Reaching Women with Instructions on Misoprostol Use in a Latin American Country

Self-management of medical abortion: a qualitative evidence synthesis

“…Providers were not, however, generally supportive of over-the-counter access to medical abortion drugs. [33][34][35][36] Self-management and selfadministration allowed providers in restricted contexts to distance themselves legally from the abortion. 37,38 Providers in legal contexts could accomplish a similar kind of distancing on moral grounds.…”

“…20,32,40,41 Providers' perceptions about which healthcare workers should be able to provide medical abortion drugs to women for self-administration varied and depended on: perceptions of the strength of the drugs and hence the expertise in anatomy and physiology needed to explain their full effects; a provider's training in appropriate counselling for abortion; a provider's knowledge of abortionfriendly emergency departments to refer women to in the case of complications; and the client's experience, and therefore trust, of different healthcare workers. 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.…”

“…Critical psychosocial components of counselling included: preparing women for the variability in individual women's physical experiences of medical abortion; the practical and physical difficulties of managing the expulsion process at home; and the fact that most women reported anxiety during the beginning of the medical abortion process but relief at its completion. 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.…”

“…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.…”

“…4,[21][22][23]44 When women were counselled by trained providers in the self-administration of misoprostol, providers trusted women's ability to comply with dosage and timing requirements, women felt confident and reported uncomplicated abortions for the most part, and women called hotlines or consulted providers when the abortion process did not proceed as expected. 19,21,26,28,[32][33][34]37,44,50 Although less commonly reported, concerns regarding the process of prescribing misoprostol for self-administration at home included not keeping oral misoprostol in one's cheek long enough, developing abrasions, feeling nauseous from the taste of misoprostol, taking the misoprostol earlier than indicated, having difficulty administering the misoprostol vaginally and worrying about whether the medication was taken properly. 19,29,44 There were also reports of misunderstandings and inconsistencies regarding the prescription and use of painkillers as part of the counselling for home use, including staff not providing pain medication, or women not taking them because of fear that it would stop the abortion process or the belief that the misoprostol pill contained its own painkiller.…”