Coyaji K
Department of Obstetrics and Gynecology, KEM Hospital, Rasta Peth, Pune, India.
J Am Med Womens Assoc (1972). 2000;55(3 Suppl):191-4.
Although legal in India, abortion is frequently performed under unsafe or undesirable conditions. Moreover, the advancements required to make surgical abortion safe in India appear insurmountable in the near future. Because it requires a less extensive infrastructure than surgical abortion, medical abortion offers great potential for improving abortion access and safety now. To examine the feasibility of introducing medical abortion and to assess its potential as an alternative to surgical abortion, we conducted three separate studies on the use of 600 mg mifepristone and 400 micrograms oral misoprostol for medical abortion. Study 1 focused on the safety, efficacy, and feasibility of the standard French, three-visit protocol and was conducted in urban research centers in China, Cuba, and India. Study 2 liberalized the protocol to collect information from women using the method under more "real life" conditions in urban family planning clinics in India. Lastly, study 3 extended the trial to rural Indian villages to examine feasibility in settings typical of where the majority of the population resides. In all three settings in India mifepristone-misoprostol proved to be not only feasible, but safe and acceptable as well. With some changes to current protocols, medical abortion could now be safely phased into the existing health care infrastructure in India. Yet, medical abortion will bring its own set of service delivery challenges to address.
尽管堕胎在印度是合法的，但通常是在不安全或不理想的条件下进行。此外，在印度使手术堕胎安全所需的进展在不久的将来似乎难以实现。由于药物流产所需的基础设施不如手术堕胎广泛，它目前在改善堕胎可及性和安全性方面具有巨大潜力。为了检验引入药物流产的可行性并评估其作为手术堕胎替代方法的潜力，我们针对使用600毫克米非司酮和400微克口服米索前列醇进行药物流产开展了三项独立研究。研究1聚焦于标准的法国三次就诊方案的安全性、有效性和可行性，在中国、古巴和印度的城市研究中心进行。研究2放宽了方案，以便在印度城市计划生育诊所更“现实生活”的条件下从使用该方法的女性那里收集信息。最后，研究3将试验扩展到印度农村村庄，以检验在大多数人口居住的典型环境中的可行性。在印度的所有三种环境中，米非司酮 - 米索前列醇不仅被证明是可行的，而且也是安全且可接受的。对当前方案进行一些修改后，药物流产现在可以安全地逐步纳入印度现有的医疗保健基础设施。然而，药物流产也将带来一系列需要应对的服务提供挑战。
