New research shows abortions with support of non-medically trained counselors could offer safe alternative for women in legally-restrictive contexts

July 2018

A new study published by Ibis  in BMJ Sexual & Reproductive Health shows that a safe-abortion hotline staffed by trained abortion counselors can help women who are more than 12 weeks pregnant to safely self-manage medication abortion. Results suggest that this model has the potential to be as effective as providing medication abortion in a clinic and could provide a safe option for women who need an abortion after 12 weeks in restrictive legal settings.

“Even in places where abortion is legal, structural and institutional barriers can delay women from accessing abortion care. These barriers are even greater in contexts where abortion is legally restricted,” said Caitlin Gerdts, PhD, vice president for research at Ibis and lead author of the study. “Research has shown that young women, poor women, unmarried women, and women who live farther from abortion providers are more likely to require abortion care after 12 weeks—and in contexts where abortion is legally restricted, the majority of abortion-related deaths occur among women seeking abortion after 12 weeks. This study documents a promising alternative for safely terminating a pregnancy outside of a clinical setting for women in their second trimester who cannot access safe, legal abortion.”

The study analyzed electronic service records from women calling a safe-abortion hotline in Indonesia during the second trimester of pregnancy. Callers received evidence-based information on medication abortion from skilled counselors who were trained in medication abortion procedures and counseling but did not have medical training.

  • Ninety-one women who called the hotline with pregnancies beyond 12 weeks gestation received support by phone throughout their self-managed medication abortion process.
  • Eighty-three women (91%) successfully terminated their pregnancies without additional medical intervention.
  • Five women sought medical care after experiencing symptoms that could signal potential complications, and one woman sought medical care after a failed medication abortion attempt. Records for two callers did not contain outcome data and they were considered lost to follow-up.

Evidence has shown that restricting access to legal abortion care does not make abortions less common, but it does lead to more unsafe abortions and increases risks to the health and lives of women and their families. Given the need for abortion throughout the duration of a woman’s pregnancy regardless of local laws, safe-abortion hotlines can provide women with essential, evidence-based information on how to self-manage medication abortions at any point in their pregnancy. This is the first quantitative study to document a model of supporting women to self-manage abortions beyond 12 weeks gestation.

The hotline counselors provide callers with the most current, evidence-based guidelines for using medications to terminate pregnancies after 12 weeks, which includes instructions on self-management using the combination regimen with mifepristone and misoprostol, or misoprostol-only regimens.