Feasibility of medication abortion self-care service delivery in Ghana

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.