Self-managed medication abortion outcomes: results from a prospective pilot study
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RESEARCH
Self‑managed medication abortion outcomes: results from a prospective pilot study Heidi Moseson1* , Ruvani Jayaweera1, Sarah Raifman2, Brianna Keefe‑Oates3, Sofia Filippa1, Relebohile Motana4, Ijeoma Egwuatu5, Belen Grosso6, Ika Kristianingrum7, Sybil Nmezi5, Ruth Zurbriggen6 and Caitlin Gerdts1
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 prospec‑ tive 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. Keywords: Abortion, Accompaniment, Africa, Mifepristone, Misoprostol, Self-managed abortion, South America, Southeast Asia
*Correspondence: [email protected] 1 Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA 94612, USA Full list of author information is available at the end of the article
Background Around the world, people face structural barriers and legal restrictions that prevent access to high-quality abortion services. Even when abortion services are available in facility settings, some people prefer out-of-clinic abortion care for reasons related to privacy, autonomy, and concerns such as stigma, mistreatm
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