Acceptability and Feasibility of Mifepristone-Misoprostol for Menstrual Regulation in Bangladesh

Self-management of medical abortion: a qualitative evidence synthesis

“…In legal settings, we found that the older studies described more medicalized approaches that required women to remain in clinic for four hours following misoprostol administration. 16,17 Shifts to less medicalized care in the more recent studies took the following forms: administering the misoprostol to women at the second appointment but then sending them home to abort, [18][19][20]4 giving women misoprostol at the second appointment but allowing them to selfadminister it at home, 18,21 giving women misoprostol at the first appointment to be self-administered at home, 19,[22][23][24][25][26][27] and giving women both mifepristone and misoprostol at the first appointment to be taken at home. 27,28 The studies from legal settings that reported misoprostol-only abortions reported self-administration at home.…”

“…[16][17][18][19]25,[27][28][29][30][31][32] Even in restricted contexts, some offered support for women self-administering, by providing clinical advice and counselling and noting likely sources of the drug. Providers were not, however, generally supportive of over-the-counter access to medical abortion drugs.…”

“…They often reported some degree of anxiety at the beginning of the process but reported relief at the end and a strong sense of satisfaction with the choice to self-manage. 19,20,22,23,29 In some contexts, the use of misoprostol at home for early medical abortion falls within existing interpretive frameworks and practices (such as "menstrual regulation" (Bangladesh) and was understood as one of many treatments for local illness categories referring to missed menstrual periods (e.g. "late menses" in Brazil).…”

“…16,33,42 Preparation for self-management In preparing for self-management of medical abortion, women reported anxiety, uncertainty, or ambivalence, sometimes to do with the decision to terminate the pregnancy, but more often in relation to the process and experience of the medical abortion. 19,20,22,23,29,39,43,44 Effective counselling by trained providers during the first step of medical abortion that offered women a sense of confidence, being prepared, having a choice, and being in control, was important in building the acceptability of self-management among women. 17,[22][23][24]44 Women and providers both felt that critical aspects of the educational component of counselling included preparing women for possible side effects and complications.…”

“…20,22,23,30,33,36 Providing adequate counselling in the context of health facilities was, however, seen as time consuming for health professionals and written materials for patients were reported to be underutilized. 19,22,29,33,34 We also derived a number of insights from evidence in both restricted and legal contexts where women self-administer misoprostol through informal networks. Women seek advice from a range of sources: friends, family, older women, websites, hotlines, pharmacists, informal sellers and sometimes even GPs without expertise in abortion.…”