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Foregrounding pain in self-managed early medication abortion: a qualitative study
  1. Carrie Purcell1,
  2. Victoria Louise Newton2,
  3. Fiona Bloomer3,
  4. Lesley Hoggart2
  1. 1Faculty of Wellbeing, Education and Language Studies, The Open University in Scotland, Edinburgh, UK
  2. 2Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
  3. 3School of Applied Social and Policy Sciences, Ulster University, Belfast, UK
  1. Correspondence to Dr Carrie Purcell; carrie.purcell{at}open.ac.uk

Abstract

Objective To explore experiences of pain in the context of early medical abortion (EMA) in the UK and to guide best practice around anticipatory guidance on pain.

Methods From late 2020 to early 2021, we recruited individuals from across the UK who had undergone abortion during the COVID-19 pandemic to participate in in-depth, semi-structured telephone interviews. A storytelling approach was used and data were analysed thematically using NVivo 12 software.

Results Focused coding and thematic analysis addressed accounts of pain, which were prominent in many interviews. We constructed the following subthemes: expected pain is manageable for some; the problem with unexpected pain; pain (co)produces fear; and problematising ‘period-like pain’. The key issue which our analysis draws out is that while EMA pain experience might vary, for some it may be much worse than anticipated. Moreover, the common trope of likening it to ‘period pain’ can be misleading and a source of additional uncertainty at a potentially already challenging time.

Conclusions For some individuals, pain experienced in EMA will be severe and/or worse than expected. Insufficient preparation for pain can result in extremely negative experiences of EMA. Alongside development of improved analgesia, improvements should be made to anticipatory guidance on pain, particularly for those self-manging EMA at home. Framings of ‘period-like pain’ do not clarify expectations and should be avoided.

  • abortion, induced
  • Mifepristone
  • Patient Satisfaction
  • qualitative research
  • Reproductive Health Services
  • Reproductive Rights

Data availability statement

Data are available upon reasonable request. Data are available upon request from the study PI by emailing victoria.newton@open.ac.uk or via DOI:10.21954/ou.rd.25292800

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Data availability statement

Data are available upon reasonable request. Data are available upon request from the study PI by emailing victoria.newton@open.ac.uk or via DOI:10.21954/ou.rd.25292800

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Footnotes

  • X @DrCarrieP, @drhoggart

  • Contributors LH and VLN devised the original study, in collaboration with CP and FB. LH, CP and FB conducted interviews. CP led the analysis presented here, in consultation with VLN, LH and FB. All authors contributed to the drafting of this article and approved the final version. CP is the guarantor of the article content overall.

  • Funding This research on which this article was based was co-funded by the Open University (no grant number) and the Wellcome Trust (grant number 207878/Z/17/Z).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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