BMJ Sexual & Reproductive Health Vol.51, Issue 1, 2025. https://srh.bmj.com/content/51/1/80
by Ingrid D Lui, Sue Sing Tsing Lo, Jianchao Quan
The new WHO Abortion Care Guideline published in 2022 highlighted the need for quality person-centred service, including a recommendation for the self-management of medical abortions at gestational ages under 12 weeks. International studies have found that home-based medical abortions were as safe and effective as institution-based care and that this service mode was well accepted by women. However, this option is currently unavailable in Hong Kong, as abortions can only legally be conducted at one of 20 gazetted institutions, including the Family Planning Association of Hong Kong (FPAHK), where one-third of the legal abortions were performed. Few studies have examined women’s opinions on medical abortion in Hong Kong since two pilot studies in the 1990s when this abortion method was first introduced for research purposes. We sought to assess whether a home-based medical abortion service would be accepted by potential service users.
We surveyed 204 women undergoing medical (n=99) and surgical (n=105) abortions at FPAHK from June to July 2022 on whether they would accept home-based medical abortion were it to become available in Hong Kong. Women in the medical abortion group were significantly younger, received tertiary education, and were more likely to be students. Women in the surgical abortion group were significantly more likely to have had a prior surgical abortion, while the association between prior and current medical abortion was not statistically significant. When asked if they believed they could manage a home-based medical abortion, 25.5% of participants answered ‘yes’ and 35.5% answered ‘maybe’. When asked if they would choose the home-based medical option for a future abortion, 26.0% of participants answered ‘yes’ and 30.9% answered ‘maybe’.
Compared with the two pilot studies in the 1990s in which only 1.5% of women indicated they would choose home-based medical abortion for a future abortion, the substantially greater acceptance of this method in the present cohort could be related to the establishment of medical abortion as a routine service at FPAHK since 2011. Despite increasing acceptance, nearly all (96.2%) participants in the surgical abortion group preferred surgical as their first, and sometimes only, choice in the future, and most believed that monitoring by medical professionals is required during medical abortion. Furthermore, participants who believed they could not manage a home-based medical abortion were significantly more likely to have previously had a surgical abortion (p=0.033).
Previous research has shown the self-efficacy of chronic disease patients affects their ability to self-manage their conditions, and it is possible this also applies to women selecting their preferred abortion method. In this cohort, we found that confidence in managing home-based medical abortion was significantly associated with prior medical abortion (p<0.001) but not with age, education or prior surgical abortion experience. Women who were confident in managing abortion at home were significantly more likely to choose this method in future compared with those who lacked confidence (78.8% vs 7.9%, p<0.001). Conversely, women who believed medical monitoring is necessary for abortions perhaps felt that such procedures should not be handled by women themselves, and thus were more likely to select surgical abortion, which requires the least self-efficacy.
Home-based medical abortion has become more acceptable now than 20 years ago. Acceptance could be further increased through supporting the self-efficacy of women who are hesitant but do not reject medical abortion at home, through the delivery of more detailed information about the process and by asking women who have had a medical abortion to share their experiences. This could be a first step towards potentially introducing and increasing acceptance of home-based medical abortion in Hong Kong in the future.