A group of U.S. women who had a medical abortion reported a significantly higher level of satisfaction with the method than a similar group who underwent suction curettage at the same facility. Nearly all women in both groups (93-97%) said that they would recommend their method to a friend, but those who had a medical procedure were more likely than those who had surgery to say that they would choose the same method if they needed to terminate another pregnancy.1
Using self-administered questionnaires given to abortion patients just before and about three weeks after their procedure, researchers gathered information on women's expectations about and actual experiences with their method. To be included in the study, women had to be at least 18 years old and no more than nine weeks pregnant.
The analyses are based on data from 146 women who participated in an acceptability trial of abortion using mifepristone and misoprostol in 1994-1995 and 174 women who had a surgical procedure in 1995-1996. Women in both groups were predominantly white (90-92%), with an average age of 26-27. The average gestation of their pregnancies was 51-52 days, and roughly three in 10 had never been pregnant before.
Participants were asked to rate the amount of discomfort, anxiety and bleeding that they expected and experienced, on a scale from one (indicating none) to five (signifying extreme). They also were asked to rate their expected and actual length of bleeding on a scale from one (denoting 1-3 days) to five (indicating 13 or more).
The two groups both expected and experienced similar levels of discomfort, but differed on most other measures. Women undergoing surgical abortions anticipated a significantly higher level of anxiety (mean rating, 3.1) than those having medical procedures (2.9), yet ratings of the actual level were statistically indistinguishable (2.7-2.8). Those who had medical abortions expected significantly more bleeding than those who had surgical procedures (3.6 vs. 3.1) and experienced significantly more (3.4 vs. 2.6). Likewise, the medical abortion group thought they would bleed longer than women having surgical abortions (3.2 vs. 2.8) and rated the actual duration of bleeding higher (3.8 vs. 3.2).
Women's overall satisfaction with their abortion, rated on a scale from one (signifying very satisfied) to five (denoting very dissatisfied) was high, but those in the medical group gave the procedure a significantly more positive rating (1.4) than those in the surgical group (1.8). The overwhelming majority in both groups would recommend their method to a friend: 93% of those who had surgical procedures and 97% of those who had medical abortions. However, women in the medical abortion group were significantly more likely than surgical abortion patients to say that they would choose the same procedure if they had to have another abortion (91% vs. 58%).
Among women who had medical abortions, overall satisfaction with the method was reduced if bleeding was heavier than expected. Also in this group, overall satisfaction, the likelihood of recommending the procedure to a friend and the likelihood of choosing the same method to terminate a subsequent pregnancy declined if the method failed and the woman required a surgical procedure. Failure of surgical abortions, however, had no effect on these measures.
The researchers point out that their study has the advantage of directly comparing women undergoing medical and surgical abortion. However, they add, medical abortion patients "made a conscious decision to seek out a generally unavailable [procedure] as research subjects," whereas surgical abortion patients had no choice of procedure, and this difference may have biased the results. For example, women in the medical abortion study may have viewed the procedure more favorably and may have reported symptoms more accurately than those in the surgical abortion group. Furthermore, some surgical abortion patients might have chosen a medical procedure if given the option.
Despite the study's limitations, the investigators conclude that women's experiences with abortion depend to some extent on the procedure used. Although both medical and surgical abortion are safe and effective, they note, women contemplating abortion should receive thorough counseling and education about both methods before making their choice. In particular, "attitudes and expectations regarding fears of instrumentation and bleeding should be explored," to help ensure that women choose the procedure with which they are most likely to feel satisfied.--D. Hollander
1. Jensen JT, Harvey SM and Beckman LJ, Acceptability of suction curettage and mifepristone abortion in the United States: a prospective comparison study, American Journal of Obstetrics and Gynecology, 2000, 182(6):1292-1299.