Medical methods of abortion promise to change women’s lives as had oral contraceptive pills 40 years ago. Medical abortionwill improve the accessibility to safe abortion practice. Abortions have been legally approved in India since 1972, but access to these services remains difficult. Complications of unsafe abortions account for 12% of all maternal deaths.

Medical abortion can be offered early in pregnancy. Amount of blood loss is almost similar in both medical and surgical abortions. Surgical abortion is associated with major morbidity in 1% and minor morbidity in 10% of patients (Joint Study of RCGP and RCOG, 1989).

Medical abortion is safer than surgical abortion in terms of avoidance of anaesthesia, any surgical instrumentation leading to chances of perforation (1 per 1000), infection (0.1 to 4.7%), cervical injury, etc. More than 3 million women, worldwide, have till now used medical methods with impressive safety and efficacy (Crenin & Aubery, 1999). Rates of complete abortion in pregnancies up to 49 days have been 94 to 96% and in pregnancies up to 56 days, the success rate is 91% (Kahn et al, 2000).

Acceptability rates of women undergoing medical abortion have been found to be quite high. Most of the women are satisfied or highly satisfied with the procedure. Acceptability rates of medical abortion are such that 75 to 90% women would like to use it again and 80 to 90% would recommend to their friends and those who have undergone surgical abortion previously would opt for it next time.

Women choose medical abortion because they feel it is more natural and private. Being conscious of the time the abortion occurs, it increases motivation for contraception and frequent contact with healthcare provider.

Adolescent and nulliparous women also opt for it because it avoids surgical procedure, visits to abortion clinic and is highly effective and is well-tolerated physically and emotionally (Phelps et al, 2001).

It involves less work-loss for women and better compatibility with duties and obligations. It gives them a feeling of self-confidence about handling this event and management of their reproductive health. Medical abortion is a moral property of women.

Thus, medical methods could usher in a new era of attention to cost, comfort and convenience of women undergoing abortion services, replacing a time when women were considered lucky to get abortion at all.

Although serious adverse events of early abortion have been studied, little attention has been paid to the more common side - effect sexperienced by early medical or surgical abortion clients. Using data from a multicenter comparative trial of women < 56 days gestation in China, Cuba and India, side-effects experienced by mifepristonemisoprostol medical abortion and surgical abortion clients were analysed at different stages of their abortions. Data on side-effects came from women’s reports at each clinic visit, providers’ observations during the clinic visits, and symptom diaries maintained during the study period. Medical abortion clients at all sites experienced more side-effects than surgical abortion counterparts. he disparity between the two groups was particularly pronounced for bleeding and pain. Despite more reports of side-effects among medical abortion clients, however, assessments of wellbeing and reports of satisfaction at the exit interview were similar in both treatment groups.

In some cases, in fact, side-effects of medical abortion are considered so unpleasant or severe as to negate the advantages the method offers over surgical alternatives. Indeed, women who initially select medical abortion in preference to surgical abortion may even request a surgical intervention to halt these side-effects.

Medical abortion clients receive 200 mg mifepristone orally on their first visit and 400µg misoprostol orally on second visit with a third follow-up visit at 14 days to note the completeness of abortion. The need for three visits may compromise confidentiality and act as a hindrance to increasing access. Thus, medical abortion requires patient participation throughout a multiple-step process.

Surgical abortion clients receive their abortion on the first visit and contraception can be simultaneously provided. It involves less waiting and less doubt about when the abortion occurs. In addition, the woman will not see any products of conception or blood clots during the procedure.

"Failure" is defined as referring to any medical client who received a surgical intervention, whether on request or deemed medically necessary during the study, or for an ongoing pregnancy or incomplete abortion at the study end; and any surgical client who received a second surgical intervention. In all conditions, surgical abortion is more effective than medical abortion.

Medical abortion clients report more bleeding than do surgical clients, although the difference in blood-loss are seldom, clinically, significant. They also report substantial pain during their abortions. Additionally, the abortion process takes longer to complete than surgical abortion. The risk of gastro-intestinal side-effects (nausea, vomiting, diarrhoea) and hyperthermia, chills and rigor is more with medical abortion clients. (Related to PG analogue). Provision of medical abortion services in rural settings in India requires emergency back-up facilities. This can limit its availability across the country.

Country differences also appear to influence women’s reports and characterization of their sideeffects. Women’s inability to return for a follow-up visit is also a limitation.

To date, clinical tracking of women choosing medical abortion has been diligent, primarily because these women have been participating in research settings. To introduce these abortion methods into more widespread clinical practice, requires continued emphasis on follow-up, because failure rates for medical abortion are higher than with surgical techniques, and both methotrexate and misoprostol are potentially teratogenic.

Thus, patients should demonstrate the willingness and ability to comply with all steps in the medical abortion process.