For a new technology to be a viable option in a healthcare system, both patients and providers need to want to use it and to ask for it. For this reason, understanding how women and medical personnel perceive and value a new technology is important. In the case of medical abortion, however, patient-acceptability is also the key to success of the method.

Medical abortion may be more acceptable than surgical abortion to many women; in some studies, as many as 70% of women indicated that they would prefer a medical abortion if it were available.

The most common reason women cited for choosing medical abortion in China, Cuba and India were their desire to avoid surgery and general anaesthesia; and for choosing surgical abortion were speed, simplicity and effectiveness.

To study the efficacy of medical abortion, two WHO multicentric, double blind randomized studies were undertaken at Mumbai.

Study-I : Comparison of 2 doses of mifepristone
(200 mg and 600 mg orally) in combination with misoprostol 400 µg orally for early medical abortion (up to 5 weeks gestation).

Study-II : Three misoprostol regimens after pretreatment with mifepristone for termination of early pregnancy. A total of 205 women were interviewed initially and on or after day 43 to determine their views and experience regarding acceptability of medical abortion. Reasons given by women for choosing medical abortion were: to avoid a surgical procedure in 27.7%, presumption that non-surgical method would bean easier method in 61.5%, and expecting a new method to be better in 10.7%.

The reasons given by women who refused medical abortion were: they were working women, were staying far from clinic, had no one to look after children at home or could not come to the clinic repeatedly alone and due to such reasons, they were not willing for repeated follow-up clinic visits which were required if they opted for medical abortion.

When asked about their views on medical abortion at follow-up visit after pregnancy termination, 67.5% of the women said it was an excellent method, 27.3% and 4.1% reported the method to be good and fair respectively. 1.1% of the women had an indifferent attitude. On further enquiry, 72.2% women found the method to be better than expectation, 26% as per expectation and 1.8% found it to be worse than expectation. It was interesting to note that 91.1% women preferred to take treatment in a hospital rather than self-medication at home (8.9%).

A large proportion of women, nearly 92.9%, preferred medical to surgical abortion among those who experienced both. Oral route of administration was preferred by 51.4% women versus vaginal route by 5.8% and any route by 42.8%. Continued tablet intake from 4 to 10 days in Study II was found convenient by 93.5%. Debris and clots seen in uterine cavity on day 15, when followed conservatively, complete abortion occurred in most cases.

At the end of the study, 59.7% women chose intrauterine device (IUD) as a contraceptive measure, 17.9% oral pills and 3% tubal ligation. Overall contraceptive acceptance was less than surgical method. New pregnancy before resumption of menses was found in 2 cases.

Thus, majority of women found medical abortion a highly acceptable method to terminate pregnancy.