Women’s experiences of self-administration of misoprostol at home as part of early medical abortion: a qualitative evaluation

Harden, Jeni; Ancian, Julie; Cameron, Sharon; Boydell, Nicola

doi:10.1136/bmjsrh-2020-200661

Cited by 17 publications

(50 citation statements)

References 27 publications

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“…A large majority of practitioners reported a “good” or “very good” experience of MA at home between 7 and 9 W G by the majority of the women. These data are comparable to those of a study already conducted in Scotland that supports the existing evidence that home-self administration of misoprostol is acceptable to women and improves their overall satisfaction [ 13 ]. In addition, difficulties in accessing ultrasound, laboratory tests or abortion treatments were reported by some practitioners in our study.…”

Section: Discussionsupporting

confidence: 87%

COVID-19 impact in abortions’ practice, a regional French evaluation

Gibelin

Agostini

Marcot

et al. 2021

Journal of Gynecology Obstetrics and Human Reproduction

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Section: Discussionsupporting

confidence: 87%

COVID-19 impact in abortions’ practice, a regional French evaluation

Gibelin

Agostini

Marcot

et al. 2021

Journal of Gynecology Obstetrics and Human Reproduction

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“…Experiences of the abortion process and passing the pregnancy were largely in line with our previous, pre‐pandemic, research on medical abortion at home 2 ; participants described benefits associated with being in the comfort of their own home and having control over timing. Some experienced challenges associated with the availability of their preferred supporter or location for the abortion; in some cases this was directly related to COVID‐19 ‘lockdown’ conditions.…”

Section: Resultssupporting

confidence: 64%

“…The importance of information and support for women undergoing medical abortion at home has been highlighted (2,19,25). There were no reported issues in this study with accessing or…”

Section: Accepted Articlementioning

confidence: 78%

“…Prior to the coronavirus (COVID-19) pandemic women and pregnant people in Great Britain who chose medical abortion (less than 10 weeks' gestation) at home, were required to make an inperson visit to an abortion service for assessment; this usually involved a routine ultrasound scan to confirm gestation (1). Mifepristone was received in the clinic, however, the second part of medical abortion treatment (misoprostol) could be self-administered at home (1,2).…”

Section: Introductionmentioning

confidence: 99%

“… 1 Mifepristone was received in the clinic; however, the second part of medical abortion treatment (misoprostol) could be self‐administered at home. 1 , 2 …”

Section: Introductionmentioning

confidence: 99%

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Women’s experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID‐19) pandemic: a qualitative evaluation

Boydell

Reynolds-Wright

Cameron

et al. 2021

BJOG

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Objective To explore the experiences of women in Scotland who accessed medical abortion at home up to 12 weeks’ gestation, delivered via a telemedicine abortion service implemented in response to the coronavirus (COVID‐19) pandemic, to identify areas for improvement and inform service provision. Design Qualitative interview study. Setting Abortion service in one National Health Service health board in Scotland. Population or sample Twenty women who accessed telemedicine abortion services and self‐administered mifepristone and misoprostol at home up to 12 weeks’ gestation. Methods Thematic analysis of semi‐structured qualitative interviews, informed by the Framework analytic approach. Main outcome measures Women’s experiences of accessing telemedicine for medical abortion at home, specifically: acceptability of the telephone consultation and remote support; views on no pre‐abortion ultrasound scan; and self‐administration of abortion medications at home. Results Novel study findings were three‐fold: (1) participants valued the option of accessing abortion care via telemedicine and emphasised the benefits of providing a choice of telephone and in‐person consultation to suit those with different life circumstances; (2) the quality of abortion care was enhanced by the telemedicine service in relation to access, comfort and flexibility, and ongoing telephone support; (3) participants described being comfortable with, and in some cases a preference for, not having an ultrasound scan. Conclusions This research demonstrates support for the continuation of telemedicine abortion services beyond the temporary arrangements in place during COVID‐19, and lends weight to the argument that offering the option of telemedicine abortion care can enable women to access this essential health service. Tweetable abstract #Telemedicine provision of medical #abortion at home up to 12 weeks’ gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher.

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Impact of approval of home use of misoprostol in England on access to medical abortion: An interrupted time series analysis

Lewandowska,

Carter,

Gasparrini

et al. 2023

Intl J Gynecology & Obste

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ObjectiveIn 2018, the Department of Health and Social Care in England approved the use of misoprostol at home for early medical abortions, following administration of mifepristone at clinic. The objective of the present study was to assess the impact of the approval of home administration of misoprostol in England on access to medical abortion, assessed through proxy measures of the proportion of all abortions that were medical and gestational age.MethodsThis study uses the clinical data from the British Pregnancy Advisory Service on abortions in England in years 2018–2019, containing demographic and procedure characteristics of patients. We conducted an interrupted time series analysis to establish the differences before and after the approval in access to medical abortion, measured by the proportion of all abortions that were medical, and gestational age. The analysis also examined whether these changes were equitable, with focus on area‐level deprivation.ResultsThe analysis of the data (145 529 abortions) suggested that there was an increase in the proportion of medical abortions and decrease in gestational age of abortions after the approval. Compared with the situation if former trends had continued, the actual proportion of early medical abortions was 4.2% higher in December 2019, and the mean gestational age 3.4 days lower. We found that the acceleration of existing trends in increase in proportion of medical abortions and decrease in gestational age were larger in the most deprived quintiles and in those reporting a disability, but not equal across ethnic groups, with Black and Black British women experiencing little change in trajectories post‐approval.ConclusionThe approval of home use of misoprostol as part of an early medical abortion regimen in England was associated with material and equitable improvements in abortion access. Pre‐approval trends toward greater uptake of medical abortion and declining gestational age were accelerated post‐approval and were greatest in the most deprived areas of England, but not across all racial/ethnic groups. The present findings strongly support the continuation or introduction of home management of medical abortions.

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Women’s experiences of self-administration of misoprostol at home as part of early medical abortion: a qualitative evaluation

Cited by 17 publications

References 27 publications

COVID-19 impact in abortions’ practice, a regional French evaluation

COVID-19 impact in abortions’ practice, a regional French evaluation

Women’s experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID‐19) pandemic: a qualitative evaluation

Impact of approval of home use of misoprostol in England on access to medical abortion: An interrupted time series analysis

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