safety, and acceptability of home use of misoprostol as compared to clinic misoprostol in a low-resource setting.

Material and methods: This was a secondary analysis of a randomised controlled trial conducted in 6 primary care clinics in India. Women seeking medical abortion up to 9 gestational weeks (n=731) received mifepristone in the clinic, and were allocated either to home or clinic administration of misoprostol. Follow-up contact was after 10-15 days.

Results: Of 731 participants, 73% were rural and 55% had no formal education. Complete abortion rates in the home and clinic misoprostol groups were 94.2% and 94.4% respectively. The rate of adverse events was similar in both groups (0.3%). A greater proportion of home users (90.2%) said that they would opt for misoprostol at home in the event of a future abortion, than the proportion of clinic users (79.7%) that would opt for misoprostol at the clinic, in a similar situation (p=0.0002). 96% of women using misoprostol at home or in the clinic were satisfied with their abortion experience.

Conclusions: Home use of misoprostol for early medical abortion is as effective and acceptable as clinic use, in low-resource settings. Women should be offered a choice of this option regardless of distance of their residence from the clinic and communication facilities.

PHOTO, ARTH health project near Udaipur, India