Medical abortion successfully integrated in public health services in South African province

Friday, December 4, 2015

Mifepristone-misoprostol medical abortion (MA) 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, according to a recent study published in Contraception.

Legal abortion has reduced abortion-related deaths and injuries in South Africa, but barriers to high-quality legal services remain. Medical abortion—or abortion with pills—is not widely available in public sector facilities, where 80 percent of South African women receive their health care.

The study was conducted in KwaZulu-Natal (KZN), one of the most populous provinces in the country, yet one with the lowest numbers of facilities offering abortion services, between 2009 and 2011.

“Studies have shown that increasing the availability of MA could increase the number of providers willing to provide the service, as well as the number of women who might seek abortion earlier,” says Tam Fetters, Ipas senior research advisor and study co-author. “We wanted to examine the feasibility of introducing MA with mifepristone and misoprostol into existing public sector surgical abortion services in KZN. We looked at the uptake of this method, assessed the safety, effectiveness and acceptability of medical and surgical abortion, and compared clients' experiences.”

Snapshot: facts and results

  • 1,167 women seeking first-trimester abortion were enrolled at the four intervention sites; 923 women 9 weeks or less gestation were eligible for medical abortion.
  • Of those eligible (923), 865 chose that method and 58 chose surgical abortion (manual vacuum aspiration).
  • No adverse events were reported by women who chose surgical abortion; and only 3 percent of women who had a medical abortion reported adverse events—such as bleeding, pain or vomiting—and 0.4 percent reported a serious adverse event and were hospitalized overnight.
  • 76 percent of women received a family planning method at the facility, with no difference based on procedure type.
  • Medical abortion patients were significantly more likely to report they would choose this method again and recommend the method to a friend.

Overwhelmingly, says Fetters, the majority of women involved in the study reported feeling satisfied with their experience. That, coupled with the low number of adverse events and the relatively high number of women who received postabortion family planning, suggests that the introduction of MA in KZN was largely successful.

“There were several factors that may have led to more women choosing MA over MVA,” says Fetters. Primarily, women who chose MA could begin their abortion the same day, whereas those who did not had to wait for an appointment—roughly a day or two, sometimes more depending on facility caseloads. “Providing MA as well as same-day surgical abortion could potentially increase access to safe abortion even more,” she adds.

The researchers note that future studies should examine whether or not high uptake of MA is sustained over time. “In spite of the successes shown in this study, mifepristone is still only registered in five countries in Africa,” adds Fetters.  “The majority of women who have abortions in the global south don't have this choice.”