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. 2023 Apr 3;6(4):e238701.
doi: 10.1001/jamanetworkopen.2023.8701.

Factors Associated With Knowledge and Experience of Self-managed Abortion Among Patients Seeking Care at 49 US Abortion Clinics

Abigail R A Aiken  1 , Luisa Alejandra Tello-Pérez  1   2 , Melissa Madera  1 , Jennifer E Starling  3 , Dana M Johnson  1 , Kathleen Broussard  4 , Elisa Padron  5 , Carol Armelle Ze-Noah  6 , Aleta Baldwin  7 , James G Scott  8   9
Affiliations

Factors Associated With Knowledge and Experience of Self-managed Abortion Among Patients Seeking Care at 49 US Abortion Clinics

Abigail R A Aiken et al. JAMA Netw Open. .

Abstract

Importance: Patients attending US abortion clinics may consider or try self-managing their abortion before coming to the clinic, yet little is known about the factors associated with self-management behavior.

Objective: To examine the prevalence and factors associated with considering or attempting a self-managed abortion before attending a clinic.

Design, setting, and participants: This survey study included patients obtaining an abortion at 49 independent, Planned Parenthood, and academic-affiliated clinics chosen to maximize diversity in geographic, state policy, and demographic context in 29 states between December 2018 and May 2020. Data were analyzed from December 2020 to July 2021.

Exposures: Obtaining an abortion at a clinic.

Main outcomes and measures: Knowledge of medications used to self-manage an abortion, having considered medication self-management before attending the clinic, having considered any method of self-management before attending the clinic, and having tried any method of self-management before attending the clinic.

Results: The study included 19 830 patients, of which 99.6.% (17 823 patients) identified as female; 60.9% (11 834 patients) were aged 20 to 29 years; 29.6% (5824 patients) identified as Black, 19.3% (3799 patients) as Hispanic, and 36.0% (7095 patients) as non-Hispanic White; 44.1% (8252 patients) received social services; and 78.3% (15 197 patients) were 10 weeks pregnant or less. Approximately 1 in 3 (34%) knew about self-managed medication abortion, and among this subsample of 6750 patients, 1 in 6 (1079 patients [16.1%]) had considered using medications to self-manage before attending the clinic. Among the full sample, 1 in 8 (11.7%) considered self-managing using any method before clinic attendance, and among this subsample of 2328 patients, almost 1 in 3 (670 patients [28.8%]) attempted to do so. Preference for at-home abortion care was associated with considering medication self-management (odds ratio [OR], 3.52; 95% CI, 2.94-4.21), considering any method of self-management (OR, 2.80; 95% CI, 2.50-3.13), and attempting any method of self-management (OR, 1.37; 95% CI, 1.10-1.69). Experiencing clinic access barriers was also associated with considering medication self-management (OR, 1.98; 95% CI, 1.69-2.32) and considering any method of self-management (OR, 2.09; 95% CI, 1.89-2.32).

Conclusions and relevance: In this survey study, considering self-managed abortion was common before accessing in-clinic care, particularly among those on the margins of access or with a preference for at-home care. These findings suggest a need for expanded access to telemedicine and other decentralized abortion care models.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Aiken reported receiving grants from the Society of Family Planning, the National Institutes of Health and Child Development, and Kopcho Reproductive Justice Fund during the conduct of the study. Dr Madera reported receiving grants from Society of Family Planning, Kopcho Reproductive Justice Fund, and the National Institutes of Health during the conduct of the study; and reported being a paid consultant at Plan C outside the submitted work. Dr Johnson reported being affiliated with Ibis Reproductive Health (Senior Associate Research Scientist, part-time). No other disclosures were reported.

Figures

Figure.
Figure.. Reasons Why Respondents Considered Self-managed Medication Abortion Before Attending the Clinic
Percentages do not sum to 100 because respondents could select more than 1 reason.
See this image and copyright information in PMC

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References

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