Choice of and satisfaction with methods of medical and surgical abortion among US clinic patients

Context: Abortion induced by drugs is now a viable alternative to surgicall y induced abortion for U.S. women. Women's willingness to use these new met hods of medical abortion hinges on the extent to which they prove acceptabl e, however. Methods: Among 304 women participating in a clinical trial of medical abort ion, 186 received a methotrexate-induced abortion and 118 were offered the option of a medical abortion but chose a surgical procedure instead. Study participants completed self-administered questionnaires before the abortion and again at a follow-up visit. Results: Women in the medical and surgical abortion groups did not differ s ignificantly with regard to demographic and other background characteristic s: Their mean age was about 27, more than two-thirds were white, and three- quarters were unmarried and worked either part-time or full-time. However, women's ratings of seven attributes of abortion methods were significant pr edictors of choosing a medical abortion: Women were more likely to choose m edical abortion if they placed greater importance on a method that was nons urgical, one that resembled a miscarriage or one that could take place at h ome (odds ratios, 2.0-3.3). Conversely, women were less likely to choose me dical abortion if they valued methods that were quick, that did not involve painful cramping or seeing blood or blood clots and that needed a doctor o r nurse to be present (odds ratios, 0.3-0.5). Compared with those who had a surgical abortion, women who had a methotrexate-induced abortion expected more bleeding (mean scores, 3.5 vs. 3.1) and reported more pain (3.4 vs. 2. 9), heavier bleeding (3.4 vs. 2.5) and bleeding of longer duration (3.3 vs. 2.6). The overwhelming majority of women in the medical and surgical abort ion groups reported that they were either very or somewhat satisfied with t heir abortion method (81% and 82%, respectively), would recommend it to oth ers (82% and 78%) and would choose the method again (89% and 93%). Conclusions: Factors affecting the choice of abortion method appear to be n umerous and complex. Providers need to be sensitive to differences in women s values and life circumstances when counseling them about an abortion meth od. In particular, providers should incorporate into their counseling sessi ons what women need to know about the characteristics of abortion methods a nd help women to identify what is the best option for them.