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. 2023 Oct;49(4):300-307.
doi: 10.1136/bmjsrh-2022-201722. Epub 2023 Mar 9.

A prospective, comparative study of clinical outcomes following clinic-based versus self-use of medical abortion

Nathalie Kapp  1 , Bunsoth Mao  2 , Jamie Menzel  3 , Elisabeth Eckersberger  3 , Vonthanak Saphonn  2 , Tung Rathavy  4 , Erin Pearson  3
Affiliations

A prospective, comparative study of clinical outcomes following clinic-based versus self-use of medical abortion

Nathalie Kapp et al. BMJ Sex Reprod Health. 2023 Oct.

Abstract

Background: To determine whether clinical outcomes differ among women accessing a combined medical abortion regimen from a health clinic when compared with those accessing it from a pharmacy.

Methods: We conducted a multicentre, prospective, comparative, non-inferiority study of participants aged ≥15 years seeking medical abortion from five clinics and five adjacent pharmacy clusters in three provinces of Cambodia. Participants were recruited in-person at the point of purchase (clinic or pharmacy). Follow-up for self-reported pill use, acceptability, and clinical outcomes occurred by telephone at days 10 and 30 after mifepristone administration.

Results: Over 10 months, we enrolled 2083 women with 1847 providing outcome data: 937 from clinics and 910 from pharmacies. Most were early in their pregnancy (mean gestational age of 6.3 and 6.1 weeks, respectively) and almost all took the pills correctly (98% and 96%,). Additional treatment needed to complete the abortion was non-inferior for the pharmacy group (9.3%) compared with the clinic group (12.7%). More from the clinic group received additional care from a provider, such as antibiotics or diagnostics tests, than those from the pharmacy group (11.5% and 3.2%,), and one ectopic pregnancy (pharmacy group) was successfully treated. Most said they felt prepared for what happened after taking the pills (90.9% and 81.3%, respectively, p=0.273).

Conclusions: Self-use of a combined medical abortion product resulted in comparable clinical outcomes as use following a clinical visit, consistent with existing literature on its safety and efficacy. Registration and availability of medical abortion as an over-the-counter product would likely increase women's access to safe abortion.

Keywords: Abortion, Incomplete; Abortion, Therapeutic; Health Policy; Pharmaceutical Services; Reproductive Health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow of participants through the study. MA, medical abortion.
See this image and copyright information in PMC

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