Client satisfaction and experience of home use of mifepristone and misoprostol for medical abortion up to 10 weeks’ gestation at British Pregnancy Advisory Service: a cross-sectional evaluation

Objective: Evaluate satisfaction and experience with telemedicine and home use of mifepristone and misoprostol for abortion to 10 weeks’ gestation. Design: Cross-sectional evaluation. Setting: British Pregnancy Advisory Service (BPAS) clinics in England and Wales. Population: 1,144 clients who used mifepristone and misoprostol at home from 11 May to 10 July 2020. Methods: We sent a text message with a link to a web-survey 2-3 weeks after treatment. Questions evaluated satisfaction and experiences, including telephone consultations and provision of medicines by post or collection from clinic. We used bivariate and multivariate regression to explore associations between client characteristics and outcomes. Main Outcome Measures: Overall satisfaction (5-point Likert scale) and reported contact with a healthcare provider (HCP). Results: Respondents primarily described home use of medications as ‘straightforward’ (75.8%) and most were ‘very satisfied’ (78.3%) or ‘satisfied’ (18.6%) with their overall experience. Being ‘very satisfied’ was associated with parity (aOR 1.53, 95% CI 1.09-2.14) and pain control satisfaction (aOR 2.22, 95% CI 1.44-3.44). HCP contact was reported by 14.7%; mainly to BPAS’ telephone aftercare service (76.8%). Dissatisfaction with pain control (aOR 3.62 95% CI 1.79-7.29) and waiting >1 week to use mifepristone (aOR3.71, 95% CI 1.48-9.28) were associated with HCP contact. If needed in future, most (77.8%) would prefer home use of mifepristone and misoprostol and pills by post (68.9%). Conclusions: Satisfaction with home use of mifepristone and misoprostol is high. Most clients do not need HCP support during or after home use, but aftercare should be available.