Factors behind failure of unsupervised self induced medical abortion : A Study from North India

Introduction : Unsafe abortions contribute to 8% of maternal mortality. Easy availability and rampant use of medical methods of abortion lead to upsurge in self induced abortion related complications. Present study was conducted to assess the profile, knowledge, attitude and reasons of preference of self induced abortion in women visiting our centre after complication or failure of medical abortion. We also tried to evaluate the burden of different complications and factors behind failure of self induced medical abortion. Material and Methods: It was a prospective mixed methods study performed in the department of obstetrics and gynaecology at a tertiary care centre. These women were interviewed by two doctors with the help of pre structured questionainare and their diagnosis, course of management and duration of stay in the hospital was noted down from hospital records. Results: We recruited 216 women visiting our facility after some complication of self induced medical abortion. 92 women used Mifepristone and misoprostol regimen and rest used misoprostol. 165 women have purchased drugs over the counter from pharmacists. Major source of information is husband or friends. Most of the patients [n= 87.9%] consider it low risk.97% patients follow incorrect drug schedule and misoprostol was taken by oral route only. Ruptured ectopic pregnancy, anaemia, Sepsis, Incomplete abortion, Missed abortion and continuation of pregnancy was observed in 1.8%, 69.44%, 8.3%, 68.5 %, 9.7% and 23.14%. Conclusion: Neglect of eligibility criteria and faulty drug regimens are the most common reasons for failure on self induced medical abortions. Low perceived risk and reluctance to hospital visit and interventions are most common reasons of preference of self induced abortions.