Objective
This study measures the extent to which women who access clinical abortion services in the United States report having ever used misoprostol or other substances to self-induce.
Study Design
A random sample of 107 US abortion providers was asked to distribute questionnaires to abortion patients.
Results
Information was gathered from 9493 patients at 95 facilities, and weights were constructed to make the data nationally representative of all US abortion patients. Only 1.2% of women obtaining abortions report having ever used misoprostol on their own to “bring back” their period or end a pregnancy. A similarly small proportion of women, 1.4%, reported using other substances, such as vitamin C or herbs, to attempt to end a pregnancy.
Conclusion
Media reports of self-induced abortions using misoprostol may be exaggerated, but further research is needed to estimate the incidence of self-induced abortion among women who do not access clinical abortion services.
Since 1973, abortion has been legally protected in the United States, and the need for “back alley” abortions, or abortions outside of clinical settings, has presumably disappeared. However, over the last decade several media stories have increased awareness of US women using misoprostol to self-induce.
Also known as Cytotec (Pfizer, New York, NY), misoprostol is only available by prescription in the United States, but can be obtained behind-the-counter at pharmacies in some countries, including Mexico, and has made its way to the black market in the United States. Clinical trials have shown that, while less effective than a combined regimen of mifepristone and misoprostol, misoprostol alone can achieve complete abortion between 70-94% of the time, depending on the gestation, dosage, and route of administration. But women who access the drug outside of a clinical setting may be unaware of the proper dosage and routes of administration and, in turn, experience more adverse events. Moreover, abortion without medical supervision is illegal in some states, and there have been several high-profile cases of women being prosecuted for inducing their own abortions.
Anecdotal reports suggest that use of misoprostol is most common among Latina women, particularly those who live in border towns or in areas with large immigrant populations, and there have been reports that up to 40% of women accessing clinical abortion services in some areas are doing so after unsuccessfully attempting to self-induce. In 2008, 25% of abortion patients were Hispanic, up from 20% in 2000, and 16% of all US abortion patients were foreign born. There were 1.21 million abortions performed in 2005, so the population supposedly most likely to use misoprostol to self-induce is quite sizeable.
The purpose of this study is to assess the incidence of self-induced abortion using misoprostol and other substances among a nationally representative sample of women accessing clinical abortion services. Differences in incidence by subgroups are also examined.
Materials and Methods
The current survey of abortion patients uses a design and questionnaire similar to those for 3 earlier studies, which were conducted in 1987, 1994 through 1995, and 2000 through 2001. For this survey, conducted in 2008 through 2009, a 4-page questionnaire was developed, collecting information about demographic items contained on prior surveys, and assessing several new issues such as use of misoprostol to self-induce.
The facilities in the survey were sampled from all hospitals, clinics, and physician’s offices where abortions were performed in 2005, according to information from a census of abortion providers conducted in 2006 through 2007. The universe of all known abortion providers was stratified by provider type (hospital or nonhospital) and 2005 caseload rounded to the nearest 10 (30-390; 400-1990; 2000-4990; and ≥5000 abortions), and then listed by census region and state within each stratum. Facilities that reported <25 abortions in 2005 were not included because of the high likelihood that they would perform few or no abortions during the survey period. Their exclusion could cause little bias regarding the representativeness of the sample because these facilities only accounted for 1% of all reported procedures in 2005. Next, every Nth facility was sampled (N varied by stratum), and clinics with large caseloads were oversampled to obtain adequate representation.
Each facility was assigned a sampling period that was inversely proportional to its probability of being selected and, for example, facilities with the largest caseloads (which were fewer in number) only administered the survey to all women obtaining abortions over a 2 week time period while facilities with the smallest caseloads administered the survey for 12 weeks. Our goal was to recruit 107 facilities. We employed a replacement sampling strategy, and, if a facility declined to participate or did not obtain usable questionnaires from at least half of the target women, it was replaced by the next facility listed in the same stratum, which in most cases was in the same state or a neighboring state in the same region.
The questionnaire, available in both English and Spanish (and, at one facility’s request, Portuguese) was distributed to women by facility staff. Participating facilities decided when during the patient’s visit to distribute the questionnaire; in most cases, women completed it along with other paperwork while they waited for their procedure. The questionnaire included an introduction explaining the purpose of the survey and informing women that participation was voluntary and anonymous. The questionnaire and procedures were approved by our organization’s federally registered institutional review board.
Missing information on key demographic variables was imputed on the basis of the responses of other women with similar characteristics using a ”hot-deck” procedure. Specifically, we used cross-tabulations to identify the variables most strongly associated with each item requiring imputation. Respondents were sorted according to these variables in the order of the strength of the item’s association with the variable to be imputed, so that similar cases were adjacent to one another in the file. A missing value was then replaced by the value of the preceding case in the file.
The questionnaire included 2 questions relevant to this study: “Did you take any of the following to try to bring back your period or end the CURRENT pregnancy BEFORE you came here?” and “Have you EVER taken anything ON YOUR OWN to try to bring back your period or end a pregnancy?” Response categories for both items were: (1) Yes, I have taken Cytotec, or misoprostol; (2) Yes, I have taken emergency contraception, also known as EC or the morning-after pill; (3) Yes, I have taken another drug (with a space for write-in responses); and (4) None of the above. Information from both items was combined to assess ever use of misoprostol.
Statistical analyses were performed with software (version 18.0; SPSS, Inc, Chicago, IL) using the complex sampling feature. Data were weighted to be representative of all US women obtaining abortions, and the weights took into account the complex sampling design. Descriptive statistics were used to generate estimates of self-induced abortions for all women and by subgroup. Differences between means for subgroups were assessed by t tests, using the general linear model command.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
