# Unsupervised Medication-Induced Abortions: A Cross-Sectional Study in a Tertiary-Care Hospital

## TL;DR

This study finds that most abortions at a hospital were unsupervised, often linked to socioeconomic factors and incomplete procedures.

## Contribution

The study quantifies the high prevalence of unsupervised medical abortion pill use and identifies associated demographic and clinical factors.

## Key findings

- 82.7% of abortions in the study were unsupervised, with incomplete abortion being the most common complication.
- Socioeconomic status and gravidity were significantly associated with unsupervised medical abortions.
- Facility-induced abortions were more often therapeutic, while self-medicated abortions occurred at earlier gestational ages.

## Abstract

Background

Abortion refers to the termination of pregnancy before fetal viability, which is legally recognized at 28 weeks in India. Unsafe abortions, characterized by the absence of medical supervision, pose significant risks, including incomplete abortion, retained products of conception, and elevated maternal morbidity and mortality. Despite the Medical Termination of Pregnancy (MTP) Act (1971) and the introduction of Medical Abortion Pills (MAP), unsafe abortions remain prevalent.

Objective

To determine the prevalence of induced abortions through unsupervised use of MAP and to identify socio-demographic and obstetric factors associated with these cases, reported to the All India Institute of Medical Sciences (AIIMS), Bhubaneswar.

Methods

This hospital-based cross-sectional study enrolled 81 female patients aged 14-49 years, presenting with complications of unsupervised medical abortions. Data were collected using Case Report Forms (CRFs) and analyzed using SPSS v20. Statistical associations were assessed with chi-square or Fisher’s exact tests.

Results

The prevalence of unsupervised medical abortions was 67 out of 81 (82.7%). Age of the subject was weakly associated with a number of abortions, but statistically significant (r = 0.238, p = 0.020). Socioeconomic status (χ2 = 12.96, df = 3, p = 0.011) and gravidity [Odds Ratio (OR) = 4.5, p=0.014] showed significant associations. 62 (76.5%) patients were multi-gravida, and incomplete abortions were found in 53 (79.1%) patients. The association of a number of offspring with self-inducement of medical abortion was weak but statistically significant (r = 0.336, p = 0.001). The number of years married were weakly correlated with the number of abortions, and statistically significant (r = 0.314, p = 0.003). Statistically significant higher incidence of pregnancy was confirmed by ultrasonography (χ2 = 6.94, df = 1, p <0.001). In 40 cases (59.7 %), husbands had brought MAP, and in 48 patients (71.6%), consent was taken from their husbands for medical abortion. Pearson chi-square value for association between outcome of MAP and gestational age for induction of abortion was 16.049, which was found to be statistically significant (p = 0.025). Mean days of gestation of the self-medicated group and facility-induced group were 44.76 ± 32.2 and 119.5 ± 21.7 days, respectively, for which association was found to be significant (χ2 = 36.7, df = 1, p < 0.001). Facility-induced abortions were primarily therapeutic (8 out of 14, 57.1%). Bleeding per vaginum was the most common presenting complaint, followed by abdominal pain.

Conclusion

Unsupervised use of MAP constitutes a significant proportion of induced abortions, driven by socioeconomic factors and limited access to regulated care. Incomplete abortions remain a critical issue. Strengthening regulatory measures, promoting awareness, and improving access to safe abortion services are imperative for reducing maternal morbidity and achieving sustainable health outcomes.