by Heidi Moseson, Ruvani Jayaweera, Sarah Raifman, Brianna Keefe‑Oates, Sofia Filippa,
Relebohile Motana, Ijeoma Egwuatu, Belen Grosso, Ika Kristianingrum, Sybil Nmezi, Ruth Zurbriggen Caitlin Gerdts
Reproductive Health 27 October 2020;17:Article 164 DOI:10.1186/s12978-020-01016-4
Abstract
Background: To evaluate the feasibility of conducting a prospective study to measure self-managed medication abortion outcomes, and to collect preliminary data on safety and effectiveness of self-managed medication abortion, we recruited callers to accompaniment groups (volunteer networks that provide counselling through the out-of-clinic medication abortion process by trained counselors over the phone or in-person).
Methods: In 2019, we enrolled callers to three abortion accompaniment groups in three countries into a prospective study on the safety and effectiveness of self-managed medication abortion with accompaniment support. Participants completed up to five interview-administered questionnaires from baseline through 6-weeks after taking the pills. Primary outcomes included: (1) the number of participants enrolled in a 30-day period, (2) the proportion that had a complete abortion; and (3) the proportion who experienced any warning signs of potential or actual complications.
Results: Over the 30-day recruitment period, we enrolled 227 participants (95% of those invited), and retained 204 participants (90%) for at least one study follow-up visit. At the one-week follow-up, two participants (1%) reported a miscarriage prior to taking the pills, and 202 participants (89% of those enrolled and 99% of those who participated in the 1-week survey) had obtained and taken the medications. Three weeks after taking the medications, 192 (95%) participants reported feeling that their abortion was complete. Three (1.5%) received a surgical intervention, two (1%) received antibiotics, and five (3%) received other medications. Participants did not report any major adverse events.
Conclusion: These results establish the feasibility of conducting prospective studies of self-managed medication abortion in legally restrictive settings. Further, the high effectiveness of self-managed medication abortion with accompaniment support reported here is consistent with high levels of effectiveness reported in prior studies.
From the Background section
The reasons that people attempt to self-manage abortion – defined here as ending one’s own pregnancy outside of a formal health-care setting – and the means by which they do so, vary widely by setting. The incidence of self-managed abortion is not well studied; estimates suggest that approximately 45% of abortions worldwide in 2010–2014 took place outside of a health facility – and in some settings, the proportion may be closer to 70 or 80%…
Beyond online websites, people obtain information, medications, and support to self-manage their abortions in a variety of other ways. One emerging model is abortion accompaniment, where trained volunteers provide WHO-recommended evidence-based information about medication abortion, as well as physical and emotional support and person-centred care throughout the medication abortion process, over the phone or in person, outside of the formal health care system…. Approximately fifty accompaniment groups are in operation around the world, providing support and information about self-managed medication abortion. However, despite the increasing number of abortion accompaniment groups worldwide, little research has documented the safety and effectiveness of the abortion accompaniment model. To our knowledge, only three studies have reported on outcomes of self-managed medication abortion among accompaniment group clients; all found high levels of abortion completion and few complications.
Of the data that do exist, however, there are important limitations, including a heavy reliance on retrospective records that were not collected for the purposes of research. Evidence suggests that a high proportion of abortions occur outside of the health care system and changing global dynamics may continue to shift more abortions outside of the healthcare system. Well-designed, rigorously-collected data are needed to assess the safety and effectiveness of medication abortion administered completely outside of the formal healthcare system – such as the accompaniment model – to contribute to our understanding of de-medicalized models of abortion care… [therefore this study].