National Partnership for Women & Families

Monthly Women's Health Research Review

Study affirms acceptability, feasibility of self-managed medication abortion

Summary of "Self-management of medical abortion: a qualitative evidence synthesis," Megan Wainwright et al., Reproductive Health Matters, July 21, 2016.

In this study, Megan Wainwright, a research fellow at the University of Cape Town's School of Public Health and Family Medicine, and colleagues "reviewed the global evidence on experiences with, preferences for, and concerns about greater self-management of medica[tion] abortion with lesser health professional involvement."

The researchers searched databases for studies "on the experiences of women self-managing their medica[tion] abortions" and "on perspectives (current or future) about self-management." For the review, the researchers used the term "self-administration" to refer to taking a medication abortion drug "at home without direct medical supervision." They used the term "self-management" when a "finding is not specific to taking the medication, but about other or more general aspects of the process."

Findings

The researchers reviewed 36 studies, including 19 conducted in settings where abortion is legal, 14 in settings where it is legally restricted and three "with evidence from legal and legally restricted settings."

General perceptions of self-management

The researchers found that providers largely "approv[ed] of the concept of self-management, including self-administration if initiation of medica[tion] abortion was supported by trained providers, and they believed that it could be done feasibly, effectively and safely." However, the researchers noted that providers generally were not "supportive of over-the-counter access to medica[tion] abortion drugs." The researchers also found that women similarly "approv[ed] of the concept of self-management."

Preparation for self-management

The researchers found that before self-managing a medication abortion, women "reported anxiety, uncertainty, or ambivalence." They reported feeling more empowered when they received counseling "that offered women a sense of confidence, being prepared, having a choice, and being in control." However, according to the researchers, "Providing adequate counselling in the context of health facilities was ... seen as time consuming for health professionals and written materials for patients were reported to be underutilized."

Logistical considerations

According to the researchers, "Women were drawn to self-management including self-administration for a number of practical reasons including lower costs, ease of scheduling, reduced transportation needs, ability to manage stigma," and greater control over the timing of the process. The researchers wrote that most women found "efforts to reduce the logistical demands of medica[tion] abortion via telemedicine and website and hotline-based forms of counselling to be acceptable and to support privacy and destigmatization."

The researchers added that "[w]hen women were counselled by trained providers...providers trusted women's ability to comply with dosage and timing requirements, women felt confident and reported uncomplicated abortions for the most part, and women called hotlines or consulted providers when the abortion process did not proceed as expected."

Issues of choice and control

Citing women's "desire to be able to choose the method of abortion that fit their context," the researchers wrote, "Having the choice to self-administer medication at home (versus having it in clinic), may be an important element of acceptability of medica[tion] abortion for women."

Meaning and experience

The researchers found that the medication abortion process "allowed for a new range of meanings and experiences of abortion to emerge, increasing the acceptability of self-management." Further, the review found that "[s]elf-management with self-administration also increased the opportunities for partners to be involved in supporting women through their medica[tion] abortions at home," although respondents "expressed a desire for more counselling of partners about the process of medica[tion] abortion itself ... and what role they could play in supporting their partners."

Discussion

The researchers recommended "that counselling and support to women considering self-management should include instructions and information regarding: 1) the fact that medica[tion] abortion should not be confused with emergency or oral contraception, 2) how to take the medication" correctly, "3) what to expect after taking the medication, ... 4) possible side effects and how to deal with the[m], 5) how to plan for the management of the...process at home," 6) the appropriate use of painkillers and 7) how to identify when further medical help is required.

Citing the need for additional studies, the researchers wrote, "Understanding these implicit and explicit reasons for giving some women the option to administer at home, and others not, is important because individual practitioners may be assessing 'eligibility' by their own implicit criteria, in turn limiting the options for certain women." They concluded, "The overall acceptability and feasibility of self-management of medica[tion] abortion is supported by the qualitative evidence."