Academic paper: Simple online calculator for women to self-assess length of pregnancy for early medical abortion eligibility in South Africa

by Mariette Momberg, Jane Harries, Deborah ConstantReproductive Health 2016;13(40)In South Africa, use of medical abortion is available up to nine weeks of pregnancy, so timely access is essential. This pilot study – with 78 women seeking an abortion in two Cape Town, South Africa clinics (one public, one private) in 2014 – asked whether women could self-assess how many weeks pregnant they were, using a simple online calculator on their cell/mobile phones, and whether the tool gave them an accurate answer. The tool developed by the research team was tailored to the South African context and easily accessible from computers or mobile phones. The study is part of growing research on what is called M-health (mobile health), which has been defined by the Global Observatory for e-health of the World Health Organization as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants and other wireless devices”.According to lead researcher Jane Harries, most pregnancy calculator applications on the web are intended to calculate a woman’s due-date and provide other information that is not suitable for a woman seeking to terminate a pregnancy. The use of a web-based application to determine eligibility for abortion is novel.The pilot online pregnancy calculator used in the study asked only a few questions and was optimized to be viewed and navigated on a small screen (“mobi-site”). Women are guided through several questions: first they are asked to choose on a calendar the first day of their last menstrual period. If they answer no, they are asked for an approximate date and given some clues how to try and remember, so they can continue. Then they are asked whether they suffer from any bleeding disorder, are taking a medication called warfarin, whether they have ever had an allergic reaction to medical abortion medications, whether they have had pain or bleeding during this pregnancy, and whether they currently have an IUD inserted. If they are over 9 weeks or answer any of these questions yes, they are advised to see a doctor. If they are below 9 weeks and answer no to the other questions, they are told, e.g.: “You have been pregnant for 5 Week(s) and 4 Day(s). You may be eligible for a medical abortion today, please speak to a doctor or nurse for more information.”The web-calculated weeks/days of pregnancy was then compared to the ultrasound calculation obtained from clinical records to determine accuracy.Results: Participant mean age was 28 (SD 6.8), 41% (32/78) had completed high school and 73% (57/78) reported owning a smart/feature phone. Internet searches for abortion information prior to clinic visit were undertaken by 19/78 (24%) women. Most participants found the online calculator easy to use (91%; 71/78); thought the calculation was accurate (86%; 67/78) and that it would be helpful when considering an abortion (94%; 73/78). 83% (65/78) reported regular periods and recalled the start date of their last menstrual period (LMP) (71%; 55/78). On average the women overestimated length of pregnancy by 0.5 days (SD 14.5) and first sought an abortion 10 days (SD 14.3) after pregnancy confirmation.Editor’s note: With this and other research, we are seeing the development of more and more support for women to safely self-manage abortion up to ten weeks of pregnancy with medical abortion pills, if they meet certain criteria. A more widely tested pregnancy calculator like the one used for this study can help those who need it to calculate how pregnant they are. GPs, community nurses and other trained mid-level health care providers – or phone-based and web-based clinical services – or safe abortion information hotlines – can give information about safe use of medical abortion and ongoing support through the abortion if needed. And a home-use pregnancy test can confirm whether the abortion was complete. Access to formal treatment for the few who need treatment, e.g. for heavy bleeding, and for those with an incomplete abortion, is still required, however, to make the safety picture complete.SEE ALSO: Campaign website: Safe Abortion Information Hotlines and web-based services,and Campaign newsletters for examples:Samsara Indonesia Safe Abortion Hotline , 1 June 2016;The Tabbot Foundation – Australia, 20 November 2015, and follow-up report in Abortion Services and Training, 1 July 2016