Quality of information offered to women by drug sellers providing medical abortion in Nigeria: Evidence from providers and their clients

Motivations for using misoprostol for abortion outside the formal healthcare system in Colombia: a qualitative study of women seeking postabortion care in Bogotá and the Coffee Axis

BACKGROUND

In 2006, a Constitutional Court ruling partially decriminalized abortion in Colombia, allowing the procedure in cases of rape, risk to the health or life of the woman, and fetal malformations incompatible with life. Despite this less prohibitive law, some women and pregnant people preferred self-managing their abortions outside the formal healthcare system, often without accurate information. In 2018, we undertook a study to understand what motivated women to self-manage using medications that they acquired informally. Colombia has since adopted a progressive law in 2022, permitting abortion on request through the 24th week of pregnancy. However, the implementation of this law is still underway. Examining the reasons why women chose to informally self-manage an abortion after 2006 may not only highlight how barriers to legal services persisted at that time, but also could inform strategies to increase knowledge of the current abortion law and improve access to services going forward.

METHODS

In-depth interviews were conducted in 2018 with 47 women aged 18 and older who used misoprostol obtained outside of health facilities to induce an abortion, and who were receiving postabortion care in two private clinics. Interviews explored what women knew about the 2006 abortion law which was then in effect, and the reasons why they preferred informal channels for abortion care over formal healthcare services.

RESULTS

Women's motivations to use misoprostol obtained outside the formal healthcare system were influenced by lack of trust in the healthcare system along with incomplete and inaccurate knowledge of the abortion law. Conversely, women considered misoprostol obtained outside the healthcare system to be effective, affordable, and easier to access.

CONCLUSIONS

Obtaining misoprostol outside the formal healthcare system offered a more accessible and appealing prospect for some women given fears of legal repercussion and stigma toward abortion. Though this preference will likely continue despite the more liberal abortion law, strategies should be implemented to broaden knowledge of the recent change in law and to combat misinformation and stigma. This would support knowledge of and access to legal abortion for those who wish to avail themselves of these services.

Effectiveness of self-managed abortion during the COVID-19 pandemic: Results from a pooled analysis of two prospective, observational cohort studies in Nigeria

Globally, restrictions imposed by the COVID-19 pandemic altered access to clinical abortion care, as well as people's ability to access abortion medications on their own. When clinical care is inaccessible, or when self-care is preferred, people use pills on their own, without clinical supervision, to end their pregnancies-a practice known as "self-managed" abortion. Little is known about experiences of self-managed abortion during the COVID-19 pandemic. The aim of this study was to measure experiences of self-managed abortion, including abortion completion, prior to and during the COVID-19 pandemic in Nigeria. Between October 2019-September 2020, we recruited callers to a safe abortion accompaniment group that provides information on self-managed abortion in Nigeria. Participants completed a baseline phone survey, and two follow-up phone surveys. Primary outcomes included burdens experienced prior to versus during the pandemic, and abortion completion. We calculated frequencies and percentages overall and by time period and compared outcomes across time periods using t-tests, Chi-squared tests, tests of proportion, and Mantel-Haenszel adjusted odds ratios. Overall, 807 participants were included in these analyses. Participants enrolled during the COVID-19 pandemic were more likely to report needing to borrow money (47.9% vs 29.4%) and find lodging outside the home (15.5% vs 3.2%) for their self-managed abortion than were those enrolled prior to the pandemic. Participants reported COVID-19 related difficulties most frequently during the earliest and strictest period of the lockdowns, particularly in obtaining and taking pills (32.4%), and comfort seeking healthcare (12.2%). Nearly all participants (95%) reported a complete abortion at last follow-up. Results from this study underscore the challenges Nigerians faced during the COVID-19 pandemic in self-managing their abortions, and also the essential role that a safe abortion hotline played in expanding access to safe abortion during a time when the formal healthcare system was less accessible and higher-risk.