April 2020

Effectiveness of self-managed medication abortion between 13 and 24 weeks gestation: A retrospective review of case records from accompaniment groups in Argentina, Chile, and Ecuador

Moseson H, Bullard K, Cisternas C, Grosso B, Vera C, Gerdts C. Effectiveness of self-managed medication abortion between 13 and 24 weeks gestation: A retrospective review of case records from accompaniment groups in Argentina, Chile, and Ecuador. Contraception. April 2020. https://doi.org/10.1016/j.contraception.2020.04.015

Objectives: In settings where abortion is legally restricted or inaccessible, grassroots feminist networks provide evidence-based information and support to individuals who self-manage abortions—a model of care known as abortion accompaniment. This study aims to fill a gap in existing evidence about out-of-clinic abortion beyond 12 weeks gestation.

Study design: We conducted a retrospective analysis of anonymized case records from accompaniment groups based in Argentina, Chile, and Ecuador of abortions supported between 13 and 24 weeks gestation. We report on the reproductive histories of individuals who had accompanied abortions, as well as medication regimens, and outcomes.

Results: Between 2016 and 2018, 316 individuals received accompaniment support for 318 self-managed medication abortions between 13 and 24 weeks gestation. Individuals most commonly used mifepristone-misoprostol (n = 297, 93%), with sublingual misoprostol administration (n = 288, 88%). Medication alone resulted in 241 complete abortions (76%); 37 (12%) individuals underwent manual vacuum aspiration or dilation and curettage within the formal health system, and 16 people (5%) required an additional medication abortion attempt at a later date, resulted in ongoing pregnancy, or were lost to follow-up. After accounting for additional interventions or monitoring at a healthcare facility, 302 of 318 (95%) abortion attempts completed overall. We had complete information regarding complications only from Chile (n = 78); of these, 12 (15%) experienced potential complications, including delayed placental expulsion and/or heavy bleeding (n = 5, 6%), high fever (n = 3, 4%), and hypotension, panic attack, or vomiting (n = 3, 4%). No abortions resulted in transfusion or hysterectomy.

Conclusions: Self-managed medication abortion, with accompaniment network support and linkages to the formal health system in the event that complications arise, may be an effective and safe option for abortion beyond the first trimester – particularly in legally restrictive settings.

Implications: These results build on an emerging body of evidence suggesting that self-managed medication abortion beyond 12 weeks gestation, conducted with accompaniment support and referrals to formal health care services as needed, can be an effective model of abortion care – and can provide a safe alternative to clandestine surgical procedures.