Integrating medical abortion into safe abortion services: experience from three pilot sites in South Africa.
METHODS
South Africa's Choice on Termination of Pregnancy Act of 1996 provides for safe termination of pregnancy (TOP) in designated facilities in the public and private health sectors. In 2001, mifepristone-misoprostol medical abortion was approved for TOP up to 56 days, but this method is not yet available in the public sector. Information on the operational requirements for integrating mifepristone-misoprostol medical abortion into South Africa's public sector safe abortion services is required to guide policy decisions. This study trained health workers to provide medical abortion to 290 women attending three TOP sites. Prospective data were collected to ascertain women's experience of the method, pregnancy outcome, women's and provider's acceptability of the method, and the operational requirements for providing medical abortion.


RESULTS
Twenty-nine (10%) women were lost to follow-up; 261 (90%) women had a confirmed abortion outcome, of whom 93% had a complete abortion. Given the option, the vast majority of women opted to use misoprostol at home. No serious side effects were reported; pain (66%), and heavy bleeding (67%) were the most common side effects. Most (96%) women were very satisfied with the experience. Health providers were satisfied with providing medical abortion and recommended its introduction to complement existing surgical TOP services.


CONCLUSIONS
This study demonstrates that integration of medical abortion into public sector services is feasible. The results of this study will guide policy decisions about integrating medical abortion into South Africa's public sector safe abortion services, within the context of the existing enabling legislative framework.
Kawonga
Mary
M
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. mary.kawonga@wits.ac.za
Blanchard
Kelly
K
Cooper
Diane
D
Cullingworth
Lee
L
Dickson
Kim
K
Harrison
Teresa
T
von Mollendorf
Claire
C
Winikoff
Beverly
B
D000028:Abortion, Induced / Q000592:standards / Q000706:statistics & numerical data; D000032:Abortion, Therapeutic / Q000592:standards* / Q000706:statistics & numerical data; D000328:Adult; D005193:Family Planning Services; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010865:Pilot Projects; D011247:Pregnancy; D011446:Prospective Studies; D012449:Safety / Q000592:standards* / Q000706:statistics & numerical data; D013019:South Africa