Considering medication abortion common before accessing in-clinic care

Key takeaways:

• 34.1% of participants said they knew about self-managed medication abortion.
• Preferring at-home abortion was linked to considering and attempting medication self-management.

Considering self-managed abortion with medication was common before accessing care at abortion clinics, particularly among women with access issues or at-home care preferences, according to a survey study published in JAMA Network Open.

“With these new laws in place, knowledge of the factors that motivate self-management behavior among those attending clinics is important; groups who were already more likely to consider or attempt self-management before attending a clinic before Dobbs may also be more likely to self-manage when no clinics are available,” Abigail R. A. Aiken, PhD, associate professor of public affairs at the Lyndon B. Johnson School of Public Affairs and fellow of the Richter Chair in Global Health Policy at the University of Texas at Austin in Austin, Texas, and colleagues wrote. “Knowledge of these specific groups could allow public health practitioners to ensure that information on safe and effective self-management reaches vulnerable groups and could allow physicians in ERs, primary care settings and OB/GYN offices to be prepared to encounter more patients seeking advice or follow-up care for self-management.”

Researchers surveyed 19,830 people who obtained an abortion at 49 independent, Planned Parenthood and academic-affiliated clinics between December 2018 and May 2020. The primary outcome was knowledge of medications for abortion self-management, 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.

Overall, 99.6% of participants identified as female, 29.6% as Black, 19.3% as Hispanic and 36% as non-Hispanic white. In addition, 60.9% were aged 20 to 29 years old, 78.3% were 10 weeks pregnant or less and 44.1% received social services.

About 34% of participants said they knew about self-managed medication abortion. The most known pill was misoprostol (43.1%), and 23.9% said they knew about mifepristone. Of the 6,750 participants who said they knew about self-managed medication abortion, 16.1% reported that they considered medication abortion before attending the clinic, with cost of in-clinic care and preference for the privacy of using pills at home (48% and 37.2%, respectively) the most reported motivations. Among all participants, 11.7% reported considering self-managing their abortion using any method before clinic attendance, such as abortion pills (46.3%), vitamin C (34.7%) and herbs or botanicals (30.7%), and 28.8% said they attempted self-managed abortion.

Preferring at-home abortion care was associated with considering medication abortion (OR = 3.52; 95% CI, 2.94-4.21), considering any method of self-management for abortion (OR = 2.80; 95% CI, 2.50-3.13) and attempting any method of self-management for abortion (OR = 1.37; 95% CI, 1.10-1.69). Experiencing barriers to clinic access was also associated with considering medication self-management for abortion (OR = 1.98; 95% CI, 1.69-2.32) and considering any method of self-management for abortion (OR = 2.09; 95% CI, 1.89-2.32).

Researchers noted that experiencing clinic access barriers was associated with considering medication self-management for abortion (OR = 1.98; 95% CI, 1.69-2.32) and considering any self-management abortion method (OR = 2.09; 95% CI, 1.89-2.32) before attending the clinic. In addition, identifying as Black was associated with knowledge of medication self-management for abortion (OR = 1.12; 95% CI, 1.03.1.22) and identifying as Hispanic was associated with attempting any self-management method for abortion (OR = 1.62; 95% CI, 1.12-2.35).

“Public health practitioners will need to consider how to design and disseminate accessible, quality information about safe and effective self-management, while clinicians will need to be ready to encounter those seeking advice about self-management and those seeking safe, medically appropriate and nonjudgmental aftercare,” the researchers wrote.