New research from South Africa suggests that women can use mobile devices, such as phones or tablets, to accurately assess their eligibility for medical abortion via an online gestational age calculator.
Findings from the Ipas-funded research project were recently published in the journal Reproductive Health. Led by principal investigator Dr. Jane Harries at the University of Cape Town, the study investigated whether women could use a mobile-optimized website to determine their gestational age prior to seeking an abortion.
As Ipas Senior Clinical Advisor, Bill Powell notes, clinical research has shown medical abortion to be very safe and effective, but most of that research has been conducted within the formal health system, where trained health-care providers evaluated women’s eligibility for medical abortion and provided guidance on how to use the medicines. This research suggests that women can use a mobile tool to help them determine their own eligibility.
The study is the first time “mobile health” (the use of mobile devices such as mobile phones for health practices) has been used to explore self-assessment for medical abortion. According to Dr. Harries, most pregnancy calculator applications or websites use due-date calculators and provide other information that is not suitable for a woman seeking to terminate a pregnancy. The use of a web-based application to determine eligibility for abortion is novel.
Dr. Rebecca Braun, Ipas senior mHealth advisor, says the study demonstrates “a promising opportunity to explore the role that mobile technology can play in supporting women to access comprehensive abortion information, support and care.”
‘Mobi-site’ guided women through process
Medical abortion in the first trimester (up to 63 days gestation) has been legal in South Africa since 2001, but many barriers to women’s access to services still exist, causing some women to opt for unsafe abortions or to delay seeking services until they have reached the second trimester. Seeking services earlier in pregnancy is safer, less expensive and provides more options for women.
To carry out the study, Dr. Harries and her colleagues developed a web-based application to evaluate both women’s ability to accurately assess their own gestational age and the tool’s effectiveness in helping them do so. It was tailored to the South African context and easily accessible from computers or mobile phones.
Seventy-eight women seeking abortion services were recruited from two health clinics in Cape Town in 2014 to participate in the study. A website optimized to be viewed and navigated on smaller screens—called a “mobi-site” (see image)—was used in the study. When women accessed the site, they were guided through a process that included determining the first day of their last menstrual period and five standardized medical abortion-eligibility questions. Self-calculated gestational age was then compared to ultrasound gestational age obtained from clinical records.
When women had completed the online process, they would receive confirmation messages of their self-calculated gestational age, such as “You have been pregnant for 5 Week(s) and 4 Day(s). You may be eligible for a medical abortion today, please speak to a doctor or nurse for more information.”
Vast majority found the calculator easy to use
According to the study, the women, on average, overestimated their gestational age by 0.5 days, which is not considered clinically significant. These findings “suggest that women would be able to self-assess their gestational age as well as their eligibility for MA (medical abortion) using an online gestational calculator. The vast majority of participants found the online gestational calculator easy to use.”
The study was one of two innovative research projects funded by Ipas in 2014. The other study, led by Dr. Caitlin Gerdts at the University of California at San Francisco, is testing the feasibility of a newer research methodology to identify and quantify the population of women who have used medical abortion outside of the formal health system in Cape Town, South Africa. It uses social networks to identify populations engaged in stigmatized or hidden behaviors—in this case, women who choose to use medical abortion without guidance from a health-care provider.
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