The SAFE study, the first study of its kind, recruited over 1,000 people who contacted a safe abortion accompaniment group in Argentina or Nigeria, followed them for approximately one month, and measured outcomes on their self-managed abortion experiences, with abortion completion without surgical intervention as the primary outcome.
Self-managed medication abortion involves the use of one of two medication regimens to end a pregnancy without clinical supervision recommended by the World Health Organization (WHO). The WHO-recommended medication regimens of mifepristone in combination with misoprostol, or misoprostol alone, are established safe and effective methods of terminating pregnancy in clinical settings. A self-managed abortion with accompaniment involves non-clinically trained abortion counselors who provide evidence-based information about the use of medication abortion, as well as compassionate emotional (and sometimes physical support), throughout an individual’s self-managed medication abortion process. Abortion accompaniment is provided over the phone, through secure digital messaging platforms, and/or in person.
The SAFE study reinforces an existing body of evidence that, with accurate information, people can safely and effectively use medications to terminate a pregnancy outside of a clinical setting. These findings provide evidence for the demedicalization of early abortion care, and support the importance of continued access to remote models for medication abortion—including telemedicine—that have been implemented in several countries as a result of the COVID-19 pandemic. Results from this study also suggest that SMA with support from accompaniment support can be a core strategy for expanding access to safe, effective abortion care.