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Women Seeking Early Abortions in the United States and India Can Accurately Assess the Durations of their Pregnancies

Population Council Study Has Implications for Less Supervised Use of Mifepristone-Misoprostol Medical Abortion

Recent advances in medical abortion, particularly the mifepristone-misoprostol regimen, open the possibility that women seeking early abortions may be able to terminate their pregnancies safely and effectively without routine medical supervision. Among the necessary steps for safe, unsupervised use of these drugs, women must be able to determine accurately that their pregnancies are not too advanced for the regimen.

To see if women could produce an accurate estimate of gestational age, Population Council researchers conducted a study of 442 women seeking first-trimester abortions in two clinics (Pune, India, and Atlanta, U.S.). The women were given a simple worksheet and calendar to calculate their gestational ages using the date of last menses and/or the date of intercourse thought to have led to the pregnancy. Clinicians then used standard clinic practices to make their own gestational age estimates for these same women.

Researchers compared the two sets of estimates, focusing on those women who fell into the "caution zone," that is, women who thought their pregnancy durations to be eight weeks or less, although clinicians thought the pregnancies exceeded this cutoff date. The eight-week cutoff date is a conservative one, since the mifepristone-misoprostol regimen has been used safely and effectively in clinical practice up to nine weeks' gestation.

The results of the study by Charlotte Ellertson, Batya Elul, and colleagues in Pune and Atlanta* are reported in the March 11, 2000 issue of Lancet. The researchers found that the vast majority of women (97.7 percent in Atlanta and 86.5 percent in Pune) could produce some estimate of gestational age; most of these calculations came quite close to estimates made by providers. When basing their estimates on a date of last menses, only 10 percent of women in Atlanta and 9.8 percent in Pune fell into the "caution zone" by being more than eight weeks along according to providers, but assessing themselves as less far along. When basing their estimates on a date of intercourse, just 7.7 percent of women in Atlanta and 3.4 percent in Pune fell into this "caution zone," although fewer women were able to use this latter method. Although these women may be considered cause for concern, the researchers say, "For the most part, they erred by no more than one week, placing them well within the documented margin for safe and effective medical abortion."

The researchers concluded that "The vast majority of first-trimester abortion seekers in this study could accurately calculate their gestational ages within a margin of error clinically inconsequential for safe use of unsupervised medical abortion." The authors point out that all of the regimens currently being followed require two or three visits and that ability to assess her gestational age correctly does not guarantee a woman a safe and effective mifepristone-misoprostol abortion without medical supervision.

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*"Accuracy of assessment of pregnancy duration by women seeking early abortions"
Charlotte Ellertson, Ph.D., M.P.H., Director of Reproductive Health for Latin America and the Caribbean, Population Council, Mexico; Batya Elul, M.Sc., formerly Staff Program Associate, Population Council; Shuba Ambardekar, M.D., Senior Research Officer, K.E.M. Hospital, Pune, India; Lindy Wood, B.A., Study Coordinator, Feminist Women's Health Center, Atlanta, GA; Julie Carroll, B.A., Graduate Student, University of California at Berkeley, Berkeley, CA; Kurus Coyaji, M.D., Director, Department of Obstetrics and Gynecology, K.E.M. Hospital, Pune, India.

The Population Council is an international, nonprofit, nongovernmental institution that seeks to improve the wellbeing and reproductive health of current and future generations around the world and to help achieve a humane, equitable, and sustainable balance between people and resources. The Council conducts biomedical, social science, and public health research and helps build research capacities in developing countries. Established in 1952, the Council is governed by an international board of trustees. Its New York headquarters supports a global network of regional and country offices.