Perils of self-managed medical abortion: an observational study in aspirational district Fatehpur, Uttar Pradesh, India

Abstract

Background

Despite legislation governing medical termination of pregnancy (MTP), many women self-administer MTP pills

without medical supervision. This study aims to investigate the maternal morbidity and mortality associated with

the use of self-managed abortion pills and the various factors contributing to their misuse.

Methodology

We conducted a prospective, hospital-based observational study at Amar Shaheed Jodha Singh Attaiya Thakur

Dariyaon Singh Medical College, Fatehpur, Uttar Pradesh. Eligible women were consecutively enrolled during

routine clinical care between 1 July 2024 and 30 June 2025. Two hundred thirty-nine pregnant women who reported

to the outpatient department (OPD) or the emergency room with a history of taking the MTP pill (mifepristone–

misoprostol combination) without a valid medical prescription, whether procured by themselves or by another

person over the counter, were included in the study.

Results

Of 239 participants, most (76.15%) were aged 20–30 years. Over half (55.23%) were from rural areas, and 53.97%

belonged to the middle class. The majority (64.02%) had two or more children, and 61.51% had vaginal deliveries.

At the time of taking the MTP pill, 64.01% were under 12 weeks pregnant. Nearly one-third (31.80%) sought hospital

care more than 30 days after taking the pill. Severe anemia occurred in 21 participants, while 3 required ICU care, 3

developed sepsis, and 1 underwent laparotomy for ectopic pregnancy or perforation. No maternal deaths were

reported. Only 40.59% assessed their eligibility for medical abortion, and awareness of possible complications was

low (12.97%).

Conclusion

Using MTP pills without medical supervision can lead to severe and potentially life-threatening complications. It is

imperative to restrict easy and unrestricted access to these medications, necessitating the implementation of

stringent regulations targeting both individuals seeking the pills and those providing them.