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Luchetti G, Albardonedo V, Alfonso MV. [Women's rescuers network: Community support for self-managed abortion in Argentina]. Salud Colect 2024; 20:e4810. [PMID: 38992339 DOI: 10.18294/sc.2024.4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/30/2024] [Indexed: 07/13/2024] Open
Abstract
The availability of medications to induce abortion, especially in contexts of restricted access, has transformed practices and allowed women and/or their community organizations to assist other women in obtaining abortions, whether or not they interact with the healthcare system. This study recovers the experience of a feminist community organization that, from the province of Neuquén, extends throughout the country, creating a network of community care. An exploratory descriptive study with a qualitative approach was conducted to analyze the experiences of women who facilitate access to permitted abortion in Argentina. Through in-depth interviews with three leaders of the feminist collective La Revuelta and semi-structured interviews with 33 members of the socorrista groups, conducted between November 2019 and December 2020, we describe their history and processes of work and growth; we explore their motivations and feelings and characterize the interactions of these organizations with public and private health systems. The results of this work align with the international conversation and bibliographic production about these organizations and their particularities, and with the need to incorporate these forms of care into institutional health systems.
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Affiliation(s)
- Gabriela Luchetti
- Médica, ginecóloga-obstetra. Magíster en Genero Sociedad y Políticas. Profesora adjunta, Facultad de Medicina, Universidad Nacional del Comahue, Neuquén, Argentina
| | - Valeria Albardonedo
- Licenciada en Comunicación Social. Magíster en Ciencias Sociales. Asistente Docencia, Facultad de Medicina, Universidad Nacional del Comahue, Neuquén, Argentina
| | - María Victoria Alfonso
- Licenciada en Comunicación Social. Magíster en Política y Gestión de la Ciencia y la Tecnología. Secretaria, Consejo Superior, Universidad Nacional del Comahue, Neuquén, Argentina
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Coleman PK. The Turnaway Study: A Case of Self-Correction in Science Upended by Political Motivation and Unvetted Findings. Front Psychol 2022; 13:905221. [PMID: 35783786 PMCID: PMC9247501 DOI: 10.3389/fpsyg.2022.905221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/24/2022] [Indexed: 01/14/2023] Open
Abstract
This review begins with a detailed focus on the Turnaway Study, which addresses associations among early abortion, later abortion, and denied abortion relative to various outcomes including mental health indicators. The Turnaway Study was comprised of 516 women; however, an exact percentage of the population is not discernable due to missing information. Extrapolating from what is known reveals a likely low of 0.32% to a maximum of 3.18% of participants sampled from the available the pool. Motivation for conducting the Turnaway Study, methodological deficiencies (sampling issues and others), and bias are specifically addressed. Despite serious departures from accepted scientific practices, journals in psychology and medicine have published dozens of articles generated from the study's data. The high volume of one-sided publications has stifled dialogue on potential adverse psychological consequences of this common procedure. Following a critical analysis of the Turnaway Study, an overview of the strongest studies on abortion and mental health is offered. This comprehensive literature comprised of numerous large-scale studies from across the globe has been largely overlooked by scientists and the public, while the Turnaway Study dominates the media, information provided to women, and legal challenges involving abortion restrictions. In the final section of this article, literature reviews by professional organizations are considered, demonstrating that the biased science characterizing the Turnaway Study is aligned with a pervasive and systemic phenomenon wherein deriving reliable and valid results via careful attention to methodology and scrutiny by the scientific community have been supplanted by politics.
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Affiliation(s)
- Priscilla K. Coleman
- Human Development and Family Studies, Bowling Green State University, Bowling Green, OH, United States
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Gambir K, Kim C, Necastro KA, Ganatra B, Ngo TD. Self-administered versus provider-administered medical abortion. Cochrane Database Syst Rev 2020; 3:CD013181. [PMID: 32150279 PMCID: PMC7062143 DOI: 10.1002/14651858.cd013181.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The advent of medical abortion has improved access to safe abortion procedures. Medical abortion procedures involve either administering mifepristone followed by misoprostol or a misoprostol-only regimen. The drugs are commonly administered in the presence of clinicians, which is known as provider-administered medical abortion. In self-administered medical abortion, drugs are administered by the woman herself without the supervision of a healthcare provider during at least one stage of the drug protocol. Self-administration of medical abortion has the potential to provide women with control over the abortion process. In settings where there is a shortage of healthcare providers, self-administration may reduce the burden on the health system. However, it remains unclear whether self-administration of medical abortion is effective and safe. It is important to understand whether women can safely and effectively terminate their own pregnancies when having access to accurate and adequate information, high-quality drugs, and facility-based care in case of complications. OBJECTIVES To compare the effectiveness, safety, and acceptability of self-administered versus provider-administered medical abortion in any setting. SEARCH METHODS We searched Cochrane Central Register of Controlled Trials, MEDLINE in process and other non-indexed citations, Embase, CINAHL, POPLINE, LILACS, ClinicalTrials.gov, WHO ICTRP, and Google Scholar from inception to 10 July 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs) and prospective cohort studies with a concurrent comparison group, using study designs that compared medical abortion by self-administered versus provider-administered methods. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted the data, and we performed a meta-analysis where appropriate using Review Manager 5. Our primary outcome was successful abortion (effectiveness), defined as complete uterine evacuation without the need for surgical intervention. Ongoing pregnancy (the presence of an intact gestational sac) was our secondary outcome measuring success or effectiveness. We assessed statistical heterogeneity with Chi2 tests and I2 statistics using a cut-off point of P < 0.10 to indicate statistical heterogeneity. Quality assessment of the data used the GRADE approach. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We identified 18 studies (two RCTs and 16 non-randomized studies (NRSs)) comprising 11,043 women undergoing early medical abortion (≤ 9 weeks gestation) in 10 countries. Sixteen studies took place in low-to-middle income resource settings and two studies were in high-resource settings. One NRS study received analgesics from a pharmaceutical company. Five NRSs and one RCT did not report on funding; nine NRSs received all or partial funding from an anonymous donor. Five NRSs and one RCT received funding from government agencies, private foundations, or non-profit bodies. The intervention in the evidence is predominantly from women taking mifepristone in the presence of a healthcare provider, and subsequently taking misoprostol without healthcare provider supervision (e.g. at home). There is no evidence of a difference in rates of successful abortions between self-administered and provider-administered groups: for two RCTs, risk ratio (RR) 0.99, 95% confidence interval (CI) 0.97 to 1.01; 919 participants; moderate certainty of evidence. There is very low certainty of evidence from 16 NRSs: RR 0.99, 95% CI 0.97 to 1.01; 10,124 participants. For the outcome of ongoing pregnancy there may be little or no difference between the two groups: for one RCT: RR 1.69, 95% CI 0.41 to 7.02; 735 participants; low certainty of evidence; and very low certainty evidence for 11 NRSs: RR 1.28, 95% CI 0.65 to 2.49; 6691 participants. We are uncertain whether there are any differences in complications requiring surgical intervention, since we found no RCTs and evidence from three NRSs was of very low certainty: for three NRSs: RR 2.14, 95% CI 0.80 to 5.71; 2452 participants. AUTHORS' CONCLUSIONS This review shows that self-administering the second stage of early medical abortion procedures is as effective as provider-administered procedures for the outcome of abortion success. There may be no difference for the outcome of ongoing pregnancy, although the evidence for this is uncertain for this outcome. There is very low-certainty evidence for the risk of complications requiring surgical intervention. Data are limited by the scarcity of high-quality research study designs and the presence of risks of bias. This review provides insufficient evidence to determine the safety of self-administration when compared with administering medication in the presence of healthcare provider supervision. Future research should investigate the effectiveness and safety of self-administered medical abortion in the absence of healthcare provider supervision through the entirety of the medical abortion protocol (e.g. during administration of mifepristone or as part of a misoprostol-only regimen) and at later gestational ages (i.e. more than nine weeks). In the absence of any supervision from medical personnel, research is needed to understand how best to inform and support women who choose to self-administer, including when to seek clinical care.
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Affiliation(s)
- Katherine Gambir
- Population CouncilPoverty, Gender and Youth ProgramOne Dag Hammarskjöld PlazaNew YorkNew YorkUSA10017
| | - Caron Kim
- World Health OrganizationDepartment of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerland1211
| | | | - Bela Ganatra
- World Health OrganizationDepartment of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerland1211
| | - Thoai D Ngo
- Population CouncilPoverty, Gender and Youth ProgramOne Dag Hammarskjöld PlazaNew YorkNew YorkUSA10017
- Population CouncilThe GIRL CenterNew YorkNew YorkUSA
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Heath J, Mitchell N, Fletcher J. A comparison of termination of pregnancy procedures: Patient choice, emotional impact and satisfaction with care. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 19:42-49. [DOI: 10.1016/j.srhc.2018.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/12/2018] [Accepted: 12/02/2018] [Indexed: 01/17/2023]
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Kjelsvik M, Sekse RJT, Moi AL, Aasen EM, Chesla CA, Gjengedal E. Women's experiences when unsure about whether or not to have an abortion in the first trimester. Health Care Women Int 2018; 39:784-807. [DOI: 10.1080/07399332.2018.1465945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Marianne Kjelsvik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health Sciences in Aalesund, Norwegian University of Science and Technology (NTNU), Aalesund, Norway
| | - Ragnhild J. Tveit Sekse
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Norway
| | - Asgjerd Litleré Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences (HVL), Bergen, Norway
- Department of Plastic Surgery and Burn Center, Haukeland University Hospital, Bergen, Norway
| | - Elin M. Aasen
- Department of Health Sciences in Aalesund, Norwegian University of Science and Technology (NTNU), Aalesund, Norway
| | - Catherine A. Chesla
- Family Health Care Nursing, University of California San Francisco, California USA
| | - Eva Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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Purcell C, Cameron S, Lawton J, Glasier A, Harden J. Self-management of first trimester medical termination of pregnancy: a qualitative study of women's experiences. BJOG 2017; 124:2001-2008. [PMID: 28421651 PMCID: PMC5724679 DOI: 10.1111/1471-0528.14690] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the experiences of women in Scotland who return home to complete medical termination of pregnancy (TOP) ≤63 days of gestation, after being administered with mifepristone and misoprostol at an NHS TOP clinic. DESIGN Qualitative interview study. SETTING One National Health Service health board (administrative) area in Scotland. POPULATION OR SAMPLE Women in Scotland who had undergone medical TOP ≤63 days, and self-managed passing the pregnancy at home; recruited from three clinics in one NHS health board area between January and July 2014. METHODS In-depth, semi-structured interviews with 44 women in Scotland who had recently undergone TOP ≤63 days of gestation, and who returned home to pass the pregnancy. Data were analysed thematically using an approach informed by the Framework method. MAIN OUTCOME MEASURES Women's experiences of self-management of TOP ≤63 days of gestation. RESULTS Key themes emerging from the analysis related to self-administration of misoprostol in clinic; reasons for choosing home self-management; facilitation of self-management and expectation-setting; experiences of getting home; self-managing and monitoring treatment progress; support for self-management (in person and remotely); and pregnancy self-testing to confirm completion. CONCLUSIONS Participants primarily found self-administration of misoprostol and home self-management to be acceptable and/or preferable, particularly where this was experienced as a decision made jointly with health professionals. The way in which home self-management is presented to women at clinic requires ongoing attention. Women could benefit from the option of home administration of misoprostol. TWEETABLE ABSTRACT Women undergoing medical TOP 63 days found home self-management to be acceptable and/or preferable.
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Affiliation(s)
- C Purcell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Cameron
- Chalmers Centre for Sexual and Reproductive Health (NHS Lothian), Edinburgh, UK
| | - J Lawton
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - A Glasier
- Obstetrics and Gynaecology, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J Harden
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Iyengar K, Klingberg Allvin M, Iyengar SD, Danielsson KG, Essén B. "Who Wants to Go Repeatedly to the Hospital?" Perceptions and Experiences of Simplified Medical Abortion in Rajasthan, India. Glob Qual Nurs Res 2017; 3:2333393616683073. [PMID: 28462355 PMCID: PMC5342849 DOI: 10.1177/2333393616683073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/04/2016] [Accepted: 11/04/2016] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to explore women's experiences and perceptions of home use of misoprostol and of the self-assessment of the outcome of early medical abortion in a low-resource setting in India. In-depth interviews were conducted with 20 women seeking early medical abortion, who administered misoprostol at home and assessed their own outcome of abortion using a low-sensitivity pregnancy test. With home use of misoprostol, women were able to avoid inconvenience of travel, child care, and housework, and maintain confidentiality. The use of a low-sensitivity pregnancy test alleviated women's anxieties about retained products. Majority said they would prefer medical abortion involving a single visit in future. This study provides nuanced understanding of how women manage a simplified medical abortion in the context of low literacy and limited communication facilities. Service delivery guidelines should be revised to allow women to have medical abortion with fewer visits.
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Affiliation(s)
- Kirti Iyengar
- Karolinska University Hospital, Stockholm, Sweden.,Action Research and Training for Health, Udaipur, Rajasthan, India
| | | | - Sharad D Iyengar
- Action Research and Training for Health, Udaipur, Rajasthan, India
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Altshuler AL, Nguyen BT, Riley HEM, Tinsley ML, Tuncalp Ö. Male Partners' Involvement in Abortion Care: A Mixed-Methods Systematic Review. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2016; 48:209-219. [PMID: 27727503 DOI: 10.1363/psrh.12000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 06/06/2023]
Abstract
CONTEXT Although some women may desire the involvement of their partners when obtaining abortion care, male partners are not routinely included in the abortion process. A review of the literature on how male involvement relates to women's abortion experiences may help guide facilities that are considering incorporating male partners in abortion care. METHODS PubMed, PsycINFO (Ovid), the Cumulative Index to Nursing and Allied Health Literature, the Latin American and Caribbean Health Sciences Literature database, and the Cochrane Library were systematically searched without restrictions through September 23, 2015, to identify qualitative and quantitative primary studies investigating male partner accompaniment during the abortion process in noncoercive situations. Analysis focused on identifying different types of male involvement and their associations with women's abortion experiences. RESULTS Some 1,316 unique articles were reviewed; 15 were analyzed. These studies were conducted in six countries and published between 1985 and 2012, primarily with observational designs. Four types of male partner involvement emerged: presence in the medical facility, participation in preabortion counseling, presence in the room during the surgical abortion procedure or while the woman is experiencing the effects of abortifacient medications, and participation in postabortion care. Studies explored relationships between type of involvement and women's access to abortion care and their emotional and physical well-being. Most findings suggested that male involvement was positively associated with women's well-being and their assessment of the experience; no negative associations were found. CONCLUSION In noncoercive circumstances, women who include their male partners in the abortion process may find this involvement beneficial.
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Affiliation(s)
- Anna L Altshuler
- Obstetriciangynecologist, California Pacifi c Medical Center Research Institute, San Francisco
| | - Brian T Nguyen
- Fellow in family planning, Department of Obstetrics and Gynecology, University of Chicago
| | - Halley E M Riley
- Doctoral student, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta
| | - Marilyn L Tinsley
- Research services librarian, Lane Medical Library, Stanford University School of Medicine, Stanford, California
| | - Özge Tuncalp
- Scientist, Department of Reproductive Health and Research, World Health Organization, Geneva
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9
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Hedqvist M, Brolin L, Tydén T, Larsson M. Women's experiences of having an early medical abortion at home. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 9:48-54. [DOI: 10.1016/j.srhc.2016.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 07/05/2016] [Accepted: 07/09/2016] [Indexed: 11/29/2022]
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10
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Li CL, Song LP, Tang SY, Zhou LJGYK, He H, Mo XT, Liao YM. Efficacy, Safety, and Acceptability of Low-Dose Mifepristone and Self-Administered Misoprostol for Ultra-Early Medical Abortion: A Randomized Controlled Trial. Reprod Sci 2016; 24:731-737. [PMID: 27678099 DOI: 10.1177/1933719116669055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the efficacy, safety, and acceptability of low-dose mifepristone combined with self-administered misoprostol for ultra-early medical abortion. A total of 744 women with ultra-early pregnancy (amenorrhea ≤35 days) who fulfilled the inclusion criteria were enrolled in the study. Equal numbers of participants were allocated randomly to the hospital administration and self-administration groups. All participants took 75 mg mifepristone at the initial visit and 400 µg oral misoprostol 24 hours later in the hospital or by self-administration. The primary end point was complete abortion. Secondary end points were rates of unscheduled reattendance, time required for and cost of hospital observation and follow-up, vaginal bleeding, adverse effects, menstrual disturbance in the posttreatment period, and satisfaction rating. No differences in the rates of complete abortion, unscheduled reattendance, vaginal bleeding, adverse effects, or return of posttreatment menstruation were observed. The time required for (and costs of) hospital observation and follow-up per participant was 557.82 minutes (and US$40.12) in the hospital administration group and 18.46 minutes (and US$1.96) in the self-administration group (both P < .001). Satisfaction rates were similar in both groups, but the rates of "very satisfied" responses (87.60% vs 25.41%) and follow-up compliance (loss to follow-up, 0.45% vs 7.70%) were higher in the self-administration group (both P < .001). Low-dose mifepristone combined with self-administered misoprostol for ultra-early pregnancy termination was as effective and safe as hospital administration, with greater acceptability and lower cost to the women.
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Affiliation(s)
- Cui-Lan Li
- 1 Key Laboratory for Reproduction and Genetics of Guangdong Higher-Education Institutes and Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital, Guangzhou Institute of Obstetrics and Gynecology, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Li-Ping Song
- 1 Key Laboratory for Reproduction and Genetics of Guangdong Higher-Education Institutes and Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital, Guangzhou Institute of Obstetrics and Gynecology, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Shi-Yan Tang
- 1 Key Laboratory for Reproduction and Genetics of Guangdong Higher-Education Institutes and Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital, Guangzhou Institute of Obstetrics and Gynecology, Guangzhou Medical University, Guangzhou, People's Republic of China
| | | | - Hong He
- 1 Key Laboratory for Reproduction and Genetics of Guangdong Higher-Education Institutes and Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital, Guangzhou Institute of Obstetrics and Gynecology, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xue-Tang Mo
- 1 Key Laboratory for Reproduction and Genetics of Guangdong Higher-Education Institutes and Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital, Guangzhou Institute of Obstetrics and Gynecology, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yi-Ming Liao
- 1 Key Laboratory for Reproduction and Genetics of Guangdong Higher-Education Institutes and Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital, Guangzhou Institute of Obstetrics and Gynecology, Guangzhou Medical University, Guangzhou, People's Republic of China
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Wainwright M, Colvin CJ, Swartz A, Leon N. Self-management of medical abortion: a qualitative evidence synthesis. REPRODUCTIVE HEALTH MATTERS 2016; 24:155-67. [PMID: 27578349 DOI: 10.1016/j.rhm.2016.06.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/25/2016] [Accepted: 06/26/2016] [Indexed: 11/28/2022] Open
Abstract
Medical abortion is a method of pregnancy termination that by its nature enables more active involvement of women in the process of managing, and sometimes even administering the medications for, their abortions. This qualitative evidence synthesis reviewed the global evidence on experiences with, preferences for, and concerns about greater self-management of medical abortion with lesser health professional involvement. We focused on qualitative research from multiple perspectives on women's experiences of self-management of first trimester medical abortion (<12weeks gestation). We included research from both legal and legally-restricted contexts whether medical abortion was accessed through formal or informal systems. A review team of four identified 36 studies meeting inclusion criteria, extracted data from these studies, and synthesized review findings. Review findings were organized under the following themes: general perceptions of self-management, preparation for self-management, logistical considerations, issues of choice and control, and meaning and experience. The synthesis highlights that the qualitative evidence base is still small, but that the available evidence points to the overall acceptability of self-administration of medical abortion. We highlight particular considerations when offering self-management options, and identify key areas for future research. Further qualitative research is needed to strengthen this important evidence base.
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Affiliation(s)
- Megan Wainwright
- Postdoctoral Research Fellow, Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa.
| | - Christopher J Colvin
- Associate Professor, Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Alison Swartz
- Lecturer, Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Natalie Leon
- Specialist Scientist, Medical Research Council, South Africa
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Wallin Lundell I, Öhman SG, Sundström Poromaa I, Högberg U, Sydsjö G, Skoog Svanberg A. How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress. EUR J CONTRACEP REPR 2015; 20:211-22. [PMID: 25666812 DOI: 10.3109/13625187.2014.1002032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives To identify perceived deficiencies in the quality of abortion care among healthy women and those with mental stress. Methods This multi-centre cohort study included six obstetrics and gynaecology departments in Sweden. Posttraumatic stress (PTSD/PTSS) was assessed using the Screen Questionnaire-Posttraumatic Stress Disorder; anxiety and depressive symptoms, using the Hospital Anxiety Depression Scale; and abortion quality perceptions, using a modified version of the Quality from the Patient's Perspective questionnaire. Pain during medical abortion was assessed in a subsample using a visual analogue scale. Results Overall, 16% of the participants assessed the abortion care as being deficient, and 22% experienced intense pain during medical abortion. Women with PTSD/PTSS more often perceived the abortion care as deficient overall and differed from healthy women in reports of deficiencies in support, respectful treatment, opportunities for privacy and rest, and availability of support from a significant person during the procedure. There was a marginally significant difference between PTSD/PTSS and the comparison group for insufficient pain alleviation. Conclusions Women with PTSD/PTSS perceived abortion care to be deficient more often than did healthy women. These women do require extra support, relatively simple efforts to provide adequate pain alleviation, support and privacy during abortion may improve abortion care.
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Affiliation(s)
- Inger Wallin Lundell
- * Department of Women's and Children's Health, Uppsala University , Uppsala , Sweden
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A prospective open-label study of home use of mifepristone for medical abortion in Nepal. Int J Gynaecol Obstet 2014; 128:220-3. [DOI: 10.1016/j.ijgo.2014.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 09/16/2014] [Accepted: 11/17/2014] [Indexed: 11/21/2022]
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14
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Makenzius M, Tydén T, Darj E, Larsson M. Autonomy and dependence - experiences of home abortion, contraception and prevention. Scand J Caring Sci 2012; 27:569-79. [DOI: 10.1111/j.1471-6712.2012.01068.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cameron ST, Glasier A, Dewart H, Johnstone A, Burnside A. Telephone follow-up and self-performed urine pregnancy testing after early medical abortion: a service evaluation. Contraception 2012; 86:67-73. [DOI: 10.1016/j.contraception.2011.11.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 11/17/2011] [Accepted: 11/19/2011] [Indexed: 10/14/2022]
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Abstract
OBJECTIVE To gain knowledge about the male partner's experience of being present during an induced home abortion. METHODS Twenty-three couples, whose male partner had been present when the woman aborted at home, were interviewed one to two weeks post-abortion. RESULTS Each of the men supported his partner in her decision to have a home abortion, as this gave him the possibility of being near and of caring for her needs on the expulsion day. All the men were present and all their partners confirmed that they had been supportive. Half the men had been anxious prior to the expulsion, but most considered that their experiences during the expulsion had been 'easier than expected' and their dominant feeling was one of relief. CONCLUSIONS Abortion is an important life event. When taking place at home, it increases the possibility for the couple to share the experience. Sharing an abortion may have a positive impact on those men who lack a sense of responsibility regarding reproductive issues, such as contraceptive use. This could facilitate society's efforts to involve men as a target group in this field. Designing an abortion policy that caters for the needs of both partners is a challenge.
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Affiliation(s)
- Anneli Kero
- Department of Social Work, Umeå University, Sweden.
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Boersma AA, Meyboom-de Jong B, Kleiverda G. Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curaçao. EUR J CONTRACEP REPR 2011; 16:61-6. [DOI: 10.3109/13625187.2011.555568] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gresh A, Maharaj P. A qualitative assessment of the acceptability and potential demand for medical abortion among university students in Durban, South Africa. EUR J CONTRACEP REPR 2011; 16:67-75. [PMID: 21261553 DOI: 10.3109/13625187.2010.546534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the acceptability of medical abortion as a method for pregnancy termination among young South African women, and further investigate the potential demand for medical abortion. METHODS Qualitative study based on in-depth interviews. The interviews were conducted with 20 sexually active, female university students in Durban, South Africa. RESULTS The findings suggest that there is a demand for medical abortion among this sample of young women. Most of them find medical abortion an acceptable method, and would choose it if they were faced with an unwanted pregnancy. Some of the positive aspects of medical abortion raised were: increased privacy; avoidance of surgery; and sense of greater control. Some of the negative aspects of medical abortion were: fear of adverse side effects; high cost; follow-up visits; and potential psychological stress. While the majority of women find this method acceptable, there were reservations and concerns about introducing it into the public sector such as misuse and abuse of the medication by clients and providers. CONCLUSION Medical abortion should be introduced into the public sector in South Africa, and this method be made affordable, accessible, and available for women.
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Affiliation(s)
- Ashley Gresh
- School of Development Studies, University of KwaZulu-Natal, Durban, South Africa.
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Cameron S, Glasier A, Dewart H, Johnstone A. Women's experiences of the final stage of early medical abortion at home: results of a pilot survey. ACTA ACUST UNITED AC 2010; 36:213-6. [PMID: 21067636 DOI: 10.1783/147118910793048719] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND METHODOLOGY Research has shown that many women choosing an early medical abortion would prefer to be at home rather than in hospital to expel the pregnancy. A service was commenced at a hospital abortion service in Edinburgh, Scotland, UK that allowed women at up to 56 days' gestation to be discharged home soon after misoprostol administration. During a 3-month period, an anonymous questionnaire of women's experiences was conducted 1-2 weeks after the procedure. RESULTS During the 3 months of the survey a total of 145 women chose to go home to abort. A total of 100 women completed questionnaires out of 145 (69%) distributed. The commonest reasons given for choosing to go home were: to get home sooner (53%) and to be in the privacy of one's own home (47%). Most (81%) of the women stated that bleeding was either "as expected" (55%) or "not as bad as expected" (26%), and 58% of the women stated that the pain was "as expected" (40%) or "not as bad as expected" (18%). The majority (84%) of the women said that they would recommend this method to a friend. DISCUSSION AND CONCLUSIONS Discharge home for the final stage of a medical abortion was highly acceptable to women. Since availability is not limited by hospital bed space, more women can be treated by medical methods.
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Affiliation(s)
- Sharon Cameron
- NHS Lothian Family Planning/Well Women's Services, Royal Infirmary of Edinburgh, UK.
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Kero A, Lalos A, Wulff M. Why shouldn't one report on women's positive feelings with regard to abortion? EUR J CONTRACEP REPR 2010; 15:150-1. [PMID: 20230341 DOI: 10.3109/13625181003706604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Verkuyl D. A contraceptive opportunity is often missed with medical abortions. EUR J CONTRACEP REPR 2010; 15:150. [DOI: 10.3109/13625181003602605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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