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 may already be self-managed without clinical support.

Given this shift to self-managed MA—meaning use outside clinical settings—the Studying Accompaniment model Feasibility & Effectiveness (SAFE) Study was designed to evaluate the safety and effectiveness of self-managed MA with the support of accompaniment groups in Argentina, Indonesia, 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 1,300 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, preliminary analyses confirm that abortion completion following self-managed medication use is not inferior to abortion completion following clinical administration of medication. 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.