Overcoming challenges in research on self-managed medical abortion: lessons from a collaborative activist–researcher partnership

Kristianingrum, Ika Ayu; Nmezi, Sybil; Zurbriggen, Ruth; Gerdts, Caitlin; Jayaweera, Ruvani; Moseson, Heidi

doi:10.1080/26410397.2022.2077282

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…This study has several strengths, including a large sample size, detailed and systematic data collection on previously unreported aspects of the misoprostol-alone experience (particularly physical and health care–seeking experiences), low loss to follow-up, and strong collaborative partnership 32 in design and implementation of the study. This study also has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Medication Abortion Safety and Effectiveness With Misoprostol Alone

Jayaweera,

Egwuatu,

Nmezi

et al. 2023

JAMA Netw Open

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ImportanceMisoprostol-alone regimens for abortion may be more effective than previously thought.ObjectiveTo estimate the effectiveness of medication abortion with misoprostol alone among individuals self-managing their abortion.Design, Setting, and ParticipantsFor this prospective observational cohort study of callers to safe abortion hotlines and accompaniment groups in Argentina, Nigeria, and Southeast Asia, participants were recruited between July 31, 2019, and October 1, 2020, prior to starting their medication abortion. Eligible participants were 13 years or older, had no contraindications to medication abortion, and were not currently bleeding. Participants completed a baseline and 2 follow-up surveys. The analysis was restricted to participants who reported using misoprostol alone and was performed between January 6, 2022 and September 8, 2023.ExposureSelf-managed medication abortion using misoprostol alone.Main Outcomes and MeasuresThe primary outcome was effectiveness, defined as participant self-report of complete abortion without procedural intervention, measured at 1 week and 3 weeks after taking misoprostol. Secondary outcomes included method safety, measured by self-report of experiencing warning signs (eg, heavy bleeding, pain, fever, discharge) indicative of a potential complication and by medical treatment (eg, blood transfusion, intravenous fluids, overnight hospital stay) indicative of a potential adverse event. Additional outcomes included length of bleeding and cramping, time to expulsion, and experience of adverse effects.ResultsAmong 1352 enrolled participants, 637 used misoprostol-alone regimens for abortion and were included in the analysis (591 [92.8%] from Nigeria, 45 [7.1%] from Southeast Asia, and 1 [0.2%] from Argentina; 384 [60.2%] aged 20-29 years; 317 [49.8%] with pregnancy durations &lt;7 weeks and 205 [32.2%] with pregnancy durations between 7 and &lt;9 weeks). At last follow-up after taking medication (median, 22 days; IQR, 21-26 days), 625 participants (98.1%; 95% CI, 96.7%-98.9%) had a complete abortion without procedural intervention. Potential adverse events were reported by 6 participants (0.9%; 95% CI, 0.4%-2.1%). Most participants experienced bleeding for less than 1 week (median, 4 days; IQR, 3-6 days) and expelled their pregnancy within 24 hours of starting the abortion process (median, 12 hours; IQR, 9-15 hours). Common side effects included nausea (335 participants [52.6%]), fever (232 [36.4%]), and diarrhea (181 [28.4%]).Conclusions and RelevanceThe findings suggest that misoprostol alone is a highly effective method of pregnancy termination. Future research should explore strategies to maximize the effectiveness of misoprostol alone in clinical and nonclinical settings.

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Section: Discussionmentioning

confidence: 99%

Medication Abortion Safety and Effectiveness With Misoprostol Alone

Jayaweera,

Egwuatu,

Nmezi

et al. 2023

JAMA Netw Open

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“…118 Self-managed abortion Self-managed abortion (SMA) is a termination of pregnancy performed by an individual outside of a formal health care system and has been observed across the world, even when there is access to safe and legal abortion. [119][120][121] In the current environment of worsening abortion access, attention is turning to SMA. 122 SMA can include self-sourcing and ingesting mifepristone and misoprostol, misoprostol alone, other medications or pills, herbs, toxic substances, or physical methods (ie, trauma or inserting foreign objects into the uterus).…”

Section: Therapeutic Advancesmentioning

confidence: 99%

Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era

Schmidt

Katz

Stein³

2022

American Journal of Therapeutics

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Background:The U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization decision on June 24, 2022 effectively overturned federal constitutional protections for abortion that have existed since 1973 and returned jurisdiction to the states. Several states implemented abortion bans, some of which banned abortion after 6 weeks and others that permit abortion under limited exceptions, such as if the health or the life of the woman is in danger. Other states introduced bills that define life as beginning at fertilization. As a result of these new and proposed laws, the future availability of mifepristone, one of two drugs used for medical abortion in the United States, has become the topic of intense debate and speculation.Areas of Uncertainty:Although its safety and effectiveness has been confirmed by many studies, the use of mifepristone has been politicized regularly since its approval. Areas of future study include mifepristone for induction termination and fetal demise in the third trimester and the management of leiomyoma.Data Sources:PubMed, Society of Family Planning, American College of Obstetricians and Gynecologists, the World Health Organization.Therapeutic Advances:The use of no-touch medical abortion, which entails providing a medical abortion via a telehealth platform without a screening ultrasound or bloodwork, expanded during the COVID-19 pandemic, and studies have confirmed its safety. With the Dobbs decision, legal abortion will be less accessible and, consequently, self-managed abortion with mifepristone and misoprostol will become more prevalent.Conclusions:Mifepristone and misoprostol are extremely safe medications with many applications. In the current changing political climate, physicians and pregnancy-capable individuals must have access to these medications.

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“…Challenges remain, however, in research on self‐managed abortion. For instance, it is difficult to quantify how many people have self‐managed their abortions or to study outcomes from self‐managed abortion due to abortion stigma, the inability to identify people self‐managing, general secrecy, and well‐founded fears of legal consequences 17 . Through partnerships with local feminist activist collectives and networks of grassroots abortion supporters and community health workers, however, researchers are overcoming these challenges and contributing new knowledge to the evidence base on the safety and efficacy of self‐managed medication abortion.…”

Section: Clinical Safety Of Self‐managed Abortion With Medicationmentioning

confidence: 99%

Self‐managed abortion: Aligning law and policy with medical evidence

Skuster

Moseson

Perritt

2022

Intl J Gynecology & Obste

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People have always and will always find ways to try to end their pregnancies when necessary. Many do so safely without the involvement or direct supervision of healthcare professionals by self-managing their abortions. In 2022, the well-established safety and efficacy of abortion medications prompted WHO to fully endorse self-managed medication abortion as part of a comprehensive range of safe, effective options for abortion care. But despite robust evidence supporting the safety and effectiveness of the self-use of medications for abortion, abortion laws and policies around the world remain at odds with clinical evidence and with the realities of self-managed medication abortion in the present day. The present article considers legal issues related to self-managed abortion and addresses the role of obstetricians, gynecologists, and other healthcare professionals in promoting clinical and legal safety in abortion care through support of self-managed abortion.

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Overcoming challenges in research on self-managed medical abortion: lessons from a collaborative activist–researcher partnership

Cited by 5 publications

References 12 publications

Medication Abortion Safety and Effectiveness With Misoprostol Alone

Medication Abortion Safety and Effectiveness With Misoprostol Alone

Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era

Self‐managed abortion: Aligning law and policy with medical evidence

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