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 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.

Patient Experience with Postpartum Pain Management in the Face of the Opioid Crisis

“…Indeed, data regarding women's experience with pain in the postpartum period are limited. Grossman et al examined the pain experience of 42 women following early medical abortions 16 . Similar to our findings, many of the participants reported that counseling and education about pain management resulted in an improved experience with pain.…”

Clients’ perceptions of the quality of post-abortion care in eight health facilities in Dakar, Senegal

“…Whereas recent research has emphasized the need for strengthened post-abortion family planning counselling, this analysis suggests that women's overall satisfaction with care is more related to whether their provider counsels them on the treatment procedure. That this association was significant after adjustment for women's rating of the comfort they felt during the procedure suggests that receiving counselling on treatment steps and the likely discomfort women will feel during the procedure helps women cope with pain and emotional stress (Grossman et al, 2019).…”

“…Past research has found that clients' satisfaction with abortion-related care is associated with the interpersonal treatment by staff and the information provided, as well as the individual-level socio-demographic characteristics of clients (Graff & Tabbutt-Henry, 2003;Deitch et al, 2019). Studies have also shown that components and processes of care shape clients' satisfaction with care received, such as procedure type, facility type, intensity of pain felt during treatment and client choice of treatment method (Becker et al, 2011;Diaz-Olavarrieta, et al, 2012;Maternowska et al, 2015;Grossman, et al, 2019). Additional research has highlighted the relevance of other domains of quality of care to women's evaluation of quality, such as the accessibility of services, the facility environment, integration of family planning counselling and method provision and women's perception of provider's technical competence (Becker et al, 2011;Diaz-Olavarrieta, et al, 2012).…”

Two prophylactic pain management regimens for medical abortion ≤63 days' gestation with mifepristone and misoprostol: A multicenter, randomized, placebo-controlled trial

“…Prior studies have focused on populations of women in the United States, Canada, France, and Israel [3 , 5 , 12] . In a separate manuscript, we report on qualitative findings of study participants' experiences with the pain of medical abortion [13] .…”