Patients are Highly Satisfied with MVA
The majority of women who have had an MVA procedure are very satisfied with the experience. Patient acceptability is a very important consideration when making decisions about what kind of abortion services to offer. Ensuring that patients have a positive experience is an integral part of offering high-quality services. Between 88 and 95 percent of women say they would recommend MVA to a friend. 5 One study examining satisfaction of patients who were randomly assigned to have either EVA or MVA found that the majority of both groups were very satisfied with their procedure. No major differences in acceptability were found between the two groups (Thornburn Bird et al., 2001). In another study where women opted for a first-trimester procedure using either medical abortion or vacuum aspiration, 82 percent of those who chose vacuum aspiration reported that they were “very” or “somewhat” satisfied. Seventy-eight percent said 6 they would recommend vacuum aspiration to a friend, and 93 percent said they would choose vacuum aspiration if they needed another abortion (Harvey et al., 2001). A U.S. study randomly assigned women with no treatment preference to receive either MVA or medical abortion, and then examined the patients’ satisfaction. Ninety-two percent of women who received MVA said they would choose the same method again, compared to 63 percent of medical abortion patients. Such response indicates high patient satisfaction with the MVA method (Creinin, 2000). Where MVA is provided in an office setting or lower-level health facility, women may also appreciate the greater personal attention and less institutional environment (Westfall et al., 1998). Because MVA uses a handheld, non-electric aspirator, the procedure does not generate any noise. This leads to a gentle and silent procedure, and one which is often more comfortable for the woman. Doctors in Vietnam have noted that MVA’s lack of noise helps reduce patient’s anxiety during the abortion procedure (unpublished focus group discussions, 1998). Some MVA providers have commented that patients ask for the “quiet abortion,” indicating the patient’s preference for this aspect of the MVA procedure. One study of 108 women found that EVA patients felt the noise associated with the procedure increased their pain although, in general, the patients’ pain perception was not significantly different between the two techniques (Edelman et al., 2001).
Abortion is a highly personal experience, and what is best for one woman may not be for another. Women place high value on being able to choose between abortion methods. Moreover, the ability to choose yields high satisfaction regardless of which procedure women select. The option to choose between abortion methods helps to increase patient satisfaction and has emotional benefits for the woman, regardless of the method selected (Jensen et al., 2000; Creinin, 2000).
Pain Management with MVA is Simple and Affordable
MVA allows a lower level of pain control medication than sharp curettage. Local anesthesia which has been proven to be very safe for use in abortion procedures—can beeffectively used in conjunction with analgesics for pain control during MVA. Local anesthesia reduces recovery time and requires fewer expenses for personnel, infrastructure and equipment. In contrast, the D&C procedure is typically performed with general anesthetic or heavy sedation. This level of pain management is expensive, and general anesthesia is associated with an increased risk of complications from blood loss, cervical injury, uterine perforation and subsequent abdominal hemorrhage (Grimes et al., 1979;Greenslade et al, 1993b). Heavy anesthesia also places a strain on the health care system, as it requires more complicated facilities and equipment. In many countries, reliance upon general anesthesia limits the settings in which surgical abortions can be performed. The patient’s reduced perception of pain with MVA is particularly notable in comparison with the D&C procedure. In focus groups with Vietnamese physicians, participants consistently described a reduction of patients’ pain as a major benefit of MVA. Reducing pain also lessens the patient’s anxiety and fear, thereby improving her overall satisfaction with the procedure. As an added benefit, enhancing the woman’s experience and lowering her pain makes the procedure more comfortable for providers as well (Focus Group, 1998). By allowing pain to be effectively managed with local anesthetic, analgesics and verbal support, MVA lowers costs, improves safety, enhances patient satisfaction and expands service availability. Manual Vacuum Aspiration: Service Delivery Providers appreciate the simplicity, portability and cost-effectiveness of MVA. Any provider who engages in gynecological services is probably well equipped to provide MVA. The method can be offered with little in the way of specialized instruments and 9 By allowing pain to be effectively managed with local anesthetic, analgesics and verbal support,MVA lowers costs, improves safety, enhances patient satisfaction and expands service availability. Paul Blumenthal supplies and with modest adaptations to existing facilities. The instruments do not require electricity, and providers at various levels of the health care system can safely perform MVA. Further, there are few additional expenses once the MVA instruments are purchased, the staff trained and the facility arranged. MVA is easy to use in a variety of settings, including first-referral level sites, primary care facilities, medical offices and clinics. Its simplicity helps move abortion services out of hospital and operating room settings where D&C is typically performed (Magotti et al., 1995). (See Table 4.) MVA also allows providers to offer women safe and effective abortions in a private office or when the operating theater is booked, reducing delays and decreasing the number of staff required for the procedure. The burden on health care systems is reduced when a provider is able to perform an abortion at the time the woman presents at the facility, rather than waiting for physicians and operating rooms to become available. According to a 1997 study by de Pinho and McIntyre, cost is also reduced; in South Africa, first-trimester procedures performed in health centers7 cost 26 percent less than those performed in communitybased clinics and 133 percent less than hospital-based abortions (as cited in Althaus, 2000). A shift to performing MVA outside the hospital and/or operating room setting helps conserve resources that can then be directed to family planning and other essential health care services for women and their families. Other locales face more challenging difficulties in providing medical care, such as a lack of trained health care professionals or inadequate equipment. MVA makes safe abortions possible in low-resource or remote areas, particularly where other methods are not feasible. MVA presents a means of offering surgical services by trained midlevel providers, which is especially important in regions with low doctor-patient ratios or few available physicians. When health professionals must travel to rural areas to offer health care, MVA offers a convenient, portable and cost-efficient way to ensure that abortion services reach remote areas of the country. MVA allows safe abortion without electricity and provides an excellent back-up method for EVA where electricity is unreliable. Equipment and Facility Requirements Adopting MVA services requires few, if any, changes to either facilities or infrastructure. Because of its simplicity, MVA can be offered in lower-level health facilities and as an outpatient procedure. It is suitable for integration into hospital ob/gyn wards, private practices, community clinics, emergency rooms and other settings. Optimally, providers will have a private space for counseling and discussing the procedure with the patient, as well as a comfortable and appropriate place for the patient to recover after the procedure. If private space is not available, providers should find a way to counsel women that respects privacy and confidentiality. The abortion itself can be performed in a small examination or procedure room, which should be well-lit, well-ventilated and large enough to accommodate a gynecological examination table. The instruments necessary for MVA are significantly less expensive than those required for EVA. Supplies needed for sterilizing or high-level disinfecting instruments and for examining the products of conception are generally simple.