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Second-trimester self-use of medication abortion outside of the formal health system supported by feminist activist groups could provide an alternative model for second-trimester care worldwide. More research is needed to document the safety and effectiveness of this accompaniment service-provision model.

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 1-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. Trial registration ISRCTN95769543.

IntroductionA range of barriers deter or prevent people from accessing facility-based abortion care. As a result, people are obtaining and using abortifacient medications to end their pregnancies outside of the formal healthcare system, without clinical supervision. One model of self-managed abortion has come to be known as the ‘accompaniment’ model, in which grassroots organisations provide pregnant people with evidence-based counselling and support through the medication abortion process. Data are needed to understand the safety and effectiveness of this increasingly common model of abortion care.Methods and analysisThis is a large, prospective, observational study in Argentina and Nigeria. All people who contact one of two accompaniment groups seeking information for their own self-managed medication abortion, are ages 13 years and older, have no contraindications for medication abortion, are within the gestational range supported by the group (up to 12 weeks’ gestation for the primary outcome) and are willing to be contacted for follow-up will be recruited. Participants will respond to an interviewer-administered baseline survey at enrolment, and 1–4 additional surveys over 6 weeks to ascertain whether they obtain medications for abortion, dosing and route of administration of medications, physical and emotional experience of medication abortion self-management, and effectiveness and safety outcomes. Analyses will include estimates of the primary outcome: the proportion of participants that report a complete abortion without surgical intervention at last recorded follow-up; as well as secondary outcomes including a pseudo-experimental test of non-inferiority of the effectiveness of self-managed medication abortion as compared with clinical medication abortion.Ethics and disseminationWe describe the ethical considerations and protections for this study, as well the creation of a study-specific Data Monitoring and Oversight Committee. We describe dissemination plans to ensure that study results are shared widely with all relevant audiences, particularly researchers, advocates, policymakers and clinicians.Trial registration numberISRCTN95769543.

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 six-weeks after taking the pills. Primary outcomes included: (1) the proportion that had a complete abortion; and (2) the proportion who experienced any warning signs of potential or actual complications.Results: Over the 30-day recruitment period, we enrolled 227 participants. 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 one-week survey) had obtained and taken the medications. Three weeks after taking the medications, 192 (95%) participants reported feeling that their abortion was complete, and 189 (94%) felt their abortion was complete and had not reported a surgical intervention. Three (1.5%) received a surgical intervention, two (1%) received antibiotics, and five (3%) 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, these prospectively collected pilot data suggest that self-managed medication abortion with accompaniment support may be safe and effective. Trial Registration: ISRCTN95769543

In Argentina, Chile and Ecuador, abortion at later durations of pregnancy is legally restricted. Feminist collectives in these contexts support people through self-managed medical abortion outside the healthcare system. The model of in-person abortion accompaniment represents an opportunity to examine a self-care practice that challenges and reimagines abortion provision. We formed a collaborative partnership built on a commitment to shared power and decision-making between researchers and partners. We conducted 28 key informant interviews with accompaniers in Argentina, Chile and Ecuador in 2019 about their model of in-person abortion accompaniment at later durations of pregnancy. We iteratively coded transcripts using a thematic analysis approach. Accompaniers premised their work in a feminist activist framework that understands accompaniment as addressing inequalities and expanding rights, especially for the historically marginalised. Through a detailed description of the process of in-person accompaniment, we show that the model, including the logistical considerations and security mechanisms put in place to ensure favourable abortion outcomes, emphasises peer-to-peer provision of supportive physical and emotional care of the accompanied person. In this way, it represents supported self-care through which individuals are centred as the protagonists of their own abortion, while being accompanied by feminist peers. This model of supported self-care challenges the idea that “self-care” necessarily means “solo care”, or care that happens alone. The model’s focus on peer-to-peer transfer of knowledge, providing emotional support, and centring the accompanied person not only expands access to abortion, but represents person-centred practices that could be scaled and replicated across contexts.

Introduction Little is known about how people who have abortions describe high-quality interpersonal care in Argentina. This qualitative study aimed to understand preferences and priorities in their interactions with providers. Study design We conducted 24 in-depth interviews with people who obtained abortions at a comprehensive reproductive health clinic or with support from a feminist accompaniment group in Buenos Aires and Neuquén, Argentina. We iteratively coded transcripts using a thematic analysis approach based on interpersonal domains present in current quality of care frameworks. Results Participants described high-quality abortion care as feeling acompañamiento and contención from their providers – terms that imply receiving kind, caring, compassionate and emotionally supportive care throughout their abortion. They described four key elements of interpersonal interactions: attentive communication from providers and accompaniers, clear and understandable information provision, non-judgmental support, and individualized options for pain management. Conclusions People obtaining abortions in Argentina consistently identified receiving compassionate and supportive care throughout an abortion as a key aspect of care. The findings have implications for incorporating people’s perspectives in the development of care guidelines, training of providers, and monitoring and improving of services. This is particularly important as the government of Argentina prepares to expand legal access to abortion.

RESUMENEn este escrito reflexionaremos acerca de interpelaciones que corporalidades dislocadas de la ostensiva heteronormatividad realizan a las instituciones educativas, abriendo posibilidades para estirar y desbordar los límites epistemológicos y habilitar acciones pedagógicas y políticas en su interior. Las especulaciones que propondremos están situadas en perspectivas político epistemológicas feministas, queer y decoloniales, engarzadas con y entre nuestras prácticas en el activismo feminista y en nuestro trabajo en el campo de la formación docente en instituciones educativas públicas. El texto consta de tres partes. En la primera, configurada como una breve genealogía, nos detendremos en aportes del feminismo radical, en tanto abrevamos de ellos para politizar nuestra mirada del mundo y sus relaciones. Lo hacemos sin rehuir algunas menciones críticas que mereció esta perspectiva feminista. En la segunda, traeremos líneas de pensamiento construidas a partir de un proyecto de extensión: Por una educación pública antidiscriminatoria, no androcéntrica, no sexista, no heterosexista; de un trabajo de investigación: Aproximaciones al estudio del movimiento sexo-genérico en Argentina; y de intervenciones institucionales desarrolladas en la Universidad Nacional del Comahue y en el Instituto de Formación Docente n.º 12 de Neuquén. En la tercera, proyectamos algunos interrogantes en la búsqueda constante por dinamitar las ficcionales fronteras de la heteronormatividad en las aulas, para una pedagogía otra, para una pedagogía transgresora al decir de Deborah Britzman.Palabras claves: feminismos; heteronormatividad; corporalidades; formación docente; pedagogía otra. RESUMONeste texto realizaremos reflexões sobre as interpelações que as corporalidades deslocadas da ostensiva heteronormatividade realizam sobre as instituições educacionais, criando possibilidades para distender e transbordar os limites epistemológicos, além de possibilitar ações pedagógicas e políticas em seu interior. As especulações que propomos neste texto estão situadas nas perspectivas político-epistemológicas feministas, queer e anticoloniais, entrelaçadas com/entre nossas práticas no ativismo feminista e em nosso trabalho no campo da formação docente em instituições educacionais públicas. O texto é composto por três partes. Na primeira, configurada como uma breve genealogia, iremos nos deter nas questões do feminismo radical, abreviando a exposição para politizar nosso olhar sobre o mundo e suas relações, o que fazemos sem deixar de mencionar algumas críticas a esta perspectiva feminista. Na segunda, traremos reflexões construídas a partir de um projeto de extensão intitulado Por una educación pública antidiscriminatoria, no androcéntrica, no sexista, no heterosexista; além de uma pesquisa intitulada Aproximaciones al estudio del movimiento sexo-genérico en Argentina e intervenções institucionais desenvolvidas na Universidad Nacional del Comahue e no Instituto de Formación Docente n.º 12 de Neuquén. Na terceira parte, interrogamos sobre uma busca co...