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

Abstract

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.

Telehealth for Addressing Sexual and Reproductive Health and Rights Needs During the COVID-19 Pandemic and Beyond: A Hybrid Telemedicine-Community Accompaniment Model for Abortion and Contraception Services in Pakistan

“…It is also important to note that telehealth models are one pathway to care and should not be perceived as a magic bullet to access or siloed from the broader health system. MA is critical for expanding access to abortion services largely because people seeking abortion can do so on their own, with proven high efficacy and safety (14)(15)(16)(17). This benefit cannot be overstated especially during the COVID-19 pandemic.…”

Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19

“…Thus, the experiences of people seeking medical abortion beyond 9 weeks of gestation are not represented in this review; however, a recently published paper demonstrated that prospective studies of home-based medical abortion up to 84 days are feasible. 45 All studies in this review used a combined mifepristone and misoprostol drug regimen and results are therefore not applicable to scenarios where mifepristone is unavailable, or where misoprostol is used in higher doses. Finally, all women included in the studies engaged with and had access to clinic services at some point in their abortion process, and thus results are not applicable to settings where people have no interaction with formal healthcare services.…”

“Becoming the woman she wishes you to be”: A qualitative study exploring the experiences of medication abortion acompañantes in three regions in Mexico

“…This flexibility, combined with the other characteristics of holistic accompaniment (trusting the accompanied women, not asking for reasons for abortion, respecting autonomy, emotional accompaniment, economic support, and preventing criminalization) sets the model described in this study apart from other types of self-managed medication abortion. It also adds to the existing knowledge of accompaniment models mainly limited to data on telephone hotlines and some other models managed by well-known feminist collectives [18,[20][21][22][23]31].…”