ArticleThe Lancet. Global health2022
Effectiveness of self-managed medication abortion with accompaniment support in Argentina and Nigeria (SAFE): a prospective, observational cohort study and non-inferiority analysis with historical controls.
Article in The Lancet. Global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
55 citing papers in PubMed, 109 citations in OpenAlex.
- Effect of intervention based on the 5A self-management model on the improvement of behaviors related to women's reproductive health after legal abortion.Scientific reports · 2023Trial
- Severity and management of postabortion complications in Kenya: results from a nationally representative cross-sectional survey.BMJ global health · 2026Article
- Mexico-Based Accompaniment Collectives for Abortion in the US After Dobbs.JAMA network open · 2026Article
- Ensuring an enabling environment for abortion self-care: individuals' experiences with self-managed abortion in India.BMJ global health · 2026Article
- 'Come on, Give Me the Pills Now': A Narrative Analysis of Reproductive Agency in Self-Managed Abortion in Argentina.Sociology of health & illness · 2026Article
- Self-managed medical abortion in Nigeria: a prospective, comparative study of clinical outcomes for a misoprostol-alone regimen obtained from patent medicine vendors compared to clinics.Reproductive health · 2026Article
- Supporting self-managed abortion care in "practice not premise": a qualitative study of provider perspectives, roles, and information pathways to care in India.Sexual and reproductive health matters · 2025Article
- "They're not used to people asking what they need": work processes and care practices in feminist abortion accompaniment - a qualitative study.Sexual and reproductive health matters · 2025Article
- Acceptability of misoprostol-only medication abortion dispensed by mail-order or retail pharmacy: a qualitative study based on in-depth interviews in the United States.Sexual and reproductive health matters · 2025Article
- Hegemonic medicine and self-managed abortion: reclaiming Latin American feminists' contributions to knowledge and practice development.Sexual and reproductive health matters · 2025Article
- 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.Reproductive health · 2025Observational
- Self-Managed Medication Abortion: History, Evidence, Models of Care, and Policy Considerations.American journal of public health · 2025Article
- Article
- Financial Barriers Are Associated With Self-Managed Abortion in Indiana: Results From a Mixed-Methods Study in 2021-2022.Perspectives on sexual and reproductive health · 2025Article
- Incidence and safety of abortion in two humanitarian settings in Uganda and Kenya: a respondent-driven sampling study.EClinicalMedicine · 2025Article
- A qualitative study of abortion decision-making trajectories among pregnant women at their first antenatal care visit in Kampala, Uganda.Journal of global health · 2025Article
- Self-managed abortion as a humanitarian revolution: accounts of a telehealth pilot in the Middle East.Conflict and health · 2025Article
- Seeking abortion medications online: experiences from a mystery client study in Colombia.BMJ open · 2025Article
- Preventing Unintended Pregnancies and HIV Through Self-Care Interventions in East and Southern Africa: Findings From a Structured Review.Public health reviews · 2025Review
- Quality of care offered by health care retail markets for medication abortion self-management: Findings from states in Nigeria and India.PLOS global public health · 2025Article
Corrections and comments
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Authors and funding
11 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundClinical trials have established the high effectiveness and safety of medication abortion in clinical settings. However, barriers to clinical abortion care have shifted most medication abortion use to out-of-clinic settings, especially in the context of the COVID-19 pandemic. Given this shift, we aimed to estimate the effectiveness of self-managed medication abortion (medication abortion without clinical support), and to compare it to effectiveness of clinician-managed medication abortion.
methodsFor this prospective, observational cohort study, we recruited callers from two safe abortion accompaniment groups in Argentina and Nigeria who requested information on self-managed medication abortion. Before using one of two medication regimens (misoprostol alone or in combination with mifepristone), participants completed a baseline survey, and then two follow-up phone surveys at 1 week and 3 weeks after taking pills. The primary outcome was the proportion of participants reporting a complete abortion without surgical intervention. Legal restrictions precluded enrolment of a concurrent clinical control group; thus, a non-inferiority analysis compared abortion completion among those in our self-managed medication abortion cohort with abortion completion reported in historical clinical trials using the same medication regimens, restricted to participants with pregnancies of less than 9 weeks' gestation. This study was registered with ISCRTN, ISRCTN95769543.
findingsBetween July 31, 2019, and April 27, 2020, we enrolled 1051 participants. We analysed abortion outcomes for 961 participants, with an additional 47 participants reached after the study period. Most pregnancies were less than 12 weeks' duration. Participants in follow-up self-managed their abortions using misoprostol alone (593 participants) or the combined regimen of misoprostol plus mifepristone (356 participants). At last follow-up, 586 (99%) misoprostol alone users and 334 (94%) combined regimen users had a complete abortion without surgical intervention. For those with pregnancies of less than 9 weeks' gestation, both regimens were non-inferior to medication abortion effectiveness in clinical settings.
interpretationFindings from this prospective cohort study show that self-managed medication abortion with accompaniment group support is highly effective and, for those with pregnancies of less than 9 weeks' gestation, non-inferior to the effectiveness of clinician-managed medication abortion administered in a clinical setting. These findings support the use of remote self-managed models of early abortion care, as well as telemedicine, as is being considered in several countries because of the COVID-19 pandemic.
fundingDavid and Lucile Packard Foundation. TRANSLATIONS: For the Arabic, French, Bahasa Indonesian, Spanish and Yoruba translations of the Article see Supplementary Materials section.
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