USA: Study on Self-Managed Medication Abortion

A recent study has shown that self-managed medication abortion with accompaniment group support is highly effective. For those having pregnancies of less than 9 weeks gestation, it is non-inferior to the effectiveness of clinician-managed medication abortion administered in a clinical setting.

The findings of the prospective cohort study, published in The Lancet Global Health, support the use of remote self-managed models of early abortion care and telemedicine, as is being considered in several countries owing to the COVID-19 pandemic.

The rate of unsafe abortions is higher where access to effective contraception and safe abortion is limited or unavailable. The popular medications prescribed for medical abortion are mifepristone and misoprostol. Medication abortion is a low-cost, safe, effective, and relatively simple method of pregnancy termination with its own legal restrictions.

Heidi Moseson, Ibis Reproductive Health, Oakland, CA, USA, and colleagues aimed to estimate the effectiveness of self-managed medication abortion and to compare its effectiveness with clinician-managed medication abortion.

In the prospective, observational cohort study, the researchers recruited callers from two safe abortion accompaniment groups in Argentina and Nigeria who requested information on self-managed medication abortion. Misoprostol alone or in combination with mifepristone was used. Participants completed a baseline survey, with 1 to 3 week follow-up. The primary outcome was the proportion of participants reporting a complete abortion without surgical intervention. A non-inferiority analysis compared abortion completion by self-management to historical abortion that restricted participants with pregnancies of less than 9 weeks gestation.

A total of 1051 participants were enrolled. Abortion outcomes were analyzed for 961 participants.

Results of the Study

• Most pregnancies were less than 12 weeks' duration. Participants in follow-up self-managed their abortions using misoprostol alone (n=593) or the combined regimen of misoprostol plus mifepristone (n=356).
• 586 misoprostol alone users and 334 combined regimen users had a complete abortion without surgical intervention at the last follow-up.
• For those with pregnancies of less than 9 weeks gestation, both regimens were non-inferior to medication abortion effectiveness in clinical settings.

Moseson and team concluded that "self-managed medication abortion with accompaniment group support is highly effective and, for those with pregnancies of less than 9 weeks gestation, non-inferior to the effectiveness of clinician-managed medication abortion administered in a clinical setting. These findings support the use of remote self-managed models of early abortion care, as well as telemedicine, as is being considered in several countries because of the COVID-19 pandemic."

Reference: DOI:10.1016/S2214-109X(21)00461-7