Most Patients Successfully Self-Manage Medication Abortion, Study Shows

In several countries, nearly all participants successfully completed a self-managed medication abortion without procedural intervention, a prospective observational study showed.

In Argentina, Nigeria, and Southeast Asia, nine out of every ten individuals completed a self-managed medication abortion, which compares with data from randomized clinical trials. Among those who took misoprostol only, 95.7% had success, reported Heidi Moseson, PhD, MPH, senior research scientist at Ibis Reproductive Health in Oakland, California, and co-authors in Obstetrics & Gynecology.

Most participants successfully had a complete abortion without procedural intervention, while a few had a manual vacuum aspiration or dilation and curettage procedure to complete the abortion (89.4% and 5.3%, respectively). A minority had an incomplete abortion and one participant did not report her abortion outcome (4.9% and 0.4%, respectively).

Overall, the study had 1,352 participants. In total, 264 women self-managed a medication abortion at 9 or more weeks of gestation, three-quarters of whom self-managed an abortion at 9 to 11 weeks gestation (n=198). The rest self-managed an abortion at 12 to 14 weeks (19.3%; n=51) or 15 to 22 weeks (5.7%; n=15).

“Most research on medication abortion regimens has focused on safety and effectiveness outcomes in clinical settings in the first 9 weeks of pregnancy, and indeed, most abortions occur within this gestational window,” study authors wrote. “However, a robust body of clinical research indicates that the effectiveness and safety of medication abortion at 9 or more weeks of pregnancy remain high.”

Moseson noted that with abortion care harder to access in a growing number of states, restrictive laws push many people seeking abortion later into pregnancy.

“We are going to see more people needing to self-manage [their abortion] … and more people choosing to self-manage or use these pills beyond 10 weeks of pregnancy,” Moseson told MedPage Today. “There’s no magic line at 10 weeks after which these pills stop working. They continue to be effective. In fact, the uterus is even more responsive to misoprostol in particular after 10 weeks of pregnancy. So I think that’s a very important finding that these pills remain a safe and effective way to end a pregnancy after 9 or 10 weeks of pregnancy.”

The FDA approves medication abortion up until 10 weeks gestation, which Moseson said is more conservative than the timelines other countries use.

“This paper indicates that even when people are self-managing — so even when people are using these pills without clinical supervision or involvement — the pills remain a safe and effective way to end a pregnancy… for people with pregnancies between 9 and 16 weeks,” Moseson said.

She told MedPage Today that while she heard a lot of doctors had hesitations about their patients self-managing medication abortions, she also heard a lot of anecdotal success stories from activists who help people get medication abortions without clinicians.

“So why would we expect the pills to work differently depending on who gives them to you or where you take them?” Moseson posed, adding that this question was one motivator for the research.

Her group recruited study participants among people who reached out to abortion-accompaniment groups in Argentina, Nigeria, and a country in Southeast Asia to obtain medication abortion information or support. From July 31, 2019, to October 1, 2020, counselors screened potential participants, who had to be older than 13 and have no contraindications to medication abortion to qualify.

On average, participants were 26 years old. Exclusion criteria included ongoing symptoms from a previous abortion attempt, an ongoing miscarriage, and symptoms suggesting ectopic pregnancy. Participants completed phone surveys before they took abortion pills, and at 1 and 3 weeks after taking them.

Participants either used the combined mifepristone and misoprostol regimen (56.4%) or used only misoprostol (43.6%).

A quarter of participants reported seeking health care during or after their abortion and 9.1% needed additional medical care such as a procedural abortion, antibiotics, fluids, blood transfusion, or overnight hospital care. Women aborting at 12 or more weeks gestation were more likely to seek additional care than those at 9 to 11 weeks (adjusted RR 1.62, 95% CI 1.3-2.1).

Moseson and colleagues acknowledged study limitations such as the reliance on self-reported gestational age and abortion outcome and that the sample size of just three women undergoing self-managed abortion between 17 and 22 weeks gestation. They said that “additional research is needed to evaluate the safety and effectiveness of self-managed medication abortion beyond 16 weeks of gestation.”