Second-trimester medication abortion outside the clinic setting: an analysis of electronic client records from a safe abortion hotline in Indonesia

Abstract

IntroductionUnsafe abortion past the first trimester disproportionately accounts for the majority of global abortion-related morbidity and mortality; research that documents the safety, feasibility and acceptability of existing models for providing information and support to women who self-manage outside of formal clinic settings is needed.MethodsThis study is a retrospective analysis of anonymised electronic client records from callers to a safe abortion hotline in Indonesia. Between July 2012 and October 2016, a total of 96 women contacted the hotline for information on medication abortion beyond 12 weeks' gestation and are included in this study. Descriptive statistics were calculated regarding pregnancy termination status, client experience with warning signs of potential complications, and medical care seeking and treatment.ResultsNinety-six women with pregnancies beyond the first trimester called the hotline for information on medication abortion; 91 women received counselling support from the hotline. Eighty-three women (91.2%) successfully terminated their pregnancies using medication and did not seek medical care. Five women exhibited warning signs of potential complications and sought medical care; one woman sought care after a failed abortion. Two women were lost to follow-up and the outcomes of their pregnancies are unknown.ConclusionsEvidence from our analysis suggests that a model of remote provision of support for abortions later in pregnancy by non-medically trained, skilled abortion counsellors could be a safe alternative for women in need of abortions beyond 12 weeks' gestation in a legally restrictive context. Further examination and documentation of the model is warranted.

Self-managed medication abortion outcomes: results from a prospective pilot study

“…(6)(7)(8)(9)(10) There is a growing body of literature from around the world indicating that when individuals have access to information about how to obtain the pills, how to take the pills, how to assess for completion, and warning signs that may indicate potential complications, the practice of selfmanaged medication abortion is safe and the experience satisfactory. (8,9,(11)(12)(13)(14)(15) Much of the published literature has focused speci cally on the experiences of self-managed medication abortion with telemedicine support from online websites that provide access to pills as well as information on how to use them via email communication; these studies report safe and effective abortion experiences. (2,8,12,13,(16)(17)(18) Beyond online websites, people obtain information, medications, and support to self-manage their abortions in a variety of other ways as well.…”

“…One emerging model is abortion accompaniment, where trained volunteers provide WHO-recommended evidence-based information about medication abortion, as well as physical and emotional support and person-centered care throughout the medication abortion process, over the phone or in person, outside of the formal health care system. (15,(19)(20)(21)(22) This non-clinic based model of counselor-supported self-managed medication abortion care has come to be known as the "accompaniment model," as people are virtually "accompanied" through the medication abortion process. Approximately fty accompaniment groups are in operation around the world, providing support and information about self-managed medication abortion.…”

“…Among accompaniment clients, we are aware of only three studies that have reported on outcomes of self-managed medication abortion; all found high levels of abortion completion, and few complications. (15,22,23) Of the data that do exist, however, there are important limitations-including a heavy reliance on retrospective records that were not collected for the purposes of research. Evidence suggests that a high proportion of abortions occur outside of the health care system and changing global dynamics may continue to shift more abortions outside of the healthcare system.…”

“…(26,27) All of these factors could lead to an increase in incidence of and demand for self-managed abortion. These pilot study data represent some of the rst ever prospective data on the effectiveness of self-managed abortion, (2,15,22,23) and provide insight into ways that healthcare systems could adapt to support those who choose to or need to self-manage abortions.…”

Effect of a smartphone intervention on self‐managed medication abortion experiences among safe‐abortion hotline clients in Indonesia: A randomized controlled trial

“…For decades, people around the world have relied on WHO‐recommended medications to terminate unwanted pregnancies, increasingly in contexts where formal‐sector abortion care is restricted, expensive, and/or inaccessible . Studies have suggested that when individuals have accurate information about medication abortion protocols and about what to expect, access to quality medications, and access to follow‐up care if needed, they can safely and effectively manage their own abortions …”