title: Introducing medication abortion into public sector facilities in KwaZulu-Natal, South Africa: an operations research study.
abstract: OBJECTIVE
  Examine the feasibility of introducing mifepristone-misoprostol medication abortion into existing public sector surgical abortion services in KwaZulu-Natal, South Africa.
  
  
  METHODS
  Cohort study of women offered medication or surgical abortion in a larger medication abortion introduction study. The sample included 1167 women seeking first-trimester abortion at four public sector facilities; 923 women at ≤9 weeks' gestation were eligible for medication abortion. Women who chose medication abortion took 200 mg of mifepristone orally at the facility and 800 mcg of misoprostol buccally (or vaginally if they anticipated or experienced problems with buccal administration) 48 h later at home, based on international research and global safe abortion guidelines. Women who chose surgical abortion received 600 mg of misoprostol sublingually or vaginally on the day of their procedure followed by manual vacuum aspiration 4 h later. Main outcome measures included proportion of eligible women who chose each method, proportion with complete abortion and proportion reporting adverse events.
  
  
  RESULTS
  Ninety-four percent of eligible women chose medication abortion. No adverse events were reported by women who chose surgical abortion; 3% of women in the medication abortion group reported adverse events and 0.4% reported a serious adverse event. Seventy-six percent of women received a family planning method at the facility where their received their abortion, with no difference based on procedure type. Medication abortion patients were significantly more likely to report they would choose this method again (94% vs. 78%, p<.001) and recommend the method to a friend (98% vs. 84%, p<.001).
  
  
  CONCLUSIONS
  Medication abortion was successfully introduced with low and acceptable rates of adverse events; most women at study facilities chose this option.
  
  
  CONCLUSIONS
  Mifepristone-misoprostol medication abortion 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; access to medication abortion should be expanded in South Africa and other similar settings.
authors.affiliation: Ibis Reproductive Health, 17 Dunster St, Suite 201, Cambridge, MA 02138, USA. Electronic address: kblanchard@ibisreproductivehealth.org.
authors.forename: Kelly
authors.initials: K
authors.lastname: Blanchard
authors.affiliation: Ibis Reproductive Health, PO Box 1985, Parklands, 2121, Johannesburg, South Africa.
authors.forename: Naomi
authors.initials: N
authors.lastname: Lince-Deroche
authors.affiliation: Ipas, 300 Market St., Suite 200, Chapel Hill, NC 27516, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Fetters
authors.affiliation: Addington Hospital, Obstetrics and Gynecology Department, University of KwaZulu-Natal, Hospital Road, Durban, Republic of South Africa.
authors.forename: Jaymala
authors.initials: J
authors.lastname: Devjee
authors.affiliation: Ibis Reproductive Health, PO Box 1985, Parklands, 2121, Johannesburg, South Africa.
authors.forename: Ilundi Durão
authors.initials: ID
authors.lastname: de Menezes
authors.affiliation: Ipas, PO Box 2155, Parklands 2121, Johannesburg, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Trueman
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), 50 Beale Street, Suite 1200, Box 1224, San Francisco, CA 94105, USA.
authors.forename: May
authors.initials: M
authors.lastname: Sudhinaraset
authors.affiliation: Ipas, PO Box 2155, Parklands 2121, Johannesburg, South Africa.
authors.forename: Errol
authors.initials: E
authors.lastname: Nkonko
authors.affiliation: Nelson R Mandela School of Medicine, University of KwaZulu-Natal 719 Umbilo Road 4001, Durban, Republic of South Africa.
authors.forename: Jack
authors.initials: J
authors.lastname: Moodley
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D000028:Abortion, Induced; D000328:Adult; D003267:Contraception / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015735:Mifepristone; D016595:Misoprostol; D009874:Operations Research; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011247:Pregnancy; D013019:South Africa; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone
keywords: Acceptability; Medication abortion; Public sector; South Africa