title: Home use of misoprostol for early medical abortion in a low resource setting: secondary analysis of a randomized controlled trial.
abstract: BACKGROUND
  Although home use of misoprostol for early medical abortion is considered to be safe, effective and feasible, it has not become standard service delivery practice. The aim of this study was to compare the efficacy, safety, and acceptability of home use of misoprostol with clinic misoprostol in a low-resource setting.
  
  
  METHODS
  This was a secondary analysis of a randomized controlled trial conducted in six primary care clinics in India. Women seeking medical abortion within up to nine gestational weeks (n = 731) received mifepristone in the clinic and were allocated either to home or clinic administration of misoprostol. Follow-up contact was after 10-15 days.
  
  
  RESULTS
  Of 731 participants, 73% were from rural areas and 55% had no formal education. Complete abortion rates in the home and clinic misoprostol groups were 94.2 and 94.4%, respectively. The rate of adverse events was similar in both groups (0.3%). A greater proportion of home users (90.2%) said that they would opt for misoprostol at home in the event of a future abortion compared with clinic users (79.7%) who would opt for misoprostol at the clinic in a similar situation (p = 0.0002). Ninety-six percent women using misoprostol at home or in the clinic were satisfied with their abortion experience.
  
  
  CONCLUSIONS
  Home-use of misoprostol for early medical abortion is as effective and acceptable as clinic use, in low resource settings. Women should be offered a choice of this option regardless of distance of their residence from the clinic and communication facilities.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institute, WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden.|Action Research & Training for Health (ARTH), Udaipur, India.
authors.forename: Kirti
authors.identifier: http://orcid.org/0000-0003-1674-9617
authors.initials: K
authors.lastname: Iyengar
authors.affiliation: Department of Women's and Children's Health, Karolinska Institute, WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden.|School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
authors.forename: Marie
authors.identifier: http://orcid.org/0000-0002-8947-2949
authors.initials: M
authors.lastname: Klingberg-Allvin
authors.affiliation: Action Research & Training for Health (ARTH), Udaipur, India.
authors.forename: Sharad D
authors.identifier: http://orcid.org/0000-0003-2874-002X
authors.initials: SD
authors.lastname: Iyengar
authors.affiliation: Department of Women's and Children's Health, Uppsala University, IMCH/Akademiska Sjukhuset, Uppsala, Sweden.
authors.forename: Mandira
authors.identifier: http://orcid.org/0000-0002-5841-5984
authors.initials: M
authors.lastname: Paul
authors.affiliation: Department of Women's and Children's Health, Uppsala University, IMCH/Akademiska Sjukhuset, Uppsala, Sweden.
authors.forename: Birgitta
authors.identifier: http://orcid.org/0000-0002-2900-2849
authors.initials: B
authors.lastname: Essén
authors.affiliation: Department of Women's and Children's Health, Karolinska Institute, WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Kristina
authors.identifier: http://orcid.org/0000-0001-6516-1444
authors.initials: K
authors.lastname: Gemzell-Danielsson
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced; D000328:Adult; D005260:Female; D006801:Humans; D007194:India; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012646:Self Administration
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: India; Termination of pregnancy; home administration; low-resource setting; medical abortion; mifepristone; misoprostol