In This Issue:

Self-Induced Abortion in the US

New Resource: Medication Abortion Brief Series

Ellerton Fellowship

Ibis on Twitter!

Board Updates

Staff Updates

Dear Friend,

We are very pleased to highlight in this newsletter recently published results from a study we conducted with Gynuity Health Projects and collaborators in four states that aimed to document women's experiences attempting self-induced abortion in the US. The issue of self-induction of abortion has been sensationalized in the media, but a number of high-profile legal cases have highlighted that at least some women might opt to self-induce. Our research shows that in many cases this is a result of barriers to access to abortion services or a preference for self-care, and highlights the need for information about services and funding, particularly for young women and women who can’t afford them, as well as the need for expanded access to medication abortion for women who prefer a more private, natural, or less invasive experience. The article recently published in Reproductive Health Matters presents results from one piece of a larger mixed-methods study; we will be sharing more results from this study in the near future.

I am also delighted to share our recently released medication abortion brief series, which we hope will be a useful resource for our colleagues. These three briefs summarize our research and educational efforts related to medication abortion in a variety of contexts and regions.

In this newsletter we also share some of the impressive accomplishments of the most recent (2008-2010) Ellertson Fellowship cohort, and invite you to join us on Twitter!

Many thanks for your continued support and interest in our work.

Sincerely,

Kelly Blanchard, President

Self-Induced Abortion among Women in the United States

A recent qualitative study conducted by Ibis and Gynuity Health Projects in collaboration with Boston Medical Center, Montefiore Medical Center, Soundview Health Center, University of California, San Francisco, and Whole Women’s Health, and published in Reproductive Health Matters explores US women’s experiences with attempting abortion self-induction. We surveyed 1,425 women in waiting rooms of primary care and Ob/Gyn clinics serving low-income, predominantly Hispanic/Latina populations in Boston, New York City, San Francisco, and a city in Texas to identify women who had tried to induce their own abortions. We targeted low-income and Hispanic/Latina women due to previous clinical and media reports of abortion self-induction in these populations. Of the 30 women with prior self-induction attempts we interviewed, all but five were living in the US when they attempted to self-induce their abortions.

The methods women in our study used to self-induce abortion were often easily accessible and ineffective and included medications, malta beverage, herbs, and physical manipulation. The only reported method with demonstrated effectiveness was misoprostol, reported by seven women (four in Texas and one in each of the other study cities), although the regimen women used was generally ineffective. Only three women reported a successful termination of a confirmed pregnancy not requiring clinical care. In over half of the cases with confirmed pregnancies, the women in our study eventually accessed clinic-based abortion services, while in seven they continued with their pregnancy (and, as mentioned above, three reported successful terminations after self-induction). Only one woman who self-induced in the US reported medical complications.

In our clinic survey, 4.5% of the women who had ever been pregnant reported attempting self-induction at some point in the past. In another recent national study of US abortion patients, 1.2% reported having ever used misoprostol and 1.4% reported having used other methods to try to induce an abortion (Jones 2010). Neither study was designed to measure overall prevalence of self-induced abortion among women in the US, though both suggest that, contrary to a number of media reports that have sensationalized self-induced abortion as a growing phenomenon in the US, self-induction is actually quite rare.

Real and perceived barriers to accessing clinical services, a desire to avoid abortion clinics, and a preference for self-induction were factors that contributed to women’s decisions to attempt to induce their own abortions. Many of the women we interviewed were teenagers at the time they tried to induce their abortions (median age was 19 years at time of attempt) and did not want to tell their parents they were pregnant. Many of those who were teens at the time thought (correctly in Massachusetts which has a parental involvement law and incorrectly in the other states that do not) that they needed parental consent to obtain an abortion, and some did not know how to locate an abortion clinic.

Financial barriers also prevented some women from seeking clinical services. Women often mentioned the high cost of clinic-based abortions as one disadvantage of clinic-based abortions as compared to self-induced abortions. With the exception of Texas, we fielded this study in states where the Medicaid program should cover abortion in most cases for low-income women who qualify, yet women were often unaware of the financial assistance they might have been eligible to receive.

In addition, a preference for self-induction was expressed by women who wanted to avoid clinics or felt that self-induction was easier or faster than going to a clinic, who desired the privacy of their homes and preferred a less medicalized procedure, or who felt self-induction was more “natural” and akin to “bringing down one’s period” rather than an actual abortion.

In light of the real and perceived barriers to accessing clinic abortion services reported in our study, more effort is needed to inform women about federal and state abortion policies, funding sources, and the availability of clinical services in the US, and to roll back existing and new funding restrictions on abortion and ensure that women can access Medicaid funding for abortion where it is available. It is also important to expand access to medication abortion and inform women about its availability given that some women chose self-induction for many of the same reasons that women choose medication abortion over a surgical procedure: because it is a more natural, private, or less invasive experience (Winikoff et al. 1998; Teal et al. 2009). Many women in our study referred to a clinic-based abortion as a surgical procedure and did not know about the option of a clinic-based medication abortion, which can be provided in a range of health settings and by a range of health providers, and may be an acceptable alternative for women considering self-induced abortion.

References:

Grossman D, Holt K, Peña M, Lara D, Veatch M, Córdova D, Gold M, Winikoff B, Blanchard K. Self-induction of abortion among women in the United States. Reproductive Health Matters 2010;18(36):136–146.Click here to request.

Jones RK. How commonly do US abortion patients report attempts to self-induce? American Journal of Obstetrics & Gynecology 2010.

Teal SB, Harken T, Jeanelle S, et al. Efficacy, acceptability and safety of medication abortion in low-income, urban Latina women. Contraception 2009;80:479-83. Click here for the abstract.

Winikoff B, Ellertson C, Elul B, et al. Acceptability and feasibility of early pregnancy termination by mifepristone-misoprostol. Results of a large multicenter trial in the United States. Mifepristone Clinical Trials Group. Archives of Family Medicine 1998;7(4):360-66. Click here to request.

New Resource: Medication Abortion Brief Series

We are thrilled to share a new collection of resources on medication abortion. Ibis aims to improve access to medication abortion for women around the world by conducting policy- and service delivery-relevant clinical and social science research. We test ways to make protocols and regimens--including both mifepristone and misoprostol and misoprostol-alone options--more user friendly; explore ways to improve access to medication abortion services and service delivery; and examine global policy related to medication abortion. Drawing from a large collection of completed research on medication abortion from a variety of contexts and regions, Ibis developed three briefs: Making protocols and regimens more user friendly, Strategies for improving service delivery and access to services, and Education and training. Download and share these materials!

Ellerston Fellowship

From 2003-2010, Ibis coordinated the Charlotte Ellertson Social Science Postdoctoral Fellowship in Abortion and Reproductive Health. Three cohorts of fellows at five institutions were supported to study abortion and reproductive health, and produce and share research that informs policy and program design. The fellows who participated in the third cohort of the Ellertson Fellowship from 2008-2010 were remarkably productive: publishing in peer-reviewed journals, collaborating across sites on interdisciplinary research related to abortion and stigma, presenting in academic, advocacy, and policy venues, and expanding their professional networks. Here we highlight the focus of each fellow's work during their fellowship:

• Dr. Davida Becker (Bixby Center for Reproductive Health Research and Policy at UCSF) Becker conducted research on women’s perceptions of legal abortion services in Mexico City, completing surveys with 402 women and in-depth interviews with 30 women seeking abortion care at three public sector sites in Mexico City.
• Dr. Danielle Bessett (Ibis Reproductive Health) Bessett was the lead author of a report on young adults’ access to contraception in the wake of Massachusetts health reform, a report resulting from a larger Ibis research project for the REaDY Initiative, a state-wide coalition of health service providers, advocates, and researchers collaborating to reduce unplanned pregnancy among young adults. She also worked on her book manuscript entitled Pregnant with Possibility as well as a project examining the relationship between reproductive histories and women’s experiences of subsequent pregnancy and birth care.
• Dr. Silvia De Zordo (Mailman School of Public Health at Columbia University) De Zordo’s research focused on the attitudes and experiences with legal and illegal abortions among health professionals working in two maternity hospitals in Salvador, Brazil. She presented this research at a number of academic venues and in Brazil, including at the hospitals where the research was carried out.
• Dr. Megan Kavanaugh (Guttmacher Institute) Kavanaugh studied the stigma around both motherhood and abortion in the context of HIV status in Nigeria and Zambia as part of a Guttmacher-led project, Achieving Fertility Desires in the Era of HIV. She also conducted research documenting post-abortion contraceptive services in the US.
• Dr. Alison Norris (Bloomberg School of Public Health at Johns Hopkins University) Norris’s multi-method study explored unwanted pregnancy, abortion, and contraceptive use in Zanzibar and involved focus group discussions with women as well as in-depth interviews with woman who have had abortions.
• Dr. Julia Steinberg (Bixby Center for Reproductive Health Research and Policy at UCSF) Steinberg examined the methodological shortcomings in research that attempts to address the mental health sequel of abortion and the importance of considering antecedents, including previous mental health, violence, and substance use. She also is working to document the importance of mental health status on contraceptive decision-making.

Photo: Fellows at NAF 2010

Ibis on Twitter!

Ibis is very excited to share that we recently joined Twitter and we have enjoyed participating in the great reproductive health conversations going on there. Check us out at @IbisRH.

Board Updates

We are happy to introduce three new members of our Board of Directors. Ayo Ajayi, Lisa Kallenbach, and John Santelli began their terms at our most recent board meeting. These new members bring a wealth of experience and diverse perspectives to our board. We are honored to have them work with us at Ibis.

We took the opportunity of the recent board meeting to recognize the significant contributions of founding board members, Chris Elias and Frances Kissling; this was their last meeting. Both were instrumental in supporting Ibis’s growth over the last eight years, and we thank them heartily for their board service.

Staff Updates

Ibis is delighted to have added Lineo Mohultasi, Ruth Manski, and Ilundi Durao de Menezes to our staff. Lineo joined the Johannesburg office in July as the Office Manager, bringing experience from the Elizabeth Glaser Pediatric Aids Foundation in Lesotho. Ruth began as a Research Assistant in the Cambridge office in September, after completing a Fulbright Research Fellowship in Sri Lanka, where she conducted in-depth interviews and surveys with women about female kitchen culture and cooking practices. Ilundi joined the Johannesburg office in November as a Research Assistant, after completing an Honours thesis on the impact of remittances on household food security in Maputo, Mozambique, for her degree in Development Studies from the University of Cape Town. Please join us in welcoming Lineo, Ruth, and Ilundi to Ibis!

We also want to send warm wishes to several staff members who have recently departed Ibis. Laaiqah Gani, Office Manager; Danielle Bessett, Fellow; Ulla Larsen, Fellowship Director; and Jessica Stone, Development and Communications Assistant/Office Manager. They all made important contributions to Ibis’s work and will be dearly missed.