Studying Accompaniment model Feasibility & Effectiveness (SAFE) Study

Governments and professional bodies around the world have enacted a multitude of restrictions on the use of medication abortion (MA) outside of clinical settings. Yet, with increasing barriers to clinical abortion care worldwide and widespread access to abortifacient medications, the majority of MA is thought to be self-managed without clinical support.

Given this shift to self-managed MA—meaning use outside clinical settings—researchers at Ibis, in close collaboration with partners at Generation Initiative for Women and Youth, Colectiva Feminista La Revuelta, and Samsara, co-designed the Studying Accompaniment model Feasibility & Effectiveness (SAFE) Study. The SAFE study aimed to evaluate the safety and effectiveness of self-managed MA with the support of accompaniment groups in Argentina, Southeast Asia, and Nigeria. Accompaniment groups and safe abortion hotlines connect people self-managing an abortion to trained, volunteer abortion counsellors—most of whom do not have clinical training—who provide evidence-based counseling and person-centered support over the phone or in-person throughout the self-managed abortion.

Results from the full study of more than 1,000 accompaniment group callers indicate that people can effectively self-manage their abortion with medication, and that people are able to access health care during or after the abortion as needed. Importantly, an analysis of SAFE study data published in the Lancet Global Health confirmed that for pregnancies less than nine weeks duration, abortion completion following self-managed medication use is not inferior to abortion completion following clinician-managed medication abortion in clinical settings. Further, results indicate that self-managed abortion with misoprostol alone is highly effective and deserving of renewed attention. These and further SAFE study findings will be instrumental in encouraging researchers, clinicians, advocates, and policymakers to revise and update current guidelines on the use of abortifacient medications outside of the formal health system. Liberalization of these guidelines would have enormous implications for reductions in morbidity and mortality due to unsafe abortion, and revolutionary implications for the human right to bodily autonomy.