Parivar Seva Sanstha (PSS) is a registered NGO since 1978. It works to improve the reproductive health of people with emphasis on "Children By Choice, Not Chance". Its goal is "prevention of unwanted births". The NGO operates in 21 States. PSS has conducted research on early medical abortion using combination regimen of mifepristone and misoprostol in 239 cases from April, 2002 to February, 2003. The study was sponsored by Government of India and Population Council.

Drugs used were 200 mg mifepristone on D1 followed by misoprostol 400 µg orally on D3. Aim of the study was to know the efficacy, safety and acceptability of medical abortion.

Selection criteria (as per ICMR guidelines) for clients were healthy reproductive age women > 18 years, regular menstrual cycles (25-35 days) for last three cycles prior to amenorrhoea (LMP), gestational age up to or less than 56 days, confirmed pregnancy by clinical assessment and pregnancy test if required, willing to come for follow-up at
48 hours and 15 days, willing to terminate pregnancy in case of failure of treatment, willing to fill up the home card for any side-effects, bleeding, etc., willing to use only barrier contraception till her next menses and not having any problem as suggested in exclusion criteria. Exclusion criteria included all the medical contraindications, drug allergy, and previous surgery on the uterus or cervix.

All clients were interviewed to assess eligibility, provide counseling and take informed consent. The drugs were administered after routine general physical examination, pelvic examination and lab tests including haemoglobin, urine for sugar and albumin and pregnancy test if necessary. After giving a diary follow-up card, clients were called for D3 drug administration and a follow-up on D15.

Outcome assessment was done as per ICMR guidelines. Outcome was assessed as successful or failed abortion.

In PSS experience, 18% women were between 18-21 years, 36% between 22-25 years, 28% between 26-30 years and 20% were more than 31 years. The socio- demographic profile showed that 53% were graduates, 62% were housewives and 56% had children when they came for abortion. Most clients (89%) had knowledge of any of the family planning methods. 87.2% were aware of barrier contraception, 76.6% of oral pills, 70.9% of IUDs, 49.3% of tubectomy, 45% of vasectomy and 33.3% of injectables, though contraceptive use was less.

Clients that had ever used condoms were 61%, oral pills 13%, IUDS 6.4% and injectables 4.3%. The last contraceptive method used was condoms in 51%, oral pills in 8.7%, IUDs in 2.2% and injectables in 1.4%.

The gestation period in 2% was up to 30 days, in 34%, 31- 40 days; in 32%, 41-45 days; in 22%, 46-50 days; and in 10%, 51-56 days. 62% of clients had complaints following mifepristone administration (nausea 48.5%, cramps 26.7%, bleeding 25.7% and vomiting 19.9%) but only 7% required medication to control these. Following misoprostol administration, 89.3% had vaginal bleeding, 84.4% abdominal pain, 31.9% nausea, 9.9% vomiting, 5.7% diarrhoea and 2.1% fever. Abdominal pain was mild in 53%, moderate in 32%, severe in 4% and no pain in 1%. Vaginal bleeding was mild in 43%, moderate in 47%, heavy in 4% and spotting in 6%.

Complete abortion occurred in 91% of women 20% completely aborted within 4 hours; 19% in 4 to 6 hours; 4% in 6 to 12 hours; 3% in 12 to 24 hours; 8% in 24 to 36 hours; and 46% in 36-90% hours. Rest (9%) required manual vacuum aspiration to complete the abortion. Most (70%) of the clients were highly satisfied with medical abortion; 23% somewhat satisfied; and 7% not at all satisfied with the procedure.

The reasons women cited for deciding in favour of medical abortion were: easy to take (87.8%), afraid of operation (86.3%), afraid of pain (68.8%), less complicated (38.1%), and a new innovative method (51.8%) with 91% of clients going to recommend this procedure to their friends or relatives.