Women’s experiences and perceptions of simplified medical abortion: a qualitative study in Rajasthan, India
Kirti Iyengar1 ,2, Birgitta Essen3, Marie Klingberg-Alvin1, Kristina Gemzell-Danielsson1, Sharad Iyengar2, Sunita Soni2 1Karolinska Institutet, Stockholm, Sweden, 2Action Research & Training for Health, Udaipur, India, 3Uppsala University, Uppsala, Sweden - firstname.lastname@example.org
The requirement for repeated clinic visits remains an important barrier to access to medical abortion. Home use of misoprostol and alternatives to routine follow-up have been suggested as interventions to simplify the medical abortion, however there is little evidence on women’s experiences on these from low-resource settings. This qualitative study was conducted in Rajasthan, India, and explored women’s experiences and perceptions of home use of misoprostol and self-assessment of outcome of medical abortion. The reasons for preferring home use included inconvenience of travel, lack of confidentiality and child care commitments. After taking home misoprostol, most women continued with their routine household work, although they didn’t go for work outside the home. Most women experienced no major health problems, while some women made an extra clinic visit because of perceived health problems. A majority said that if they have to undergo another abortion, then they would prefer to use misoprostol at home. On self-assessment of the outcome of abortion, many women were fairly certain that their abortion was complete either because they experienced bleeding or expulsion or because their pregnancy symptoms subsided. Despite this, a majority of women found it reassuring to do the pregnancy test, to confirm that their abortion was complete. According to one woman, “if abortion is not done then we remain in confusion, any problem can arise inside the body, so it’s good to do the test”. Despite low literacy levels, the majority of the women were able to interpret the results of a pregnancy test. They felt that that this saved them a visit to the clinic. The checklist was used by many women, largely as a refresher to see how to do the pregnancy test. Our results indicate that home use of misoprostol and self-assessment using a low sensitivity pregnancy test is feasible in low-resource settings.