Written by Sadia

A study by the Guttmacher Institute shows that over half of all abortions are done via medication abortion (MAB), using misoprostol only or mifepristone with misoprostol.¹ Patients who have a MAB often wonder about the need for a follow-up appointment. Follow-up appointments are used to determine if the MAB was successful. Health care professionals need to consider all patients seeking follow-up care after MAB, whether they had a self-managed abortion (SMA), a telehealth abortion, or a MAB in clinic.

Follow-up should always be offered, but health care professionals also need to consider the reality that patients may not want or cannot attend a follow-up appointment after MAB. For some, additional visits bring challenges, such as cost, childcare, eldercare, work, travel, and privacy concerns.² If follow-up is needed or desired, patients should be provided with options, such as phone calls, virtual visits, and weekend availability. Routine follow-up after abortion is not needed if the person has sufficient information about when to seek care for possible complications and has received any relevant medical information for their concerns.³⁻⁴

Given this context, here are some tips to make your health care facility more accessible for people seeking follow-up information after MAB, including SMA:

• Provide patients with the How to Use Abortion Pills Fact Sheet. It can be downloaded and printed for in-clinic visits or distributed online for virtual/over-the-phone visits.
• Advocate for abortion doulas at your practice.⁵
• Educate patients on medically urgent symptoms, such as bleeding through more than two pads per hour for two hours.
• Inform patients about the efficacy of medication abortion (misoprostol only compared to misoprostol and mifepristone), the use of an at-home urine pregnancy test to check for pregnancy status after 4 weeks, and if a follow-up for an ultrasound is needed.⁶
• Explain follow-up options, such as an in-clinic visit, telephone call, virtual consult, or the M+A hotline.

Everyone should be able to have the abortion that fits their needs. Trusted information on abortion and medical care post-abortion is essential in the age of misinformation and public scrutiny against abortion access. There is great potential for clinicians to provide trauma-informed, medically accurate, and culturally appropriate post-abortion education to empower patients.

RHAP Resources:

How To Use Abortion Pills Fact Sheet

How To Use Misoprostol-Only for a Medication Abortion

Medication Abortion Aftercare Instructions

Sources:

1. Jones R, Nash E, Cross L, Philbin J, Kirstein M. Medication Abortion Now Accounts for More Than Half of All US Abortions. Guttmacher Institute. Published February 22, 2022. https://www.guttmacher.org/article/2022/02/medication-abortion-now-accounts-more-half-all-us-abortions

2. Upadhyay UD, Cartwright AF, Grossman D. Barriers to abortion care and incidence of attempted self-managed abortion among individuals searching Google for abortion care: A national prospective study. Contraception. 2022;106:49-56. doi:10.1016/j.contraception.2021.09.009

3. Prager S, Chaiten L, Diedrich JT, et al. 2024 Clinical Policy Guidelines for Abortion Care. National Abortion Federation. Published February 2024. Accessed February 26, 2024. https://prochoice.org/providers/quality-standards/

4. World Health Organization (WHO) Sexual and Reproductive Health and Research (SRH) Guidelines Review Committee. Abortion Care Guideline. 2022 Mar 8. World Health Organization (WHO). https://www.who.int/publications/i/item/9789240039483

5. Lindsey A, Narasimhan S, Sayyad A, Turner D, Mosley EA. “I can be pro-abortion and pro-birth”: Opportunities and challenges for full spectrum care among doulas in Georgia. Front Glob Womens Health. 2023;4:966208. Published 2023 Mar 1. doi:10.3389/fgwh.2023.966208.

6. Shimels T, Getnet M, Shafie M, Belay L. Comparison of mifepristone plus misoprostol with misoprostol alone for first trimester medical abortion: A systematic review and meta-analysis. Front Glob Womens Health. 2023;4:1112392. Published 2023 Mar 6. doi:10.3389/fgwh.2023.1112392

Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.

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