Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and Vietnam
Abstract Background Medical abortion (MA) has become an increasingly popular choice for women even where surgical abortion services are available. Pain is often cited by women as one of the worst aspects of the MA experience, yet we know little about women’s experience with pain management during th...
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| Format: | Article |
| Language: | English |
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BMC
2019-10-01
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| Series: | BMC Women's Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12905-019-0816-0 |
| _version_ | 1818333719171170304 |
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| author | Daniel Grossman Sarah Raifman Tshegofatso Bessenaar Lan Dung Duong Anand Tamang Monica V. Dragoman |
| author_facet | Daniel Grossman Sarah Raifman Tshegofatso Bessenaar Lan Dung Duong Anand Tamang Monica V. Dragoman |
| author_sort | Daniel Grossman |
| collection | DOAJ |
| description | Abstract Background Medical abortion (MA) has become an increasingly popular choice for women even where surgical abortion services are available. Pain is often cited by women as one of the worst aspects of the MA experience, yet we know little about women’s experience with pain management during the process, particularly in low resource settings. The aim of this study is to better understand women’s experiences of pain with MA and strategies for improving quality of care. Methods This qualitative study was conducted as part of a three-arm randomized, controlled trial in Nepal, Vietnam, and South Africa to investigate the effect of prophylactic pain management on pain during MA through 63 days’ gestation. We purposively sampled seven parous and seven nulliparous women with a range of reported maximum pain levels from each country, totaling 42 participants. Thematic content analysis focused on MA pain experiences and management of pain compared to menstruation, labor, and previous abortions. Results MA is relatively less painful compared to giving birth and relatively more painful than menstruation, based on four factors: pain intensity, duration, associated symptoms and side effects, and response to pain medications. We identified four types of pain trajectories: minimal overall pain, brief intense pain, intermittent pain, and constant pain. Compared to previous abortion experiences, MA pain was less extreme (but sometimes longer in duration), more private, and less frightening. There were no distinct trends in pain trajectories by treatment group, parity, or country. Methods of coping with pain in MA and menstruation are similar in each respective country context, and use of analgesics was relatively uncommon. The majority of respondents reported that counseling about pain management before the abortion and support during the abortion process helped ease their pain and emotional stress. Conclusions Pain management during MA is increasingly essential to ensuring quality abortion care in light of the growing proportion of abortions completed with medication around the world. Incorporating a discussion about pain expectations and pain management strategies into pre-MA counseling and providing access to information and support during the MA process could improve the quality of care and experiences of MA patients. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000017729, registered January 8, 2013. |
| first_indexed | 2024-12-13T13:56:06Z |
| format | Article |
| id | doaj.art-8af31e26fa41421bb3ec66fd7fb2800d |
| institution | Directory Open Access Journal |
| issn | 1472-6874 |
| language | English |
| last_indexed | 2024-12-13T13:56:06Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Women's Health |
| spelling | doaj.art-8af31e26fa41421bb3ec66fd7fb2800d2022-12-21T23:42:53ZengBMCBMC Women's Health1472-68742019-10-0119111110.1186/s12905-019-0816-0Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and VietnamDaniel Grossman0Sarah Raifman1Tshegofatso Bessenaar2Lan Dung Duong3Anand Tamang4Monica V. Dragoman5Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of CaliforniaAdvancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of CaliforniaIbis Reproductive HealthNational Hospital of Obstetrics and Gynecology (NHOG)Center for Environment Health and Population Activities (CREHPA)Department of Reproductive Health and Research, WHO, UNFP/UNDP/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)Abstract Background Medical abortion (MA) has become an increasingly popular choice for women even where surgical abortion services are available. Pain is often cited by women as one of the worst aspects of the MA experience, yet we know little about women’s experience with pain management during the process, particularly in low resource settings. The aim of this study is to better understand women’s experiences of pain with MA and strategies for improving quality of care. Methods This qualitative study was conducted as part of a three-arm randomized, controlled trial in Nepal, Vietnam, and South Africa to investigate the effect of prophylactic pain management on pain during MA through 63 days’ gestation. We purposively sampled seven parous and seven nulliparous women with a range of reported maximum pain levels from each country, totaling 42 participants. Thematic content analysis focused on MA pain experiences and management of pain compared to menstruation, labor, and previous abortions. Results MA is relatively less painful compared to giving birth and relatively more painful than menstruation, based on four factors: pain intensity, duration, associated symptoms and side effects, and response to pain medications. We identified four types of pain trajectories: minimal overall pain, brief intense pain, intermittent pain, and constant pain. Compared to previous abortion experiences, MA pain was less extreme (but sometimes longer in duration), more private, and less frightening. There were no distinct trends in pain trajectories by treatment group, parity, or country. Methods of coping with pain in MA and menstruation are similar in each respective country context, and use of analgesics was relatively uncommon. The majority of respondents reported that counseling about pain management before the abortion and support during the abortion process helped ease their pain and emotional stress. Conclusions Pain management during MA is increasingly essential to ensuring quality abortion care in light of the growing proportion of abortions completed with medication around the world. Incorporating a discussion about pain expectations and pain management strategies into pre-MA counseling and providing access to information and support during the MA process could improve the quality of care and experiences of MA patients. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000017729, registered January 8, 2013.http://link.springer.com/article/10.1186/s12905-019-0816-0Medical abortionPainNepalSouth AfricaVietnam |
| spellingShingle | Daniel Grossman Sarah Raifman Tshegofatso Bessenaar Lan Dung Duong Anand Tamang Monica V. Dragoman Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and Vietnam BMC Women's Health Medical abortion Pain Nepal South Africa Vietnam |
| title | Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and Vietnam |
| title_full | Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and Vietnam |
| title_fullStr | Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and Vietnam |
| title_full_unstemmed | Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and Vietnam |
| title_short | Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and Vietnam |
| title_sort | experiences with pain of early medical abortion qualitative results from nepal south africa and vietnam |
| topic | Medical abortion Pain Nepal South Africa Vietnam |
| url | http://link.springer.com/article/10.1186/s12905-019-0816-0 |
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