Self-managed Medication Abortion Research Articles

Supporting Self-Managed Medication Abortion: Care Needs and Preferences of SMMA Users in Three US States

Supporting Self-Managed Medication Abortion: Care Needs and Preferences of SMMA Users in Three US States

Foregrounding pain in self-managed early medication abortion: a qualitative study

ObjectiveTo explore experiences of pain in the context of early medical abortion (EMA) in the UK and to guide best practice around anticipatory guidance on pain.MethodsFrom late 2020 to early...

Automating untruths: ChatGPT, self-managed medication abortion, and the threat of misinformation in a post-Roe world.

ChatGPT is a generative artificial intelligence chatbot that uses natural language processing to understand and execute prompts in a human-like manner. While the chatbot has become popular as a source of information among the public, experts have expressed concerns about the number of false and misleading statements made by ChatGPT. Many people search online for information about self-managed medication abortion, which has become even more common following the overturning of Roe v. Wade. It is likely that ChatGPT is also being used as a source of this information; however, little is known about its accuracy. To assess the accuracy of ChatGPT responses to common questions regarding self-managed abortion safety and the process of using abortion pills. We prompted ChatGPT with 65 questions about self-managed medication abortion, which produced approximately 11,000 words of text. We qualitatively coded all data in MAXQDA and performed thematic analysis. ChatGPT responses correctly described clinician-managed medication abortion as both safe and effective. In contrast, self-managed medication abortion was inaccurately described as dangerous and associated with an increase in the risk of complications, which was attributed to the lack of clinician supervision. ChatGPT repeatedly provided responses that overstated the risk of complications associated with self-managed medication abortion in ways that directly contradict the expansive body of evidence demonstrating that self-managed medication abortion is both safe and effective. The chatbot's tendency to perpetuate health misinformation and associated stigma regarding self-managed medication abortions poses a threat to public health and reproductive autonomy.

Experiences with misoprostol-only used for self-managed abortion and acquired from an online or retail pharmacy in the United States

ObjectivesThis study aimed to understand individual experiences with medication abortion using misoprostol-only among people living in the United States. Study designWe conducted 31 semistructured anonymous in-depth interviews with individuals who used misoprostol-only for self-managed medication abortion. Participants were recruited from Aid Access, an online telemedicine organization that provided prescriptions for misoprostol to eligible people in all 50 states in May and June 2020 when a combined mifepristone and misoprostol regimen was unavailable. We coded transcripts with a flexible coding approach and focused on perceptions and experiences with use. ResultsParticipants were knowledgeable about misoprostol. Previous abortion experiences shaped perceptions of misoprostol-only by allowing comparison to the mifepristone and misoprostol regimen. Most participants expressed an unwavering desire for an effective abortion method, regardless of the medications or regimen. Individual physical experiences with misoprostol, including bleeding, cramping, nausea, and diarrhea, varied in intensity and duration. Participants proactively managed symptoms with self-care strategies and drew extensively from their prior experiences with menstruation, miscarriage, abortion, and childbirth. Clear instructions and information on potential complications and what to expect throughout the abortion fostered a sense of preparedness, and personalized interactions with an online help desk brought comfort. ConclusionsMisoprostol offered an essential abortion method for study participants. This regimen was physically challenging for some, and there is potentially a greater need for communication and support for individuals using misoprostol-only regimens. Prior reproductive experiences informed participant’s knowledge, preparedness, pain management, and ability to both recognize and manage potential complications. ImplicationsAs restrictions on mifepristone continue, more people may use misoprostol-only regimens. All regimens can be supported with detailed instructions, clear expectations, information on signs of potential complications, and personalized support. To achieve reproductive autonomy, people must have access to a range of abortion care options that meet their needs.

Self-managed medication abortion trajectories: results from a prospective observational study in Argentina, Nigeria and Southeast Asia

ObjectivesTime is a crucial factor in abortion-seeking because options for care change with pregnancy duration, and most people prefer to access abortion care early in pregnancy. We aimed to collect...

Medication Abortion Safety and Effectiveness With Misoprostol Alone

Misoprostol-alone regimens for abortion may be more effective than previously thought. To estimate the effectiveness of medication abortion with misoprostol alone among individuals self-managing their abortion. For this prospective observational cohort study of callers to safe abortion hotlines and accompaniment groups in Argentina, Nigeria, and Southeast Asia, participants were recruited between July 31, 2019, and October 1, 2020, prior to starting their medication abortion. Eligible participants were 13 years or older, had no contraindications to medication abortion, and were not currently bleeding. Participants completed a baseline and 2 follow-up surveys. The analysis was restricted to participants who reported using misoprostol alone and was performed between January 6, 2022 and September 8, 2023. Self-managed medication abortion using misoprostol alone. The primary outcome was effectiveness, defined as participant self-report of complete abortion without procedural intervention, measured at 1 week and 3 weeks after taking misoprostol. Secondary outcomes included method safety, measured by self-report of experiencing warning signs (eg, heavy bleeding, pain, fever, discharge) indicative of a potential complication and by medical treatment (eg, blood transfusion, intravenous fluids, overnight hospital stay) indicative of a potential adverse event. Additional outcomes included length of bleeding and cramping, time to expulsion, and experience of adverse effects. Among 1352 enrolled participants, 637 used misoprostol-alone regimens for abortion and were included in the analysis (591 [92.8%] from Nigeria, 45 [7.1%] from Southeast Asia, and 1 [0.2%] from Argentina; 384 [60.2%] aged 20-29 years; 317 [49.8%] with pregnancy durations <7 weeks and 205 [32.2%] with pregnancy durations between 7 and <9 weeks). At last follow-up after taking medication (median, 22 days; IQR, 21-26 days), 625 participants (98.1%; 95% CI, 96.7%-98.9%) had a complete abortion without procedural intervention. Potential adverse events were reported by 6 participants (0.9%; 95% CI, 0.4%-2.1%). Most participants experienced bleeding for less than 1 week (median, 4 days; IQR, 3-6 days) and expelled their pregnancy within 24 hours of starting the abortion process (median, 12 hours; IQR, 9-15 hours). Common side effects included nausea (335 participants [52.6%]), fever (232 [36.4%]), and diarrhea (181 [28.4%]). The findings suggest that misoprostol alone is a highly effective method of pregnancy termination. Future research should explore strategies to maximize the effectiveness of misoprostol alone in clinical and nonclinical settings.

Self-managed Medication Abortion in the United States.

Self-managed abortion (SMA) is ending a pregnancy without medical supervision, either by obtaining medications (known as self-managed medication abortion) or through other means. Many factors influence a person's decision to pursue self-managed abortion, such as time constraints, financial considerations, and local availability of abortion services. We present on the prevalence, methods and best practices for clinicians in the United States who may interface with individuals undergoing self-managed medication abortion at any point in the process through a harm reduction approach.

Effectiveness of Self-Managed Medication Abortion Between 9 and 16 Weeks of Gestation.

To evaluate abortion completion after self-managed medication abortion in pregnancies at or beyond 9 weeks of gestation. We conducted a prospective observational cohort study in which we recruited callers to three abortion-accompaniment groups in Argentina, Nigeria, and Southeast Asia who were initiating a self-managed medication abortion. Participants completed a baseline survey over the phone before taking pills and then two follow-up phone surveys 1 and 3 weeks after taking pills. The primary outcome was abortion completion; secondary outcomes included physical experiences and health care seeking and treatment. Between 2019 and 2020, we enrolled 1,352 participants, 19.5% (264/1,352) of whom self-managed a medication abortion at 9 or more weeks of gestation: 75.0% (198/264) at 9-11 weeks, 19.3% (51/264) at 12-14 weeks, and 5.7% (15/264) at 15-22 weeks. Participants were aged 26 years on average (SD 5.6 years); 56.4% (149/264) used the combined regimen (mifepristone+misoprostol), and 43.6% (115/264) used misoprostol only. At the last follow-up, 89.4% (236/264) had a complete abortion without procedural intervention, 5.3% (14/264) had a complete abortion with manual vacuum aspiration or dilation and curettage procedure, 4.9% (13/264) had an incomplete abortion, and 0.4% (1/264) participants did not report an abortion outcome. Some participants (23.5%, 62/264) sought health care during or after the self-managed medication abortion, most commonly to confirm completion (15.9%, 42/264); 9.1% (24/264) needed further medical intervention (procedural evacuation, antibiotics, additional misoprostol, intravenous fluids, blood transfusion, or overnight stay in the facility). Those who were 12 or more weeks pregnant were more likely to seek care at a clinic or hospital than those who were 9-11 weeks pregnant (adjusted relative risk 1.62, 95% CI 1.3-2.1). People who self-managed an abortion with medication between 9 and 16 weeks of gestation had high levels of abortion completion and accessed health care to confirm completion or to treat potential complications. ISRCTN, ISRCTN95769543.

Self-managed medication abortion: What nurse practitioners need to know

Given the evolving legal landscape of abortion access in the United States, the author discusses what nurse practitioners should know about their legal considerations and how to keep patients seeking their care safe when they undergo self-managed medication abortion.

Accompaniment on the edge: What can the US learn from Latin America about contested abortion care?

The US has stood as a reference point for abortion rights in the Americas since 1973, however in 2022, the US Supreme Court revoked the constitutional right to abortion. Facing similar circumstances, a huge number of grass roots accompanist networks have arisen throughout Latin America. These collectives are typically organized loosely within state and national networks that provide training and medication/supplies and promote advocacy and the expansion of new collectives. Extensive evidence and lived experience support the safety and effectiveness of self-managed medication abortion. Much can be learned from the Latin American accompanist model in the modern struggle for reproductive justice in the US. Accompaniment networks in Mexico have provided transborder abortion services-via misoprostol delivery-to US-based women living in states that required long travel or high costs to access services. Now, these transborder services will take on a new level of significance. Guaranteeing safe and low-cost access to abortion services is a key tenet of reproductive justice. Instead of relying on the political process alone to eventually provide abortion access through legal channels, an accompanist model provides an icon of resistance to oppressive legal shifts, and directly provides services to women.

Factors Associated With Knowledge and Experience of Self-managed Abortion Among Patients Seeking Care at 49 US Abortion Clinics

Patients attending US abortion clinics may consider or try self-managing their abortion before coming to the clinic, yet little is known about the factors associated with self-management behavior. To examine the prevalence and factors associated with considering or attempting a self-managed abortion before attending a clinic. This survey study included patients obtaining an abortion at 49 independent, Planned Parenthood, and academic-affiliated clinics chosen to maximize diversity in geographic, state policy, and demographic context in 29 states between December 2018 and May 2020. Data were analyzed from December 2020 to July 2021. Obtaining an abortion at a clinic. Knowledge of medications used to self-manage an abortion, having considered medication self-management before attending the clinic, having considered any method of self-management before attending the clinic, and having tried any method of self-management before attending the clinic. The study included 19 830 patients, of which 99.6.% (17 823 patients) identified as female; 60.9% (11 834 patients) were aged 20 to 29 years; 29.6% (5824 patients) identified as Black, 19.3% (3799 patients) as Hispanic, and 36.0% (7095 patients) as non-Hispanic White; 44.1% (8252 patients) received social services; and 78.3% (15 197 patients) were 10 weeks pregnant or less. Approximately 1 in 3 (34%) knew about self-managed medication abortion, and among this subsample of 6750 patients, 1 in 6 (1079 patients [16.1%]) had considered using medications to self-manage before attending the clinic. Among the full sample, 1 in 8 (11.7%) considered self-managing using any method before clinic attendance, and among this subsample of 2328 patients, almost 1 in 3 (670 patients [28.8%]) attempted to do so. Preference for at-home abortion care was associated with considering medication self-management (odds ratio [OR], 3.52; 95% CI, 2.94-4.21), considering any method of self-management (OR, 2.80; 95% CI, 2.50-3.13), and attempting any method of self-management (OR, 1.37; 95% CI, 1.10-1.69). Experiencing clinic access barriers was also associated with considering medication self-management (OR, 1.98; 95% CI, 1.69-2.32) and considering any method of self-management (OR, 2.09; 95% CI, 1.89-2.32). In this survey study, considering self-managed abortion was common before accessing in-clinic care, particularly among those on the margins of access or with a preference for at-home care. These findings suggest a need for expanded access to telemedicine and other decentralized abortion care models.

Safety and effectiveness of self-managed abortion using misoprostol alone acquired from an online telemedicine service in the United States.

To evaluate self-reported outcomes and serious adverse events following self-managed medication abortion using misoprostol alone provided from an online service. We conducted a retrospective record review of self-managed abortion outcomes using misoprostol obtained from Aid Access, an online telemedicine organization serving United States (US) residents, between June 1, 2020, and June 30, 2020. The main outcomes were the proportion of people who reported ending their pregnancy without instrumentation intervention and the proportion who received treatment for serious adverse events. During the study period, 1016 people received prescriptions for misoprostol. We obtained follow-up information for 610 (60%) of whom 568 confirmed use of the medication and 42 confirmed non-use. When taking the medication, 96% were at or less than 10 weeks' gestation and 4% were more than 10 weeks. Overall, 88% (95% CI: 84.6-90.2) reported successfully ending their pregnancy without instrumentation intervention. Of the 568 who took the misoprostol, 12 (2%) reported experiencing one or more serious adverse events and 20 (4%) reported experiencing a symptom of a potential complication. Self-managed medication abortion using misoprostol provided by an online telemedicine service has a high rate of effectiveness and a low rate of serious adverse events. Outcomes compare favorably to other service delivery models using a similar regimen. As mifepristone continues to be over-regulated and the 2022 US Supreme Court ruling allows states to severely restrict access to in-clinic abortion care, this regimen is a promising option for self-managed abortion in the US.

The Promise of Abortion Pills: Evidence on the Safety and Effectiveness of Self-Managed Medication Abortion and Opportunities to Expand Access

Since the Dobbs v. Jackson Whole Women’s Health Organization ruling, medication abortion pills have received an enormous amount of attention. The two medication abortion pill regimens, mifepristone used with misoprostol, or misoprostol used by itself, have been the subject of extensive public health research. Less discussed in the legal scholarship are the differences between the two regimens and their uses for self-managed medication abortion. In the United States, when people refer to medication abortion pills, they are often referencing mifepristone used with misoprostol. But in other parts of the world, when people refer to medication abortion pills, they often mean misoprostol alone. Public health researchers have examined the safety, effectiveness, and acceptability of self-managed abortion using both medication abortion regimens. This Article draws on this evidence base and provides opportunities for expanding access to medication abortion pills. This is especially important now that some states have legal climates similar to countries where abortion has long been restricted and researchers anticipate that people will increasingly seek access to medication abortion pills and turn to self-managed medication abortion.

Self-managed medication abortion in South Korea: A retrospective records review of the uptake of medication abortion through online telemedicine prior to decriminalization

ObjectivesTo examine the uptake of medication abortion through online telemedicine in South Korea prior to decriminalization of abortion beginning in 2019. Study designWe conducted a descriptive cross-sectional analysis of medication abortion consultations submitted to Women on Web, an online telemedicine service, from South Korea between 2013 and 2019. ResultsThe uptake of medication abortion through Women on Web increased every year between 2013 and 2019, adding up to 12,115 consultations across 7 years. The median age was 25 and the median gestational age was 37 days. Individuals reported financial constraints (66.2%) as the most common reason for wanting an abortion. This was followed by not wanting a child at this point (64.7%) and wanting to finish school (34.6%). ConclusionsThis study illustrates the uptake of medication abortions via Women on Web between 2013 and 2019, prior to decriminalization of abortion in South Korea. ImplicationsThis study attests to the use of online telemedicine for medication abortion, despite the legal restrictions prior to decriminalization of abortion in South Korea.

Self-Managed Medication Abortion: Implications for Clinical Practice.

Medication abortion has become the most common abortion method in the United States. This document provides a detailed history of the relaxation requirements on medication abortion and reviews the major studies on medication abortion complications including a discussion of their limitations. Finally, the paper delineates the ease of access to medication abortion without a health care provider and the risks associated with self-managed abortion. This paper is intended to provide information for clinicians who likely will be encountering increasing number of patients with such complications.

Self-managed abortion: Aligning law and policy with medical evidence.

People have always and will always find ways to try to end their pregnancies when necessary. Many do so safely without the involvement or direct supervision of healthcare professionals by self-managing their abortions. In 2022, the well-established safety and efficacy of abortion medications prompted WHO to fully endorse self-managed medication abortion as part of a comprehensive range of safe, effective options for abortion care. But despite robust evidence supporting the safety and effectiveness of the self-use of medications for abortion, abortion laws and policies around the world remain at odds with clinical evidence and with the realities of self-managed medication abortion in the present day. The present article considers legal issues related to self-managed abortion and addresses the role of obstetricians, gynecologists, and other healthcare professionals in promoting clinical and legal safety in abortion care through support of self-managed abortion.

P016Experiences of self-managed abortion in indiana: Financial barriers to clinical care and a need for information on self-managed medication abortion

<h3>Objectives</h3> We aimed to understand Indiana residents' experiences and preferences regarding self-managed abortion in a highly restrictive state. <h3>Methods</h3> Between June 2021 and April 2022, we recruited pregnant people who lived in Indiana and were considering abortion through Google advertisements, online posts, abortion clinics, and abortion funds. Respondents completed a self-administered online survey at baseline and a second survey one month later. We analyzed reported self-managed abortion experiences at baseline and endline, and characteristics of those who self-managed an abortion. <h3>Results</h3> Among 370 baseline respondents, 66 (18%) reported a preference for self-managed medication abortion over clinical care, while 33 (9%) participants reported an actual attempt to self-manage an abortion for the current pregnancy, and an additional four (1%) were in the process of self-managing. Most who self-managed identified as White (58%), 33% as Black, and 6% as Asian; and were aged 16–37, with pregnancies from 4 to 13 weeks' gestation. Sixteen (49%) respondents used herbs, six (18%) used misoprostol and/or mifepristone, six (18%) used other medications, two (6%) took emergency contraception after confirming the pregnancy, and 12 (37%) used other methods (eg, caffeine, physical exertion). At endline, 13 (3%) respondents reported ending their pregnancy using self-managed medication abortion. The most common reason given for self-managing an abortion was the inability to pay for clinical care. <h3>Conclusions</h3> Indiana residents need financial support to access clinical abortion care when that is their preference, and need information on safe, effective methods of self-managed medication abortion as an option, particularly in light of anticipated further restrictions on abortion access in the coming year.

O06Self-managed abortion outcomes for pregnancies of 9–22 weeks’ gestation: Results from a prospective, observational study in three countries

<h3>Objectives</h3> The literature on self-managed abortion at later gestations is sparse, and more information is urgently needed in the US and elsewhere where this practice may become increasingly common. This analysis offers novel results on the effectiveness of self-managed medication abortion among people with pregnancies >9 weeks. <h3>Methods</h3> In 2019–2020, as a part of The Studying Accompaniment Model Feasibility and Effectiveness (SAFE) Study, we recruited callers to safe-abortion hotlines in Argentina, Nigeria, and Southeast Asia who were seeking support for self-managed medication abortion. Via phone, participants completed a baseline survey prior to taking the medications, and up to three follow-up surveys over four weeks to ascertain abortion outcomes. <h3>Results</h3> We recruited 1,351 participants, of which 264 self-managed an abortion for a pregnancy that was 9–22 weeks' gestation; 149 (56%) respondents used mifepristone and misoprostol, while 115 (44%) used misoprostol alone. One week after taking the pills, 222 (91%) participants had a complete abortion — 87% with pills alone, and 4% with additional intervention. At last follow-up, 95% of participants had had a complete abortion (89% with pills alone, 5% with additional intervention; 93% of combined regimen users, and 97% of misoprostol-alone users). A minority of participants sought healthcare at a clinic or hospital at any point (30% of combined regimen users, 15% of misoprostol-alone users). Among those seeking care, most (60%) did so to confirm abortion completion, and a small minority (1.5%) received treatment indicative of a serious complication (blood transfusion). <h3>Conclusions</h3> Self-managed medication abortion can be a safe and effective option for ending a pregnancy at 9+ weeks' gestation.

P012Acceptability of self-managed medication abortion using misoprostol-alone provided via a hybrid telemedicine and pharmacy pick-up model in the US

<h3>Objectives</h3> To examine the acceptability of self-managed medication abortion using misoprostol-alone acquired from an online or local pharmacy in the US. <h3>Methods</h3> Between November and December 2021, we conducted 32 semi-structured in-depth interviews with individuals who used misoprostol-alone to self-manage an abortion in June 2020. We recruited participants from Aid Access, an online telemedicine organization that provided self-managed abortion assistance and prescriptions for misoprostol from a local or online pharmacy for eligible people in all 50 states. Interviews were transcribed and thematically coded to assess individual satisfaction with acquiring and using misoprostol. <h3>Results</h3> Participants were initially hesitant to trust Aid Access, but having a pharmacy prescription sent by a physician legitimized the service. From internet searches and previous abortion experiences, participants had extensive knowledge of misoprostol's efficacy and utility. Participants who used the in-person pharmacy pick-up model had both confidence in the familiarity of the process and concerns about intrusive questioning from the pharmacist. Although rare, some did experience pharmacist pushback or refusal. Participants who used the online pharmacy model were concerned about shipping times but had positive and informative interactions with the pharmacists. Across both models, participants desired more extensive options for emotional support. <h3>Conclusions</h3> Participants had high levels of knowledge about misoprostol and familiarity with the pharmacy as a healthcare institution. Despite some unmet emotional needs and negative encounters with pharmacists, overall, this process was acceptable to participants and has the potential to expand medication abortion access in the restrictive policy landscape of the US.

P032Covid-19 abortion experiences on reddit: A qualitative study

<h3>Objectives</h3> We sought to document the effects of COVID-19 pandemic restrictions on people seeking abortion by analyzing posts on Reddit, a popular social media website. <h3>Methods</h3> We compiled 528 anonymous posts on the abortion subreddit from March 20, 2020 to April 12, 2020 and applied deductive qualitative methods to identify codes and themes. <h3>Results</h3> In the first of four themes, posters reported several COVID-19-related barriers to abortion services: reduced in-person access due to clinic closures, mail delivery delays of self-managed medication abortion, and pandemic-related financial barriers to both self-managed and in-clinic abortion. The second theme encompassed quarantine-driven privacy challenges, primarily challenges with concealing an abortion from household members. Third, posters detailed how the pandemic constrained their pregnancy decision making, including time pressure from impending clinic closures. Finally, posters reported COVID-19-related changes to service delivery that negatively affected their abortion experiences — for example, being unable to bring a support person into the clinic due to pandemic visitor restrictions. <h3>Conclusions</h3> This analysis of real-time social media posts reveals multiple ways that the COVID-19 pandemic limited people's abortion access and affected their termination decisions and experiences. Findings shed light on the consequences of sudden changes, whether pandemic- or policy-related, on abortion service delivery.