Outcomes of self-induced late pregnancy termination in women presenting to a tertiary hospital in the Eastern Cape Province, South Africa

Abstract

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Self-managed abortion: A systematic scoping review

“…Thirty-nine studies described using misoprostol alone for abortion self-management. Six studies provided specifics of misoprostol only regimens (50,68,(85)(86)(87)(88). One study of misoprostol use among women along the Thailand/Burma border describes community health workers dispensing 12 misoprostol tablets (200mcg each), and instructing the woman to "vaginally take 800mcg followed 24 h later with another 800mcg dose and a third 800mcg dose one week after the initial administration, if needed," in accordance with evidence-based guidelines at that time (86).…”

“…A study in Uruguay reported a majority of participants administering one 800mcg dose of misoprostol vaginally (85). Another study reported details on misoprostol dosage among participants with pregnancies at or beyond 24 weeks gestation, which ranged from 400 to 1,200mcg almost all taken orally (88). Another two studies reported more generally on regimen, describing use of between one and eight misoprostol tablets, administered either vaginally or orally(87); and another described participants taking "four misoprostol pills, two or three vaginally and one or two orally"( 50).…”

“…Sources of procurement and/or information included online vendors (13,39,47,50,77,78,89), telephone vendors (47,88), friends and relatives (13,36,47,51,61,66,78,(88)(89)(90), accompaniment groups(89), pharmacists (over the counter purchase with or without prescription) (13,28,36,41,43,47,51,53,66,68,78,79,(90)(91)(92)(93)(94)(95)(96)(97), doctors or nurses (13,28,39,43,47,51,53,61,66,78,88,…”

“…Alternatively, some studies reported on effectiveness by quantifying failures of self-managed abortion, rather than successesfor instance, some studies reported on the occurrence of continuing pregnancy following abortion, but did not report in detail on other aspects of effectiveness (e.g., (70)) In nearly all studies, authors evaluated effectiveness of the self-managed abortion based on participant self-report. Thirteen studies reported on the effectiveness of self-managed abortion attempts only among people presenting to health care with concerns or complications (50,51,54,60,63,81,82,88,103,104,(106)(107)(108). Given that all participants in these studies were only eligible for inclusion in the study because of their experience of warning signs of complications or actual complications that prompted their seeking of medical care, they are likely not a fair representation of outcomes among the full sample of people that self-manage their abortions.…”

“…While 15 studies explicitly named legal restrictions as a reason for pursuing abortion self-management, it is possible that this finding is implicit in additional studies conducted in contexts where abortion is legally restricted or inaccessible. Less commonly cited barriers to clinical care included physician refusal to perform an in-clinic abortion (53,88,92,114), overly long wait-times for appointments (53,88), and lack of knowledge about where to obtain a legal abortion (44)(45)(46). Some studies described concerns that led people to pursue self-managed abortion, including concerns about privacy and confidentiality (10, 37, 40, 42-45, 53, 58, 76, 78, 82, 84, 93, 114), and about clinic staff, including mistreatment or being reported to police (23,40,43,44,47,50,51,53,109,111,114).…”