The literature on self-managed abortion at later gestations is sparse, and more information
is urgently needed in the US and elsewhere where this practice may become increasingly
common. This analysis offers novel results on the effectiveness of self-managed medication
abortion among people with pregnancies >9 weeks.
In 2019–2020, as a part of The Studying Accompaniment Model Feasibility and Effectiveness
(SAFE) Study, we recruited callers to safe-abortion hotlines in Argentina, Nigeria,
and Southeast Asia who were seeking support for self-managed medication abortion.
Via phone, participants completed a baseline survey prior to taking the medications,
and up to three follow-up surveys over four weeks to ascertain abortion outcomes.
We recruited 1,351 participants, of which 264 self-managed an abortion for a pregnancy
that was 9–22 weeks’ gestation; 149 (56%) respondents used mifepristone and misoprostol,
while 115 (44%) used misoprostol alone. One week after taking the pills, 222 (91%)
participants had a complete abortion — 87% with pills alone, and 4% with additional
intervention. At last follow-up, 95% of participants had had a complete abortion (89%
with pills alone, 5% with additional intervention; 93% of combined regimen users,
and 97% of misoprostol-alone users). A minority of participants sought healthcare
at a clinic or hospital at any point (30% of combined regimen users, 15% of misoprostol-alone
users). Among those seeking care, most (60%) did so to confirm abortion completion,
and a small minority (1.5%) received treatment indicative of a serious complication
Self-managed medication abortion can be a safe and effective option for ending a pregnancy
at 9+ weeks’ gestation.