These unique data provide a window of understanding into who contacts safe-abortion hotlines and why, and enable exploration of future directions for research on the role of safe-abortion hotlines in women's access to safe abortion. Public Health Implications. Safe-abortion hotlines should be evaluated not only for reducing harm but also for providing high-quality abortion care.
IntroductionUnsafe abortion past the first trimester disproportionately accounts for the majority of global abortion-related morbidity and mortality; research that documents the safety, feasibility and acceptability of existing models for providing information and support to women who self-manage outside of formal clinic settings is needed.MethodsThis study is a retrospective analysis of anonymised electronic client records from callers to a safe abortion hotline in Indonesia. Between July 2012 and October 2016, a total of 96 women contacted the hotline for information on medication abortion beyond 12 weeks' gestation and are included in this study. Descriptive statistics were calculated regarding pregnancy termination status, client experience with warning signs of potential complications, and medical care seeking and treatment.ResultsNinety-six women with pregnancies beyond the first trimester called the hotline for information on medication abortion; 91 women received counselling support from the hotline. Eighty-three women (91.2%) successfully terminated their pregnancies using medication and did not seek medical care. Five women exhibited warning signs of potential complications and sought medical care; one woman sought care after a failed abortion. Two women were lost to follow-up and the outcomes of their pregnancies are unknown.ConclusionsEvidence from our analysis suggests that a model of remote provision of support for abortions later in pregnancy by non-medically trained, skilled abortion counsellors could be a safe alternative for women in need of abortions beyond 12 weeks' gestation in a legally restrictive context. Further examination and documentation of the model is warranted.
Objective
To investigate the impact of a smartphone application (app) providing information and support for medication abortion (MA) on the primary outcomes of ‘feelings of support’ and ‘preparedness’ among clients of Samsara, a safe‐abortion hotline in Indonesia.
Methods
In a parallel‐arm, non‐clinical, randomized controlled trial, women (ages ≥15) who contacted Samsara between February 2017‐ July 2018 seeking information on MA for pregnancies ≤13 weeks gestation were randomized to receive either an app with abortion information, or standard of care (high‐quality comprehensive and empathic counseling on pregnancy options). Participants completed a questionnaire 24 days after enrollment; Fisher exact tests and risk differences were used to assess differences in self‐reported feelings of preparedness and support throughout the process of self‐managed MA.
Results
No differences in feelings of support or preparedness were detected between participants in the app arm versus the standard of care arm.
Conclusion
This study represents the first‐ever randomized control trial (and prospective study) among those who contacted a safe‐abortion hotline for information about and support for self‐managed abortion. Levels of preparedness, confidence, and feelings of support were all extremely high among both control and intervention arms–indicative of the high‐quality, evidence‐based information, comprehensive, and supportive abortion counseling that safe‐abortion hotline clients receive.
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