Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19

Gambir, Katherine; Garnsey, Camille; Necastro, Kelly Ann; Ngô, Thoại D.

doi:10.1136/bmjgh-2020-003934

Cited by 36 publications

(48 citation statements)

References 44 publications

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“…An analysis of more than 52 000 MA in the UK showed that the telemedicine‐hybrid model for care adopted in response to the pandemic was as effective, safe, acceptable and more accessible than conventional care provided in the first 3 months of 2020 ( 16 ). These findings align with other research showing that home-based and telemedicine first trimester MA are safe with high rates of efficacy and acceptability ( 17 , 18 ). Existing research in several high-income nations also suggests providers may be interested in maintaining the liberalized practice changes implemented since the beginning of the COVID-19 pandemic ( 19 , 20 ).…”

Section: Introductionsupporting

confidence: 91%

The perspective of Canadian health care professionals on abortion service during the COVID-19 pandemic

et al. 2021

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Background The COVID-19 pandemic and pandemic response created novel challenges for abortion services. Canada was uniquely positioned to transition to telemedicine because internationally common restrictions on abortion medication were removed before the pandemic. Objective We sought to characterize the experiences of abortion health care professionals in Canada during the COVID-19 pandemic and the impact of the pandemic response on abortion services. Methods We conducted a sequential mixed methods study between July 2020 and January 2021. We invited physicians, nurse practitioners and administrators to participate in a cross-sectional survey containing an open-ended question about the impact of the pandemic response on abortion care. We employed an inductive codebook thematic analysis, which informed the development of a second, primarily quantitative survey. Results Our initial survey had 307 respondents and our second had 78. Fifty-three percent were family physicians. Our first survey found respondents considered abortion access essential. We identified three key topicss: access to abortion care was often maintained despite pandemic-related challenges (e.g. difficulty obtaining tests, additional costs); change of practice to low-touch medication abortion care and provider perceptions of patient experience, including shifting demand, telemedicine acceptability and increased rural access. The second survey indicated uptake of telemedicine medication abortion among 89% of participants except in Quebec, where regulations meant procedures were nearly exclusively surgical. Restrictions did not delay care according to 76% of participants. Conclusions Canadian health care professionals report their facilities deemed abortion an essential service. Provinces and territories, except Quebec, described a robust pandemic transition to telemedicine to ensure access to services. Podcast An accompanying podcast is available in the Supplementary Data, in which the authors Dr Madeleine Ennis and Kate Wahl discuss their research on how family planning care and access to abortion services have changed during the COVID-19 pandemic.

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Section: Introductionsupporting

confidence: 91%

The perspective of Canadian health care professionals on abortion service during the COVID-19 pandemic

et al. 2021

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“…3 Several models for using telemedicine to facilitate medical abortion have been described but most existing trials are small, and many required attendances to have medicines administered, an ultrasound scan or blood tests. 7 , 38 Our study is the first to assess a real‐world no‐test telemedicine abortion care pathway in a national population. This new national model demonstrates how a permissive framework for medical abortion can deliver significant quality improvements to those needing to access abortion care.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness, safety and acceptability of no‐test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study

Aiken

Lohr

Lord³

et al. 2021

BJOG

190

192

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Objective To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine.Design Cohort analysis.Setting The three main abortion providers.Population or sample Medical abortions at home at ≤69 days' gestation in two cohorts: traditional model (in-person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine-hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no-test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally.Methods Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences.Main outcome measures Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability.Results Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine-hybrid model and more abortions were provided at ≤6 weeks' gestation (40% versus 25%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 0.796) were not different between models. In the telemedicine-hybrid model, 0.04% were estimated to be over 10 weeks' gestation at the time of the abortion; all were completed safely at home. Within the telemedicine-hybrid model, effectiveness was higher with telemedicine than in-person care (99.2% versus 98.1%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine.Conclusions A telemedicine-hybrid model for medical abortion that includes no-test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care.

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“…Some posters described self-managed techniques versus clinical venues for abortion care. While receiving and using medication abortion by mail can be safe, effective, and affordable [33,34], it is not legally sanctioned in the U.S. While some people seeking abortion may prefer mail-based services to abortion clinics even if they can access and afford both, Reddit posts documented that the costs and logistics of in-clinic abortions may back people into illegal services such as Aid Access.…”

Section: Discussionmentioning

confidence: 99%

Real-Time Effects of Payer Restrictions on Reproductive Healthcare: A Qualitative Analysis of Cost-Related Barriers and Their Consequences among U.S. Abortion Seekers on Reddit

Higgins

Lands

Valley

et al. 2021

IJERPH

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Objective: The Hyde Amendment and related policies limit or prohibit Medicaid coverage of abortion services in the United States. Most research on cost-related abortion barriers relies on clinic-based samples, but people who desire abortions may never make it to a healthcare center. To examine a novel, pre-abortion population, we analyzed a unique qualitative dataset of posts from Reddit, a widely used social media platform increasingly leveraged by researchers, to assess financial obstacles among anonymous posters considering abortion. Methods: In February 2020, we used Python to web-scrape the 250 most recent posts that mentioned abortion, removing all identifying information and usernames. After transferring all posts into NVivo, a qualitative software package, the team identified all datapoints related to cost. Three qualitatively trained evaluators established and applied codes, reaching saturation after 194 posts. The research team used a descriptive qualitative approach, using both inductive and deductive elements, to identify and analyze themes related to financial barriers. Results: We documented multiple cost-related deterrents, including lack of funds for both the procedure and attendant travel costs, inability to afford desired abortion modality (i.e., medication or surgical), and for some, consideration of self-managed abortion options due to cost barriers. Conclusions: Findings from this study underscore the centrality of cost barriers and third-party payer restrictions to stymying reproductive health access in the United States. Results may contribute to the growing evidence base and building political momentum focused on repealing the Hyde Amendment.

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Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19

Cited by 36 publications

References 44 publications

The perspective of Canadian health care professionals on abortion service during the COVID-19 pandemic

The perspective of Canadian health care professionals on abortion service during the COVID-19 pandemic

Effectiveness, safety and acceptability of no‐test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study

Real-Time Effects of Payer Restrictions on Reproductive Healthcare: A Qualitative Analysis of Cost-Related Barriers and Their Consequences among U.S. Abortion Seekers on Reddit

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