Understanding the support needs and preferences of people who self-managed abortion with accompaniment group support in Argentina, Nigeria, and Southeast Asia: a prospective, observational cohort study

Abstract

Abstract Background Increasingly, people use medication abortion pills to end their pregnancies on their own, without clinical supervision–a practice known as self-managed abortion (SMA). Additionally, some obtain support through a community-based care model known as the “accompaniment” model, in which volunteer-activists provide evidence-based information about medication abortion and counselling through the SMA process over the phone or in-person. Understanding factors associated with the support and care received during SMA with accompaniment can provide insight into people’s satisfaction with this community-based model of abortion care and identify opportunities to further improve this model of care, which is particularly important in legally restrictive settings. Additionally, a large proportion of people who have abortions are parents, but little research has explored the unique needs and preferences for SMA among parents. Methods This was a secondary analysis of a prospective, observational cohort study conducted in three countries among people who self-managed an abortion with accompaniment support. We implemented bivariate analyses to evaluate differences between participants who reported feeling sufficient social support during their abortion and who preferred SMA over clinical models of care, with those who did not. We used logistic regression models to explore whether the number of children a participant had was associated with feeling supported during the accompanied SMA process, and separately with preferred model of abortion care. Results While most participants felt fully supported by their social group and preferred SMA over facility-based abortion care, several characteristics were associated with not having felt supported and preferring facility-based abortion care in bivariate analyses: namely, those with less formal education, a history of prior abortion, and those who sought care at a health facility during their SMA. In adjusted logistic regression models, we found no association between number of children and feeling sufficient social support, or preference for SMA. Conclusions These results establish that most people who have an accompanied SMA feel fully supported during their abortion process and prefer SMA over facility-based care.