Self-management of medical abortion: a qualitative evidence synthesis

by Megan Wainwright, Christopher J Colvin, Alison Swartz, Natalie LeonReproductive Health Matters 2016;24(47) (Abstract only)The study: This qualitative evidence synthesis reviewed the global evidence on experiences with, preferences for, and concerns about greater self-management of medical abortion with lesser health professional involvement. It focused on qualitative research from multiple perspectives on women’s experiences of self-management of first trimester medical abortion. It included research from both legal and legally-restricted contexts whether medical abortion was accessed through formal or informal systems. The review identified 36 studies meeting inclusion criteria. Review findings were organized under the following themes: general perceptions of self-management, preparation for self-management, logistical considerations, issues of choice and control, and meaning and experience.Approaches to provision: The spectrum of approaches to the management of medical abortion ranged from most medicalized to the least medicalized processes in both legal and legally restricted settings. The three clinic-visit model is still the dominant model in highly medicalized settings. Studies from settings where abortion is legally restricted often did not specify the stage of pregnancy and frequently drew from experiences of informal care networks that may or may not have included health professionals.Important findings: (1) The qualitative evidence base is still small. Available evidence points to the overall acceptability of self-administration of medical abortion. Further qualitative research is needed to strengthen this important evidence base.(2) Providers were generally approving of the concept of self-management, including self-administration if initiation of medical abortion was supported by trained providers, and they believed that it could be done feasibly, effectively and safely. Even in restricted contexts, some offered support for women self-administering, by providing clinical advice and counselling and noting likely sources of the drug. Providers were not, however, generally supportive of over-the-counter access to medical abortion drugs. Self-management and self-administration allowed providers in restricted contexts to distance themselves legally from the abortion. Providers in legal contexts could accomplish a similar kind of distancing on moral grounds.Further research needed: Dealing with the products of conception is an important experiential element of self-management of medical abortion, and one that is not well reported on in the qualitative literature. Understanding women’s practices, and preferences regarding the expelled products is important especially… in relation to gestational age of the fetus.VISUAL