High completion rates with self-managed medication abortion at 9 to 16 weeks gestation

Key takeaways:

• Overall, 89.4% of self-managed medication abortions were complete without procedural intervention.
• Health care was sought by 23.5% either for confirmation of completion or treatment of a complication.

Women who attempted self-managed medication abortion from 9 to 16 weeks gestation experienced high completion rates, with 23.5% visiting health care professionals to confirm completion or treat complications, researchers reported.

“Most research on medication abortion regimens has focused on safety and effectiveness outcomes in clinical settings in the first 9 weeks of pregnancy, and indeed, most abortion occur within this gestational window,” Heidi Moseson, PhD, MPH, senior research scientist at Ibis Reproductive Health in Oakland, California, and colleagues wrote. “However, a robust body of clinical research indicates that the effectiveness and safety of medication abortion at 9 or more weeks of pregnancy remain high.”

Moseson and colleagues conducted a prospective, observational cohort study of 1,352 women (mean age, 26 years) from 2019 to 2020 who initiated self-managed medication abortion from three abortion-accompaniment groups in Argentina, Nigeria and Southeast Asia. Before initiation, participants completed a baseline survey and completed two follow-up surveys at 1 and 3 weeks after taking abortifacients.

The primary outcome was abortion completion. Secondary outcomes included physical experiences, seeking health care and treatment.

Overall, 19.5% of women self-managed their medication abortion at 9 or more weeks gestation, 75% at 9 to 11 weeks, 19.3% at 12 to 14 weeks and 5.7% at 15 to 22 weeks.

Results, published in Obstetrics & Gynecology, showed that 56.4% of women used the combined mifepristone plus misoprostol medication abortion regimen, and 43.6% used misoprostol only. Complete abortion was self-reported by 80.7% of women 1 week after taking abortifacients.

At final follow-up, 89.4% of women had a complete abortion without procedural intervention, 5.3% had a complete abortion with manual vacuum aspiration or dilation and curettage procedure, 4.9% had an incomplete abortion and 0.4% did not report on their abortion outcome. Both combined mifepristone plus misoprostol and misoprostol-only regimens had high abortion completion rates of 84.6% and 95.7%, respectively.

Overall, 23.5% of women visited a health care professional during or after their self-managed medication abortion. Of these, 15.9% visited a health care professional to confirm abortion completion, 2% went for concerns about bleeding, 1.8% went for concerns about pain and 1.8% went for concerns about fever or discharge.

Women at 12 or more weeks gestation had a higher likelihood of seeking clinical or hospital care compared with women at 9 to 11 weeks gestation (adjusted RR = 1.62; 95% CI, 1.3-2.1).

“These findings are consistent with the effectiveness reported in retrospective analyses of accompaniment group case records for self-managed medication abortion at these gestations and underscore the need for access to health care as an important component of the self-managed medication abortion experience,” the researchers wrote.