Original research article Acceptability of home-use of misoprostol in medical abortion Christian Fiala a , Beverly Winikoff b , Lotti Helstrfm a , Margareta Hellborg a , Kristina Gemzell-Danielsson a, * a Division for Obstetrics and Gynaecology, Department of Woman and Child Health, Karolinska Hospital/Institute, S-171 76 Stockholm, Sweden b Gynuity Health Projects, New York, NY 10010, USA Received 10 May 2004; accepted 30 June 2004 Abstract Introduction: Home-use of misoprostol would reduce the number of visits and improve access to medical abortion. We evaluated acceptance of home-use of misoprostol among women and their partners. Materials and Methods: One hundred women with up to 49 days of amenorrhea were given mifepristone, followed by misoprostol taken at home. Results: Women chose home-use of misoprostol because it felt more natural, private and allowed the presence of a partner/friend. Two women had a vacuum aspiration due to incomplete abortion. Five unscheduled visits occurred. Ninety-six women were satisfied with their choice of home-use. The male partners were generally satisfied with their partner’s choice of home-use and felt that their presence and support had been valuable. Discussion: Our study shows a high acceptability among women and their partners and confirms the safety and efficacy of home-use of misoprostol. Women should be offered this choice to allow more flexibility and privacy in their abortions. D 2004 Elsevier Inc. All rights reserved. Keywords: Acceptability; Medical abortion; Misoprostol; Home use; Male partner 1. Introduction Medical abortion using the antiprogestin mifepristone (Exelgyn; Paris, France) combined with a prostaglandin has been available in Europe since 1988. Several large multicenter studies have since confirmed the safety and efficacy of this regimen with efficacy rates over 95%, comparable to that of surgical abortion [1–3]. Several studies have examined women’s preferences for medical versus surgical abortion. When given the choice, 60 –80% of women chose the medical method (reviewed in Ref. 4). The prostaglandin most widely used today is misoprostol (Cytotec, Pfizer), a prostaglandin E1 analogue widely available for the prevention of gastric ulcers in patients taking nonsteroidal anti-inflammatory drugs. Mifepristone is approved for medical abortion in almost all countries of the European Union and the US with 600 mg mifepristone followed 36–48 h later by a prostaglandin. The most commonly used regimen of prostaglandin up to 49 days of amenorrhea in continental Europe is 400 Ag misoprostol administered orally as a single dose. This regimen is highly effective to terminate a pregnancy up to 49 days of amenorrhea but less effective in more advanced pregnancy [5–8]. At a gestational duration beyond 49 days, vaginal administration of a higher dose of misoprostol, 800 Ag instead of 400 Ag, has been shown to be more effective [9]. In a few European countries, including Sweden, France and the UK, abortion can, according to the law, be performed only in hospital-affiliated facilities or facilities approved by the Department of Health. This requirement has also been applied to medical abortion, resulting in the interpretation that all the drugs have to be given in an authorized facility followed by an obligatory observation period after misoprostol. Currently, three visits are required for medical abortion: the first is for abortion counseling, examination, contraceptive counseling and administration of mifepristone; the second visit is for the administration of misoprostol including a 3- to 4-h observation period. Finally, a follow-up visit takes place 1–4 weeks later. Although the method has been shown to be very safe and effective, several 0010-7824/$ – see front matter D 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.contraception.2004.06.005 * Corresponding author. Tel.: +46 8 517 721 28; fax: +46 8 517 743 14. E-mail address: kristina.gemzell@kbh.ki.se (K. Gemzell-Danielsson). Contraception 70 (2004) 387 – 392