Determination of medical abortion eligibility by women and community health volunteers in Nepal: A toolkit evaluation

Andersen, Kathryn; Fjerstad, Mary; Basnett, Indira; Neupane, Shailes; Acre, Valerie; Sharma, Sharad; Jackson, Emily

doi:10.1371/journal.pone.0178248

Cited by 7 publications

(10 citation statements)

References 21 publications

(19 reference statements)

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“…With simple step‐by‐step instructions (written or verbal), all the participants that tried to use the wheel could do so (regardless of accuracy) and a majority found it easy. These findings were similar to those of a recent study that examined the ability of patients to determine medical abortion eligibility and success in Nepal; the study reported that the gestational wheel was easy to use …”

Section: Discussionsupporting

confidence: 88%

Determining the accuracy of pregnancy‐length dating among women presenting for induced abortions in Ghana

Shellenberg¹,

Antobam²,

Griffin³

et al. 2017

Intl J Gynecology & Obste

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Objective: To determine the proportion of women presenting for an induced abortion in Ghana who could use a gestational wheel to determine if they had reached at least 13 weeks or fewer than 13 weeks of pregnancy accurately. Methods:The present cross-sectional study was conducted at four facilities in Ghana between February 1, and July 31, 2014. Women aged at least 18 years seeking induced abortions who had not previously been informed of the length of their pregnancy by a clinician were enrolled. Women self-assessed pregnancy duration using a gestational wheel before a clinician assessed the length via clinical assessment and bimanual exam for use as a respective reference point. The proportion of participants who used the wheel successfully was calculated. Results:The study enrolled 780 participants, 770 of whom used the gestational wheel.Of these, 221 (28.7%) could use the wheel without verbal instructions, and 465 (60.4%) described it as easy to use. Agreement in pregnancy-length assessments was recorded for 728 (94.5%) patients. There were 10 (1.3%) and 28 (3.6%) participants who made evaluations with "low-risk disagreement" and "high-risk disagreement" with the clinician assessment, respectively. Conclusion:Almost all participants could use the gestational wheel to date their pregnancies correctly. This tool could help women perform medical abortions safely in the community, reducing morbidity and mortality from unsafe abortions. K E Y W O R D SAbortion; Gestational dating; Ghana; Medical abortion; Misoprostol; Reproductive health | INTRODUCTIONDespite Ghana having relatively liberal laws surrounding induced abortion, evidence has demonstrated that the self-administration of misoprostol by women outside clinical settings is common practice. [1][2][3] Misoprostol alone, when administered according to the regimen recommended by WHO, is an effective medical abortion technique with a success rate of 85% for patients at up to 9 weeks of pregnancy. 4 Although there is limited evidence of the effectiveness of misoprostol for induced abortion of pregnancies at 9-13 weeks, WHO has endorsed using the evidence-based regimen for earlier than 9 weeks of pregnancy for pregnancies between 9 and 13 weeks. 5 Given the safety and simple administration of the regimen, arguments have been made against the need for clinical oversight in the use of misoprostol,This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Section: Discussionsupporting

confidence: 88%

Determining the accuracy of pregnancy‐length dating among women presenting for induced abortions in Ghana

Shellenberg¹,

Antobam²,

Griffin³

et al. 2017

Intl J Gynecology & Obste

View full text Add to dashboard Cite

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“…(35) Indeed, WHO technical guidance does not require ultrasound con rmation of gestational age for early medication abortion, (5) and last menstrual period is the typical assessment for pregnancy dating in many study contexts. (37,38) Furthermore, studies assessing the effectiveness of telemedicine for abortion, home administration of misoprostol, and telephone follow-up after a clinic-based medication abortion have demonstrated the reliability of self-report of completion based on structured criteria. (39,40) Our study also suffered from loss-to-follow-up.…”

Section: Discussionmentioning

confidence: 99%

Self-managed medication abortion outcomes: results from a prospective pilot study

Moseson¹,

Jayaweera²,

Raifman

et al. 2020

Preprint

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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

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“…Our findings underscore the important role FCHVs play in the dissemination of SRH information within the community, with community-based health workers being the dominant community-based health asset cited throughout the cyclical AFRPAC framework of this study. Nepal based studies on FCHVs ability to assess MA eligibility and determine MA success concluded further refinement of tools are needed before effective and widespread use could be implemented [86, 87]. However, research shows that with effective SRHR training and ongoing education, community based health care workers like FCHVs can play a pivotal role in community-based SRH information provision, contraceptive counselling and access, and increasing awareness of safe abortion services and service referral [60, 88].…”

Section: Discussionmentioning

confidence: 99%

Medical abortion in Nepal: a qualitative study on women’s experiences at safe abortion services and pharmacies

et al. 2019

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Background Although Nepal legalised abortion in 2002, a significant number of women continue to access unsafe abortions. An estimated 60% of all abortions performed in 2014 were unsafe, with unsafe abortion continuing to be a leading contributor to maternal mortality. Despite medical abortion access being solely permitted through government accredited safe abortion services, medical abortion pills are readily available for illegal purchase at pharmacies throughout the country. Methods Utilising an Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology, underpinned by a health information pyramid conceptual framework, this qualitative exploratory study collected data from in-depth, open-ended interviews. The study explored the medical abortion and sexual and reproductive health experiences of ten women who accessed medical abortion through an accredited safe abortion service, and ten women who accessed unsafe medical abortion through pharmacies. Results Thematic content analysis revealed emerging themes relating to decision-making processes in accessing safe or unsafe medical abortion; knowledge of safe abortion services; and SRH information access and post-abortion contraceptive counselling. Findings emphasised the interconnectivity of sexual and reproductive health and rights; reproductive coercion; education; poverty; spousal separation; and women’s personal, social and economic empowerment. Conclusions While barriers to safe abortion services persist, so will the continued demand for medical abortion provision through pharmacies. Innovated and effective harm reduction implementations combined with access and information expansion strategies offer the potential to increase access to safe medical abortion while decreasing adverse health outcomes for women. Electronic supplementary material The online version of this article (10.1186/s12978-019-0755-0) contains supplementary material, which is available to authorized users.

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Determination of medical abortion eligibility by women and community health volunteers in Nepal: A toolkit evaluation

Cited by 7 publications

References 21 publications

Determining the accuracy of pregnancy‐length dating among women presenting for induced abortions in Ghana

Determining the accuracy of pregnancy‐length dating among women presenting for induced abortions in Ghana

Self-managed medication abortion outcomes: results from a prospective pilot study

Medical abortion in Nepal: a qualitative study on women’s experiences at safe abortion services and pharmacies

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