Re-conceptualizing how medication abortion complications are measured

Medication abortion is the most widely used method of abortion worldwide. While ample clinical evidence shows us that medication abortion is exceedingly safe, there is no standardized framework for measuring complications or outcomes from medication abortion based on self-report. Accurate estimates of the rate and severity of abortion complications are key to evaluating innovative out-of-clinic models of abortion provision, such as safe abortion hotlines, medication abortion access at pharmacies, and telemedicine models. However, given the nuances of individual language and perception, classifying complications and understanding safety through self-report is challenging—and the lack of a standardized framework and definition of abortion complications for out-of-clinic or telemedicine models makes it difficult to systematically differentiate self-reported symptoms from complications.

In light of these measurement challenges, we sought to develop a framework for quantitatively measuring and classifying outcomes from medication abortion via self-report. We conducted in-depth interviews with 68 medication abortion users recruited from private non-profit clinics, feminist accompaniment groups, and safe abortion hotlines in Argentina, Indonesia, Mexico, Nepal, Nigeria, and Sierra Leone, and found that individuals describe and quantify their experiences with bleeding and cramping in varied ways. Our findings highlight the potential discrepancies between people’s language and perceptions of their abortion experience with clinical signs and criteria, as well as the need for a person-centered framework that emphasizes each person’s unique preferences around medical care seeking. Additionally, we found the need for reframing medical treatment as a positive outcome (if the person receives the treatment they wanted in a timely manner), rather than considering it as an indicator of a “complication.”

We propose a new framework that reserves the use of the term “complication” for moderate or severe unanticipated problems that arise following a treatment, procedure, or condition, and shifts our focus on measuring outcomes from medication abortion to measuring other dimensions of quality that center the needs and desired experiences of medication abortion users.