Over-the-Counter Use of Medical Abortion Pills: A Prospective Cohort Study

Abstract

Introduction: Medical abortion is a safe intervention in the first trimester that requires access to accurate information and the support of a trained healthcare provider. However, women often use medical abortion pills on their own or with guidance from friends, relatives, quacks, or pharmacists due to the easy availability of these drugs over-the-counter without a medical prescription. Aim: To study the effects of over-the-counter use of medical abortion pills on maternal health and to explore the possible reasons for it. Materials and Methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. The study duration was one year and five months, from June 2020 to October 2021. A total of 98 women who reported unsupervised consumption of medical abortion pills over a period of 17 months were included in the study. Demographic and obstetric profiles, clinical presentation, diagnosis, outcomes, and complications were analysed. Reasons for unsupervised intake were also explored. The data were analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The study included 98 women, with the majority (54.08%) belonging to the 25-31 years age group. Out of these, 49 (50%) women took the abortion pills between 7-12 weeks, 32 (32.65%) before seven weeks, and 17 (17.35%) between 13-20 weeks. Pregnancy was confirmed with a Urine Pregnancy Test (UPT) kit in 64 (65.30%) women, with Ultrasonography (USG) in 22 (22.45%) women, while 12 (12.25%) took pills based solely on missed periods. The most common clinical presentation was excessive vaginal bleeding in 70 (71.42%) cases. Incomplete abortions were observed in 77 (78.56%) women, missed abortions in 10 (11.22%) women, and septic abortions in 4 (4.08%) women. Laparotomy was needed in six women with ectopic pregnancy. Two women required hysterectomy, one due to uterine perforation after suction evacuation in a private hospital, and the other due to intractable haemorrhage. Blood transfusion was needed in 25 (25.5%) women, and Intensive Care Unit (ICU) care in 15 (15.3%) women. However, none experienced acute kidney injury, Disseminated Intravascular Coagulation (DIC), or mortality. The main reasons for over-thecounter use of abortion pills were privacy or non-disclosure of pregnancy in 48 (48.9%) cases, opposition from the husband in 31 (31.6%) cases, avoiding a hospital visit in 25 (25.51%) cases, and easy availability of the pills in 27 (27.55%) cases. Conclusion: Unsupervised intake of pills increases the risk of complications like incomplete or missed abortion, sepsis, and ectopic pregnancy, which may require blood transfusion, ICU admission, and major surgeries like laparotomy or hysterectomy in a few cases. Therefore, there is a need for supervised intake of pills to reduce maternal morbidities.