Abstract
BackgroundAlthough abortion is legally available in South Africa, barriers to access exist. Early medical abortion is available to women with a gestational age up to 63 days and timely access is essential. This study aimed to determine women’s acceptability and ability to self-assess eligibility for early medical abortion using an online gestational age calculator. Women’s acceptability, views and preferences of using mobile technology for gestational age (GA) determination were explored. No previous studies to ascertain the accuracy of online self-administered calculators in a non-clinical setting have been conducted.MethodsA convenience sample of abortion seekers were recruited from two health care clinics in Cape Town, South Africa in 2014. Seventy-eight women were enrolled and tasked with completing an online self-assessment by entering the first day of their last menstrual period (LMP) onto a website which calculated their GA. A short survey explored the feasibility and acceptability of employing m-Health technology in abortion services. Self-calculated GA was compared with ultrasound gestational age obtained from clinical records.ResultsParticipant mean age was 28 (SD 6.8), 41 % (32/78) had completed high school and 73 % (57/78) reported owning a smart/feature phone. Internet searches for abortion information prior to clinic visit were undertaken by 19/78 (24 %) women. Most participants found the online GA calculator easy to use (91 %; 71/78); thought the calculation was accurate (86 %; 67/78) and that it would be helpful when considering an abortion (94 %; 73/78). Eighty-three percent (65/78) reported regular periods and recalled their LMP (71 %; 55/78). On average women overestimated GA by 0.5 days (SD 14.5) and first sought an abortion 10 days (SD 14.3) after pregnancy confirmation.ConclusionsTimely access to information is an essential component of effective abortion services. Advances in the availability of mobile technology represent an opportunity to provide accurate and safe abortion information and services. Our findings indicate that an online GA calculator would be accurate and helpful. GA could be calculated based on LMP recall within an error of 0.5 days, which is not considered clinically significant. An online GA calculator could potentially act as an enabler for women to access safe abortion services sooner.
Highlights
Abortion is legally available in South Africa, barriers to access exist
Recruitment took place from two local facilities providing early Medical Abortion (MA), 46/78 (59 %) women were recruited from a private non-governmental organization (NGO) clinic and 32/78 (41 %) from a public healthcare facility (Table 2)
Mobile and electronic gestational age calculators have proven more accurate than manual calculators in clinical settings [29], studies to ascertain the accuracy of such calculators in a self-administered setting are lacking
Summary
Abortion is legally available in South Africa, barriers to access exist. Medical abortion is available to women with a gestational age up to 63 days and timely access is essential. This study aimed to determine women’s acceptability and ability to self-assess eligibility for early medical abortion using an online gestational age calculator. Despite induced abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. The South African Choice on Termination of Pregnancy Act (CTOP) of 1996 promotes a woman’s reproductive right to have an early, safe and legal abortion. As a direct result of this legislation, abortion related mortality has decreased by 91 % [4, 5] Despite this legislation there are still major barriers to women accessing abortion services
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