ICMA conference “Using hotlines to improve women’s access to information in legally restricted settings” Women on Web – Acceptability and Regional rates of surgical intervention after Medical abortion Bangkok, 09 March 2012

Last year 6000 women had access MA through WOW Website has visitors per month Helpdesk answers around s per month 50% of the s are related to misoprostol only information Each day 60 women do the online 8 Languages available - ar, en, fr, in, pl, pt, th, sp Provided the service in 125 different countries

Protocol 1 mifepristone 200 mg 24h later 4 misoprostol 200 mcg sublingual 4 h later 2 misoprostol 200 mcg sublingual

Follow-up February September women provided follow-up (2011) Gomperts et al. Regional differences in surgical intervention following medical termination of pregnancy provided by telemedicine Acta Obstetricia et Gynecologica Scandinavica

Follow ‐ up rate per region

Hospital/doctor visits per region Surgical Intervention

Older women received less surgical interventions in comparison with younger women Longer bleeding associated with less surgical interventions More advanced the pregnancy associated with more surgical intervention

Sample 825

Surgical Intervention rate 12,4% Only 5,8% of women reported signs of complications sooner USG increased probability of having a surgical intervention

Acceptability (group of 2589 women)

There is a significant difference (p=0.000) between the number of women who received a surgical intervention and reported the feeling ‘if I had known before how stressful it would be, I would never have done it myself’ in comparison to the group of women who were ‘grateful’ or ‘felt stressed but judged the medical abortion as acceptable’.

Stress factor Reliability:  Lack of knowledge that abortion pills exist  Fear that the pills are dangerous  Lots of scam and abuse Illegality and Taboo:  Fear that someone will notice I have done an abortion (doctors, family, partners) Confusing policies (in Europe):  Differences between service provision standards and myths around it

Acceptability of medical abortion with WoW Support (sample 859 women)

Future Research Study the complication rate and acceptability after 63 days LMP