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Second-trimester medication abortion outside the clinic setting: an analysis of electronic client records from a safe abortion hotline in Indonesia
  1. Caitlin Gerdts1,
  2. Ruvani T Jayaweera1,
  3. Sarah E Baum1,
  4. Inna Hudaya2
  1. 1 Ibis Reproductive Health, Oakland, California, USA
  2. 2 The Institute for the Study of Human Rights, Columbia University, New York City, New York, USA
  1. Correspondence to Dr Caitlin Gerdts, Ibis Reproductive Health, Oakland, CA 94612, USA; cgerdts{at}ibisreproductivehealth.org

Abstract

Introduction Unsafe abortion past the first trimester disproportionately accounts for the majority of global abortion-related morbidity and mortality; research that documents the safety, feasibility and acceptability of existing models for providing information and support to women who self-manage outside of formal clinic settings is needed.

Methods This study is a retrospective analysis of anonymised electronic client records from callers to a safe abortion hotline in Indonesia. Between July 2012 and October 2016, a total of 96 women contacted the hotline for information on medication abortion beyond 12 weeks' gestation and are included in this study. Descriptive statistics were calculated regarding pregnancy termination status, client experience with warning signs of potential complications, and medical care seeking and treatment.

Results Ninety-six women with pregnancies beyond the first trimester called the hotline for information on medication abortion; 91 women received counselling support from the hotline. Eighty-three women (91.2%) successfully terminated their pregnancies using medication and did not seek medical care. Five women exhibited warning signs of potential complications and sought medical care; one woman sought care after a failed abortion. Two women were lost to follow-up and the outcomes of their pregnancies are unknown.

Conclusions Evidence from our analysis suggests that a model of remote provision of support for abortions later in pregnancy by non-medically trained, skilled abortion counsellors could be a safe alternative for women in need of abortions beyond 12 weeks' gestation in a legally restrictive context. Further examination and documentation of the model is warranted.

  • safe abortion
  • self-managed abortion
  • self-induced abortion
  • accompaniment
  • safe abortion hotlines
  • second-trimester abortions
  • medication abortion

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors CG and IH originated the study question. RTJ conducted the analysis. CG and RTJ wrote the original draft of the manuscript. CG, RTJ, SB and IH all contributed in reviewing and editing the manuscript. All authors read and approved the final manuscript.

  • Funding This work was supported in part by the David and Lucile Packard Foundation. The funders were not involved in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval for this study was obtained from Allendale Investigational Review Board. As the data were collected in the process of routine service provision, and the authors only had access to data that were completely anonymised, informed consent was not collected from callers to the safe abortion hotline.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request; please contact rjayaweera@ibisreproductivehealth.org.

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