Prevalence, attitudes and knowledge of misoprostol for self-induction of abortion in women presenting for abortion at Midwestern reproductive health clinics

Abstract

In the setting of increasing restrictions to legal abortion in the United States, reports have emerged of self-induced termination of pregnancies with misoprostol, obtained without a prescription or provider. This study seeks to describe the prevalence of women seeking or employing misoprostol for self-induced abortion, and how they access information. In a cross-sectional study of women immediately following their abortion at three reproductive health clinics in the Midwestern United States, an anonymous survey queried gestational age, barriers, online investigation about self-induction and opinions concerning the availability of medical abortion. From June to September 2016, 276 women participated out of 437 presenting to the clinics during the study period. One hundred and ninety-one (74.6%) women had investigated abortion options online, and of those, 58 (30.9%) investigated misoprostol online, for home use. Women who investigated online options were less likely to have had a prior abortion than those who did not investigate online (29.3% vs. 63.1%, p < .01). They were also more likely to report prior home attempts to end this pregnancy (8.6% vs. 0%, p = .05). Overall, four (1.6%) of the respondents purchased misoprostol and three (1.2%) used it. A majority of women seeking an abortion sought online information prior to their clinic appointment, and almost a third of those had investigated misoprostol for home use. Women are accessing information regarding misoprostol for selfinduction of abortion on the Internet. As barriers to legal abortion increase, women may be more likely to selfinduce abortion.

Uptake of Misoprostol among women seeking abortion in Accra, Ghana

“…The figure is however, lower than the 60-83% reported in previous studies in Kumasi [10,29]; but higher than the 12.4% observed in Nigeria [30]. The figures are however higher than those recorded in other parts of the world (1.2%-1.6%) [31][32][33]. The possible explanation for the low uptake could be that women may not have understood the question or known what the terms "misoprostol" or "Cytotec" meant even if they had used the drug.…”

Self-managed abortion: A systematic scoping review

“…Forty-two studies provided information on specific types of plants and herbs used to self-manage an abortion, while many others mentioned herbs or herbal methods more broadly (e.g., (22,33,34)). Usually prepared as tisanes ("teas") or other infusions, a sampling of these included aloe (35), rue (11,25,36), sage (36), black and blue cohosh (36)(37)(38)(39), savin, myrrh, mugwort, and ergot (11), parsley (40), pait (41), and different types of local roots (e.g., (26,42)). Sources of procurement included local herbalists or traditional healers (26,(42)(43)(44), markets and shops (35,42,43,45), and the Internet (45)(46)(47).…”

“…Sources of procurement and/or information included online vendors (13,39,47,50,77,78,89), telephone vendors (47,88), friends and relatives (13,36,47,51,61,66,78,(88)(89)(90), accompaniment groups(89), pharmacists (over the counter purchase with or without prescription) (13,28,36,41,43,47,51,53,66,68,78,79,(90)(91)(92)(93)(94)(95)(96)(97), doctors or nurses (13,28,39,43,47,51,53,61,66,78,88,…”

“…Fifty studies reported on other methods of self-management that did not neatly fit within the above categories. For example, taking Vitamin C (36)(37)(38)(39)(40)76), chloroquine (31,42,54), Plan B or emergency contraception (27,35,43,45,53,95), laxatives (11,23,31,35,36,44,53), misoprostol mixed with other substances such as beer, plants, or injections (44,98,100), or unspecified drugs (11,24,30,36,38,45,46,48,53,55,57,59,(63)(64)(65)(100)(101)(102)(103)(104)(105). Other examples included receiving hormonal injections or oral contraceptives (24,36,…”

“…Other studies documented specific barriers to clinical care that led people to pursue or consider a selfmanaged abortion (e.g., (112)). Most commonly cited barriers were logistical difficulties, including traveling long distances to a clinic, taking time away from work, or arranging travel or childcare (10,37,39,40,46,74,76,113). Inability to pay for an in-clinic abortion (37,46,65,82,109,112) and insurmountable legal restrictions on abortion (10, 12, 23, 36, 37, 40, 45-47, 74, 89, 91, 92, 114) contributed to people pursuing self-managed abortion.…”