Amo-Adjei Joshua, Boateng Kojo Asamoah, Nicholson Martha, Wilkins Rebecca, Wachsmann Hadassah, Adu-Manu Kwasi
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
Planned Parenthood Association of Ghana, Accra, Ghana.
Reprod Health. 2025 May 2;22(1):64. doi: 10.1186/s12978-025-02021-1.
The increasing availability of medication abortion (MA) has significantly enhanced access to safe abortion services in many countries. As abortion medications become more accessible, it is essential to explore various models of care to ensure that MA is available to as many women in need as possible. This study aimed to document evidence regarding the feasibility of three models of care for providing MA utilising a combination of mifepristone and misoprostol: clinic-based, hybrid (a blend of clinic-based and home-based care), and full self-care (where women administer all medications at home without provider supervision). We interviewed 230 (80.7%) out of 285 women and girls who sought MA services within 5 months.We also conducted in-depth interviews with five (N=5) providers and 24 MA clients. The results revealed a high adoption rate for the hybrid self-care model (66%), followed by full self-care (28%). Many clients expressed satisfaction with the supportive care they received and indicated a willingness to recommend the service to others in their networks who might require medication for pregnancy termination. Notably, clients who utilised facility-based, hybrid, and full self-care models preferred to continue with the same approach for any future terminations. Only about 2.6% of clients reported experiencing incomplete abortions. Furthermore, the individual-level cost of self-managed abortion was substantially lower than that of hybrid and facility-based care. These findings contribute to the growing body of evidence on the feasibility and effectiveness of MA self-care and highlight the implications for program development.
药物流产（MA）的可及性不断提高，在许多国家显著增强了安全堕胎服务的可及性。随着堕胎药物越来越容易获得，探索各种护理模式以确保尽可能多有需要的女性能够获得药物流产至关重要。本研究旨在记录有关使用米非司酮和米索前列醇联合提供药物流产的三种护理模式可行性的证据：基于诊所的模式、混合模式（基于诊所和家庭护理的结合）和完全自我护理模式（女性在没有医护人员监督的情况下在家自行服用所有药物）。我们对在5个月内寻求药物流产服务的285名女性和女孩中的230名（80.7%）进行了访谈。我们还对5名医护人员和24名药物流产客户进行了深入访谈。结果显示，混合自我护理模式的采用率很高（66%），其次是完全自我护理模式（28%）。许多客户对她们所接受的支持性护理表示满意，并表示愿意向其社交圈中可能需要终止妊娠药物治疗的其他人推荐这项服务。值得注意的是，采用基于医疗机构、混合和完全自我护理模式的客户更愿意在未来任何终止妊娠时继续采用相同的方式。只有约2.6%的客户报告经历了不完全流产。此外，自我管理堕胎的个人成本大大低于混合模式和基于医疗机构的护理成本。这些发现为关于药物流产自我护理可行性和有效性的证据积累做出了贡献，并突出了对项目开发的启示。
