Abortion providers' experiences and views on self-managed medication abortion: an exploratory study.

Objective: Data on the practice of self-managed medication abortion are limited, in part because this practice takes place purposefully outside of established healthcare systems. Given this, we aimed to ascertain abortion providers' familiarity with self-managed medication abortion and associated complications, compare regional differences and evaluate provider attitudes.

Study Design: We distributed an online survey to members of Society for Family Planning, Association of Reproductive Health Providers and the Abortion Care Network between July and September 2017 querying experiences with and opinions about self-managed abortion.

Results: Of 650 respondents, 359 (55.1%) were direct abortion providers. Two hundred and thirty of 335 providers (68.6%) had experience with women trying to interrupt pregnancies on their own, and of those, 153 (76.1%) had seen use of misoprostol and/or mifepristone, and 204 of 342 (59.6%) thought this practice increased in the past 5 years. One hundred and seventeen of 335 (34.9%), witnessed complications from self-managed abortion with misoprostol/mifepristone, most commonly incomplete abortion and less often hemorrhage, sepsis and uterine rupture. Half of providers, 171 of 321 (53.3%), think that the use of misoprostol/mifepristone for the self-management of abortion is safe.

Conclusion: Two thirds of respondents had experiences with women attempting to self-manage abortion, and about a third witnessed complications related to self-managed medication abortion. About half of respondents agreed that self-managed abortion is safe.

Implications: This study establishes that self-managed abortion is a practice which a majority of respondents have seen among their patients and, because of its prevalence, an area that warrants further research.