Acceptability of Home-Assessment Post Medical Abortion and Medical Abortion in a Low-Resource Setting in Rajasthan, India. Secondary Outcome Analysis of a Non-Inferiority Randomized Controlled Trial.
BACKGROUND
Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education.


OBJECTIVE
To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India.


METHODS
Secondary outcome of a randomised, controlled, non-inferiority trial.


METHODS
Outpatient primary health care clinics in rural and urban Rajasthan, India.


METHODS
Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85 mg/l and were below 18 years.


METHODS
Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1:1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible.


METHODS
Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups.


RESULTS
731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as compared with 188 (70%) of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001).


CONCLUSIONS
Home-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women's preference should be offered to foster women's reproductive autonomy.


BACKGROUND
ClinicalTrials.gov NCT01827995.
Department of Women's and Children's health, Uppsala University, Uppsala, Sweden.
Mandira
M
Paul
Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, Stockholm, Sweden; Action Research & Training for Health (ARTH), Udaipur, Rajasthan, India.
Kirti
K
Iyengar
Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, Stockholm, Sweden.
Birgitta
B
Essén
Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, Stockholm, Sweden.
Kristina
K
Gemzell-Danielsson
Action Research & Training for Health (ARTH), Udaipur, Rajasthan, India.
Sharad D
SD
Iyengar
Statisticon, Stockholm, Sweden.
Johan
J
Bring
Action Research & Training for Health (ARTH), Udaipur, Rajasthan, India.
Sunita
S
Soni
Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
Marie
M
Klingberg-Allvin
D000028:Abortion, Induced / Q000379:methods*; D000293:Adolescent; D000328:Adult; D003906:Developing Countries; D005260:Female; D006699:Home Care Services; D006801:Humans; D007194:India; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011247:Pregnancy; D055815:Young Adult