Medication abortion care pathways and women's experiences in Oromia state, Ethiopia: A qualitative study

Despite Ethiopia's liberal abortion law, approximately half of abortions occur outside health facilities. Medication abortion (MA) use has increased dramatically, yet data on women's experiences - both facility-based and self-managed - remains limited. This study explored MA experiences in Oromia, Ethiopia through in-depth interviews with 20 post-abortion care clients across seven public facilities from August-October 2021. Most women (n=18) obtained MA from private clinics or pharmacies and self-managed at home. Seventeen participants used mifepristone/misoprostol combipacks, while three used misoprostol alone. Nearly all received minimal counseling on proper MA use. All participants ultimately sought post-abortion care due to concerning symptoms, most commonly heavier-than-expected bleeding. These findings highlight critical gaps in MA information and counseling in Ethiopia. Improving women's understanding of expected symptoms could significantly enhance MA experiences. This study offers rare evidence on self-managed abortion pathways in Ethiopia, providing valuable insights for stakeholders working to improve MA access, efficacy, and safety.