Accompaniment and hotline support for self-managed abortion in Indonesia

In Indonesia, legal provision of induced abortion is permitted only when a woman’s life is at risk or as the result of rape. The restricted legal status of abortion, combined with powerful social and political stigma around the topic, has made abortion difficult to study in Indonesia. In settings where abortion is legally restricted or inaccessible, people are increasingly using misoprostol alone or in combination with mifepristone to terminate their pregnancies outside the formal health care system. Samsara is a non-profit organization in Indonesia that provides essential information on how to safely use medications to have a self-managed abortion.

Over the past six years, researchers at Ibis have partnered with Samsara to collaboratively design and implement research studies to better understand the informational needs of callers to Samsara’s safe abortion hotline. We have also documented the effectiveness, safety, and overall experience of self-managed abortion with hotline support. Findings from our research demonstrate the role of safe abortion hotlines in providing high-quality abortion care via remote provision of support for self-managed abortions by non-medically trained, skilled abortion counsellors. Additionally, our research has documented the role of hotline support for self-management as a safe and effective alternative for women in need of abortions beyond 12 weeks gestation. Along with observational studies, in 2017, we conducted the first-ever randomized controlled trial with a safe abortion hotline to investigate the impact of a smartphone application (app) providing information and support for medication abortion (MA) on Samsara hotline clients. This research, along with the formative process for developing the app, has been instrumental in informing our current portfolio of app-related work.

Building on lessons learned from our rich research partnership with Samsara, we collaboratively designed and implemented a prospective observational study to document the effectiveness and safety of self-managed medication abortion with hotline and accompaniment group support in Indonesia and beyond. Participants were recruited from callers to the Samsara hotline, along with clients and callers to safe abortion hotlines and accompaniment groups in Nigeria and Argentina. You can learn more about this current study here.