A harm-reduction model of abortion counseling about misoprostol use in Peru with telephone and in-person follow-up: A cohort study

• Published in: PloS one 2018-01, Vol.13 (1), p.e0189195-e0189195
• Main Authors: Grossman, Daniel, Baum, Sarah E, Andjelic, Denitza, Tatum, Carrie, Torres, Guadalupe, Fuentes, Liza, Friedman, Jennifer
• Format: Article
• Language: English
• Subjects: Abortifacient Agents, Nonsteroidal - administration & dosage; Abortion; Adolescent; Adult; Birth control; Clinical trials; Cohort analysis; Cohort Studies; Counseling; Demographics; Engineering and Technology; Female; Follow-Up Studies; Gynecology; Harm Reduction; Hemorrhage; Humans; Laws; Medicine and Health Sciences; Methods; Middle Aged; Misoprostol; Misoprostol - administration & dosage; Obstetrics; Pain; People and places; Peru; Polls & surveys; Pregnancy; Reduction; Reproductive health; Research and Analysis Methods; Studies; Telephone; Transfusion; Womens health; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0189195

In Peru, abortion is legal only to preserve the life and health of the woman. A non-profit clinic system in Peru implemented a harm-reduction model for women with unwanted pregnancy that included pre-abortion care with instructions about misoprostol use and post-abortion care; they started offering telephone follow-up for clients in 2011. This study aimed to evaluate the effectiveness and safety of the harm-reduction model, and to compare outcomes by type of follow-up obtained. Between January 2012 and March 2013, 500 adult women seeking harm-reduction services were recruited into the study. Telephone surveys were conducted approximately four weeks after their initial harm-reduction counseling session with 262 women (response rate 52%); 9 participants were excluded. The survey focused on whether women pursued an abortion, and if so, what their experience was. Demographic and clinical data were also extracted from clinic records. Eighty-six percent of participants took misoprostol; among those taking misoprostol, 89% reported a complete abortion at the time of the survey. Twenty-two percent obtained an aspiration after taking misoprostol and 8% self-reported adverse events including hemorrhage without transfusion, infection, or severe pain. Among women who took misoprostol, 46% reported receiving in-person follow-up (in some cases both telephone and in-person), 34% received telephone only, and 20% did not report receiving any form of follow-up. Those who had in-person follow-up with the counselor were most likely to report a complete abortion (