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Abstract
Objectives Time is a crucial factor in abortion-seeking because options for care change with pregnancy duration, and most people prefer to access abortion care early in pregnancy. We aimed to collect data on the timing of steps in accompanied self-managed abortion-seeking experiences in legally restrictive settings.
Methods In this prospective, observational, cohort study we recruited callers from three abortion accompaniment groups in Argentina, Nigeria and a country in Southeast Asia. Participants completed a baseline survey before starting a self-managed medication abortion (SMA) and two follow-up surveys (approximately 1 and 3 weeks after taking medication). Primary outcomes of interest included: (1) time from abortion decision to contacting the hotline, (2) time from contacting the hotline to obtaining pills and (3) time from obtaining pills to taking the first dose. We explored relationships between participant characteristics and each of these outcomes and evaluated differences in overall abortion time using survival analyses.
Results Between July 31, 2019 and October 01, 2020 we enrolled 1352 eligible callers; 1148 provided data for this analysis. After deciding to have an abortion, participants took 12.2 days on average (95% CI: 11.6, 12.9) to start medications for abortion. On average, participants at later pregnancy durations progressed through the SMA process more quickly (<4 weeks: 20.9 days, 4 weeks: 11 days, 5–6 weeks: 10.1 days, 7–9 weeks, 10.4 days, 10+ weeks: 9.1 days; p<0.001).
Conclusions Overall, participants accessed accompaniment group support and started abortion regimens quickly and at relatively early pregnancy durations. SMA with accompaniment provided a time-efficient route for obtaining abortions.
- abortion
- abortion, induced
- epidemiology
- Reproductive Health
- surveys and questionnaires
Data availability statement
Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Study protocol, analysis plan, and instruments are available to the scientific community online (https://bmjopen.bmj.com/content/10/11/e036800). All data requests should be submitted to the Chair of the Data Monitoring and Oversight Committee via email (dzuba@gynuity.org) for consideration. Access to the anonymised data might be granted following review and approval of an investigator-initiated concept note by the Data Monitoring and Oversight Committee, and after the investigator signs a data access agreement.
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Data availability statement
Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Study protocol, analysis plan, and instruments are available to the scientific community online (https://bmjopen.bmj.com/content/10/11/e036800). All data requests should be submitted to the Chair of the Data Monitoring and Oversight Committee via email (dzuba@gynuity.org) for consideration. Access to the anonymised data might be granted following review and approval of an investigator-initiated concept note by the Data Monitoring and Oversight Committee, and after the investigator signs a data access agreement.
Footnotes
Contributors BG, CG, HM, IAK, IE, RTJ, RM, RZ and SN contributed to the quantitative study conceptualisation and design, BG, IAK, IE, CB, HM, RTJ and RM managed data collection and quality, and EAP conducted the quantitative analyses. EAP led the writing of the manuscript, with contributions, review and approval from all authors. All authors read and approved the final manuscript. All authors had access to all the data in the study, and three authors (EAP, HM, RTJ) have accessed and verified the data. EAP, HM and RTJ were responsible for the decision to submit the manuscript. HM acts as the guarantor for this work. All authors accept responsibility for the article as published.
Funding The David and Lucile Packard Foundation funded this research via three grants (Grant Nos: 2018-67537, 2019-69266, 2020-70952) to HM. HM is also supported by a National Institute of Health grant (1R21CA256759-01). The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
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