Self-management of medical abortion: a qualitative evidence synthesis

Abstract

Medical abortion is a method of pregnancy termination that by its nature enables more active involvement of women in the process of managing, and sometimes even administering the medications for, their abortions. This qualitative evidence synthesis reviewed the global evidence on experiences with, preferences for, and concerns about greater self-management of medical abortion with lesser health professional involvement. We focused on qualitative research from multiple perspectives on women's experiences of self-management of first trimester medical abortion (< 12 weeks gestation). We included research from both legal and legally-restricted contexts whether medical abortion was accessed through formal or informal systems. A review team of four identified 36 studies meeting inclusion criteria, extracted data from these studies, and synthesized review findings. Review findings were organized under the following themes: general perceptions of self-management, preparation for self-management, logistical considerations, issues of choice and control, and meaning and experience. The synthesis highlights that the qualitative evidence base is still small, but that the available evidence points to the overall acceptability of self-administration of medical abortion. We highlight particular considerations when offering self-management options, and identify key areas for future research. Further qualitative research is needed to strengthen this important evidence base.

Self‐management of first trimester medical termination of pregnancy: a qualitative study of women's experiences

“…Our analysis suggests that the comfort and privacy afforded by self‐management enabled women to cope with treatment in a way that suited them, without concerns about how they were being perceived by strangers, as they might in a hospital setting. This echoes the suggestion that self‐management can facilitate alternative experiences of TOP . Significantly, our findings shed further light on the essential role of available support (in this case by telephone) from health professionals during and following TOP .…”

“…Our findings resonate with research which suggests that much of women's anxieties around TOP are grounded not in the decision to end the pregnancy but in apprehension concerning an unknown process . Clearly informing women of what to expect of TOP is crucial to ensuring their safety and comfort, and to facilitating that sense of control . However, health professionals also need to convey the potential for variation in experiences of medical TOP, and are therefore required to strike a delicate balance between the specific detail that (some) women want and the range of experiences that they may face.…”

“…Our findings add weight to existing evidence which has suggested that women undergoing TOP ≤63 days are largely amenable to self‐management and that, although they may experience some initial anxieties, they tend to express overall satisfaction . Crucially, our analysis suggests that women value being given choices and feeling involved in decisions about their treatment, and goes some way to address concerns raised by providers about how women might cope at home .…”

Motivations and Experiences of People Seeking Medication Abortion Online in the United States

“…And second, would they have found their ensuing abortion experience acceptable? Various models of self‐managed medication abortion have been shown to be safe, effective and acceptable to users in a variety of settings, including online telemedicine in Ireland, community‐based distribution at the Thailand‐Burma border, and a service providing preabortion care with instructions about misoprostol use and postabortion follow‐up in Peru . However, the role played by the accurate instructions, medical advice and emotional support that were part of all of these models is likely to be a factor in their positive outcomes, and such information and support may not be offered by pharmacy sites simply selling medications.…”

Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland

“…A recent review of the acceptability of self managed abortion in both legal and legally restricted contexts emphasises the role of local attitudes surrounding abortion on women's experiences. 34 Higher levels of education and medical knowledge as well as better access to healthcare compared with women in developing settings might mean that women in the Republic and Northern Ireland are more likely to use the medications correctly and to seek follow-up care. The stigma surrounding abortion experienced by Irish women, however, is considerable.…”