Understanding women's experience with self-induced abortion and follow-up after harm-reduction counseling: A qualitative study

In Peru, abortion is legal only to preserve the life and health of the woman; however, self-induction with misoprostol is common. A harm-reduction model was implemented at reproductive health clinics in Peru in 2006 that encouraged women to attend consultations before and after self-induction, and discussed safe and unsafe methods, including misoprostol. Women were offered in-person or telephone follow-up. This study aimed to understand women’s abortion process following harm-reduction counseling and how women used follow-up services.  

We conducted semi-structured, qualitative interviews with 22 women who presented for harm-reduction counseling in 2012, including 20 who used misoprostol. Women were recruited following participation in a telephone survey and purposively sampled by misoprostol use and follow-up type. Interviews were conducted and analyzed in Spanish.

Women across pregnancy outcomes and follow-up types felt better informed after harm-reduction counseling, and were grateful for the lack of judgment of their circumstances and decisions. Women had uncertainty and fear regarding how to use misoprostol and what to expect, but many said that the counseling eased their concerns. Even so, many still reported visiting several pharmacies, being turned away for lack of a prescription, or being sold fewer pills than needed, and a few felt judged. Many women obtained an ultrasound after self-inducing, as advised by the counselor, but some women delayed or forwent an ultrasound because they could not afford the fee, including several who experienced ongoing bleeding. Some women whose self-induction was uneventful sought no follow-up services.