Predictors of acceptability of medication abortion

We evaluated the sociodemographic and clinical factors, including expectations, associated with satisfaction with medication abortion.

Four sites enrolled 1080 subjects in a randomized trial of misoprostol 6-8 h versus misoprostol 24 h after mifepristone treatment for abortion at up to 63 days' gestation. Method acceptability was evaluated by preabortion and postabortion interviews and with visual analog scales examining subject factors, side effects, preferences and dislikes with the experience, pain, bleeding and stated as well as measured differences from expectations.

Nulliparity and increasing gestational age (GA) were independently associated with experiencing more pain than expected. Higher GA was associated with heavier and longer bleeding than expected. Although 89.7% of the subjects would choose medication abortion again, only 58% rated the experience as positive. Independent predictors of a positive experience included older subject age, clinic site, efficacy and less pain and bleeding than expected. Significant predictors of not choosing medication abortion again were procedure failure and more pain and bleeding than expected. All outcomes were independent of the randomization group in the main study.

Satisfaction with medication abortion may be limited by differences between patients' expectations of pain and bleeding and their experienced symptoms. These differences between expectations and experience and the actual symptoms of pain and bleeding are associated with increasing GA and nulliparity. Pain, bleeding and method failure independently predict method dissatisfaction. More information regarding severity of symptoms should be incorporated into patient counseling.