A new study conducted in Peru, where abortion is legally restricted, finds that women can safely and effectively self-induce abortion after receiving information from a healthcare provider about how to use the drug misoprostol. Although abortion is common in Peru, few women qualify for legal services, and many instead seek out clandestine providers or use unsafe methods on their own.

Researchers at Ibis Reproductive Health, the University of California San Francisco (UCSF) and the International Planned Parenthood Federation/Western Hemisphere Region documented outcomes with a harm-reduction model of care implemented at non-governmental clinics in Lima and Chimbote. Women who said they were considering ending their pregnancy were evaluated by nurses, given information about ways to use misoprostol that are scientifically shown to be safe and effective for early abortion. They were encouraged to return to the clinic to ensure the abortion was complete, treat any complications and receive contraception. The study followed 220 women who took misoprostol on their own after a clinic evaluation.

“We found that almost 90% of women reported having a complete abortion after taking misoprostol, and very few had medical complications, such as heavy bleeding, infection or severe pain,” Dr. Daniel Grossman, the director of Advancing New Standards in Reproductive Health (ANSIRH) and lead author of the study, said. “Our findings corroborate those from a growing number of studies indicating that women can safely and effectively use medication abortion on their own with minimal clinical supervision.” 

Grossman shared with Lilith the ways he sees Judaism informing his work for reproductive justice. “I think my Jewish upbringing instilled in me a strong sense of tikkun olam or ‘repair of the world’ and a desire to work for the welfare of society at large,” he said. “My parents aren’t very observant Jews, but they were active volunteers in our temple’s social action work. My research on access to reproductive health care, as well as my clinical activities, are certainly motivated by a desire to reduce disparities and ensure that all people can attain the highest level of health possible.”

The study also looked at the effect of telephone follow-up after a woman takes misoprostol. After it was added, 80% of patients received some type of follow-up with the clinic, compared with 30% returning for an in-person visit before the telephone option was introduced.

“Telephone follow-up gives women another way to get support from the clinic and help them figure out if the abortion is complete or not,” Sarah Baum, an associate with Ibis Reproductive Health and co-author of the study, said. “It also may help them start using contraception after the abortion, since we saw that women with any type of follow-up contact with the clinic were more likely to be using birth control after the abortion compared to those without follow-up.” 

The harm-reduction approach to legally restricted abortion was first developed in Uruguay, where it was associated with a sharp decline in abortion-related mortality. The model is similar to the harm-reduction approach to injection drug use, which led to the development of needle-exchange programs and other efforts to make injection drug use safer. 

“Harm-reduction programs for safe abortion have been introduced in several countries in Latin America to great success, and in Uruguay, helped pave the way for the legalization of abortion,” said Jennifer Friedman, Associate Director of Programs for the International Planned Parenthood Federation/Western Hemisphere Region. “While not a substitute for laws that uphold women’s right to safe and legal abortion, harm-reduction programs help mitigate unnecessary suffering and death in a region with some of the strictest abortion laws in the world.” 

“As abortion becomes more restricted in the United States, I believe there is something we physicians can learn from the harm-reduction model in Latin America,” said Grossman. “If abortion became illegal or impossible to access in some states, would we stand up and give our patients information about how to end a pregnancy on their own using medications they could obtain online? Would we be as brave as these clinicians in Peru and Uruguay? The trend of increasing abortion restrictions across the country brings this scenario closer to reality.”