Self-Managing Some Abortion Care Later In Pregnancy Is Safe, Effective And Boosts Access, Researchers Say

Topline

Managing the early stages of medication abortion care at home later in pregnancy is safe and cuts down time spent in hospital, according to new research published on Thursday, which researchers say could boost access to the procedure as reproductive rights stand out as a key issue in the 2024 election.

Key Facts

Almost all abortions in the United States are performed at or before 13 weeks of pregnancy—the first trimester—according to the Centers for Disease Control and Prevention, and clinical guidelines typically recommend the procedure be performed exclusively in clinical settings after the 12-week mark so patients can remain under observation.

Medication abortions involve taking two types of pills to end pregnancy—mifepristone, which blocks a hormone needed for pregnancy to continue, and misoprostol, which makes the womb contract—and for abortions after 12 weeks patients are usually given mifepristone in a clinic and return to a day or two later to receive misoprostol until the procedure is complete, a process that frequently requires an overnight stay in hospital.

Based on a randomized control trial of 435 women having a medical abortion between 12 and 22 weeks published in the Lancet medical journal, researchers from universities and hospitals in Sweden found medical abortions conducted after 12 weeks of pregnancy were as safe and as effective when misoprostol was started at home instead of in hospital and that women managing the early stages of care at home spent less time in hospital.

Of the pregnant people starting misoprostol at home and returning to clinics to receive further doses—several are usually required to complete the procedure—71% spent fewer than nine hours in hospital, compared to 46% of those in the hospital treatment group, the peer reviewed study showed.

There were no differences in the pain reported by patients in either group, the type and number of side effects or rates of hospital admission earlier than what was planned, the researchers said, adding that a follow up survey revealed 78% of the home group said they preferred their allocated treatment option compared to just 49% of the hospital group.

One of the study’s authors Johanna Rydelius, a gynecologist at Sahlgrenska University Hospital and researcher at the University of Gothenburg, said the findings offer a safe alternative to a practice that often requires overnight stays many women “find stressful and isolating” and could potentially lead to more “feelings of autonomy during a time where women can feel extremely vulnerable.”

Crucial Quote

“Increasing access to abortion later in pregnancy is a crucial component of the struggle for reproductive autonomy,” said Heidi Moseson and Caitlin Gerdts, researchers at Ibis Reproductive Health, a U.S. non-profit reproductive health research organization, in a linked comment piece published alongside the study in the Lancet. Given the “overwhelming preference for at-home” misoprostol administration among the pregnant people involved in the study, Moseson and Gerdts, who were not involved in the research, said reforming guidance and “moving towards a less clinically supervised model of medical abortion care later in pregnancy is an important first step” for improving access.

Why Do Current Guidelines Recommend Facility-Based Medication Abortions After 12 Weeks?

This is because of the greater risk of complications the procedure carries in later stages of pregnancy that may require additional care. This could include pain, bleeding, infection or an incomplete abortion (material remaining). But despite “profound” implications for access, the requirement to administer medications in clinical settings is “driven primarily by the absence of data on alternative models of care,” Moseson and Gerdts explained. This system “limits the number and type of facilities that can offer abortion care after 12 weeks,” they added, pointing to limited bed spaces and staffing requirements needed to keep people overnight.

Key Background

Since the Supreme Court overturned Roe v. Wade in 2022, many states across the U.S. have harshly restricted access to abortion. The procedure is now banned from conception in 14 states and from six weeks—a time many people are not even aware they are pregnant—in four states, with the future of abortion uncertain in a handful of other states due to legal challenges. While exceptions are made under limited circumstances in states banning abortion, these vary by state and clinicians and health experts have complained the vague or inconsistent language setting out exceptions are out of touch with medical reality and unworkable in practice. This fits within broader efforts to roll back reproductive care even further, such as Republican attempts to restrict access to mifepristone. The matter has polarized the country and both Democrats and Republicans have seized upon reproductive healthcare as a major dividing issue for the upcoming presidential election.

Big Number

625,978. That’s how many legal induced abortions there were in the U.S. in 2021, according to the CDC, excluding California, Maryland, New Hampshire and New Jersey, which did not submit data to the agency. Almost all of these, 93.5%, happened at or before 13 weeks.