title: Choosing early pregnancy termination methods in Urban Mozambique.
abstract: Little is known about who chooses medication abortion with misoprostol and why. Women seeking early abortion in 5 public hospitals in Maputo, Mozambique were recruited in 2005 and 2006 to explore decision-making strategies, method preferences and experiences with misoprostol and vacuum aspiration for early abortion. Client screenings (n=1799), structured clinical surveys (n=837), in-depth exit interviews (n=70), and nurse focus groups (n=2) were conducted. Triangulation of qualitative and quantitative data revealed seemingly contradictory findings. Choice of method reflected women's heightened concerns about privacy, pain, quality of home support, HIV infection risk, sexuality, and safety of research participation. Urban Mozambican women are highly motivated to find early pregnancy termination techniques that they deem socially and clinically low-risk. Although 42% found vaginal misoprostol self-administration challenging and 25% delayed care for over a week to amass funds for user fees, almost all (96%) reported adequate preparation and comfort with home management. Women reported satisfaction with all methods and quality of care, even if the initial method failed or pain management or postabortion contraception were not offered. A more nuanced understanding of what women value most can yield service delivery models that are responsive and effective in reducing maternal death and disability from unsafe abortion.
authors.affiliation: Academic Medical Center, University of Amsterdam, CINIMA, Amsterdam, Netherlands. mitchelle@kncvtbc.nl
authors.forename: Ellen M H
authors.initials: EM
authors.lastname: Mitchell
authors.forename: Amata
authors.initials: A
authors.lastname: Kwizera
authors.forename: Momade
authors.initials: M
authors.lastname: Usta
authors.forename: Hailemichael
authors.initials: H
authors.lastname: Gebreselassie
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000028:Abortion, Induced / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D005260:Female; D017144:Focus Groups; D006779:Hospitals, Public; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage; D009073:Mozambique; D017060:Patient Satisfaction; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D037841:Pregnant People / Q000523:psychology*; D036301:Qualitative Research; D012646:Self Administration; D014505:Urban Population / Q000706:statistics & numerical data*; D014619:Vacuum Curettage / Q000379:methods / Q000523:psychology; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol