Making medical abortion woman-centered and accessible in Kazakhstan: a study of 600 mcg sublingual misoprostol following 200 mg mifepristone for abortion up to 70 days’ gestation
Ingrida Platais1, Tamar Tsereteli1, Galina Grebennikova2, Beverly Winikoff1 1Gynuity Health Projects, New York, NY, USA, 2Kazakhstan Association on Sexual and Reproductive Health, Almaty, Kazakhstan - firstname.lastname@example.org
Objective: To assess whether the option to take mifepristone at home is feasible and acceptable to women with pregnancies up to 70 days' LMP seeking medical abortion in Kazakhstan. Method: Typically, medical abortion in Kazakhstan consists of four visits. This study consisted of two visits. During their initial visit, women were given the option to swallow mifepristone at the clinic or take it home, and all women were instructed to take misoprostol at home. The follow-up visit was scheduled two weeks after mifepristone. This open-label study enrolled women with pregnancies ≤70 days' LMP. The study regimen consisted of 200 mg mifepristone, followed by 600 mcg misoprostol 24-48 hours later. Results: As of April 2014, 106 women were enrolled. Ninety-eight percent of women had successful abortions. All women took mifepristone and misoprostol at the scheduled time, and no woman took mifepristone after 70 days' LMP. No serious adverse events were reported. Most women (99.0%) reported that the ability to plan when the abortion would occur was important for them. More than half of the women (61.3%) chose to take mifepristone at home, citing compatibility with home and family duties as the top reason for their choice in location of mifepristone administration. For clinic users, the presence of a provider was the most common reason for their choice. Almost all women (99%) were satisfied with the abortion procedure and most (98.1%) would choose medical abortion in the future. Most home users (90.8%) said they would choose to take mifepristone at home again if they needed another abortion, whereas only 12.2% of the clinic users would choose to take mifepristone in the clinic again. Conclusion: An outpatient medical abortion procedure up to 70 days’ gestation using mifepristone and misoprostol, taken at a place of women's choosing, is safe, effective and acceptable.