Increasing access to safe abortion services in rural India: experiences with medical abortion in a primary health center

Introduction: To increase access to safe abortion in rural India, the feasibility and acceptability of mifepristone-misoprostol abortion was assessed in a typical government run primary health center (PHC) in Nagpur district, Maharashtra State, that does not offer surgical abortion services and must refer off-site for emergency and backup services. Materials and Methods: Consenting pregnant women (n=149) with <= 56 days amenorrhea seeking terminations received 200 mg mifepristone, and returned 48 h later for 400-mu g sublingual misoprostol and 12 days later for abortion confirmation. Surgical backup was conducted at a nearby community health center (CHC). Results: Nearly all women (98.6%) with known outcomes had successful medical abortions, and those who did not (1.4%) were successfully referred to the CHC for surgical backup. Women reported the method's ease and simplicity as the best features. Conclusion: Medical abortion provision is feasible and acceptable in an Indian rural PHC that does not offer surgical abortion services. This study suggests that introduction of medical abortion at lower levels of the health-care system could increase access to safe abortion in rural India. (c) 2007 Elsevier Inc. All rights reserved.