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SIMPLIFIED MEDICAL ABORTION FOR WOMEN IN LESS-DEVELOPED COUNTRIES (p 1402)

May 03, 2001

A low-cost medical programme of abortion involving oral consumption of mifepristone and misoprostol hormones could be of benefit to women in less-developed countries, conclude authors of a study in this week's issue of THE LANCET.

Mifepristone-misoprostol abortion, consisting of oral pills, is potentially simple and safe enough for use in less-developed countries. But the labour-intensive, costly, clinic-based European protocols are not affordable or feasible in most of these settings. Batya Elul and colleagues from the Population Council, New York, USA, prospectively tested two simplifications to the French mifepristone-misoprostol regimen in Vietnam and Tunisia.

315 pregnant women (120 in Vietnam, 195 in Tunisia) seeking termination of pregnancy and who had not had a menstrual period for up to eight weeks received 200 mg mifepristone (a third of the recommended European dose) in a clinic and then chose whether to take 400 �g oral misoprostol 2 days later either at home or in a clinic. Success rates were high: Vietnam 93%, Tunisia 91%. About 88% of women chose home administration of misoprostol. Most Vietnamese and Tunisian women were satisfied with their abortions, but efficacy and satisfaction rates were higher among those who used misoprostol at home. Women who failed to have medical terminations were offered surgical abortions.

Beverly Winikoff (one of the investigators) comments: "A simplified medical abortion regimen of 200 mg mifepristone followed by home administration of misoprostol appears feasible in less-developed countries. Home administration offers women more choice, control, and privacy in managing their abortions. The safety, efficacy, and acceptability of the regimen combining 200 mg mifepristone and the option of home administration of misoprostol used in our study suggests that it should be considered further in more-developed and less-developed countries".

Contact: Dr Beverly Winikoff, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017, USA; T) +1 212 339 0623; F) +1 212 755 6052; E) bwinikoff@popcouncil.org

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