Effectiveness, safety, and acceptability of medical abortion at home vs. in the clinic: An updated systematic review in response to COVID-19

BackgroundIncreased access to home-based medical abortion may offer women a convenient, safe and effective abortion method, reduce burdens on healthcare systems and support social distancing during the COVID-19 pandemic. Home-based medical abortion is defined as any abortion where mifepristone, misoprostol or both medications are taken at home.MethodsA systematic review and meta-analysis of randomised controlled trials (RCTs) and non-randomised studies (NRSs) were conducted. We searched databases from inception to 10 July 2019 and 14 June 2020. Successful abortion was the main outcome of interest. Eligible studies were RCTs and NRSs studies with a concurrent comparison group comparing home versus clinic-based medical abortion. Risk ratios (RRs) and their 95% CIs were calculated. Estimates were calculated using a random-effects model. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess risk of bias by outcome and to evaluate the overall quality of the evidence.ResultsWe identified 6277 potentially eligible published studies. Nineteen studies (3 RCTs and 16 NRSs) were included with 11 576 women seeking abortion up to 9 weeks gestation. Neither the RCTs nor the NRS found any difference between home-based and clinic-based administration of medical abortion in having a successful abortion (RR 0.99, 95% CI 0.98 to 1.01, I2=0%; RR 0.99, 95% CI 0.97 to 1.01, I2=52%, respectively). The certainty of the evidence for the 16 NRSs was downgraded from low to very low due to high risk of bias and publication bias. The certainty of the evidence for the three RCTs was downgraded from high to moderate by one level for high risk of bias.ConclusionHome-based medical abortion is effective, safe and acceptable to women. This evidence should be used to expand women’s abortion options and ensure access to abortion for women during COVID-19 and beyond.PROSPERO registration numberCRD42020183171.

show abstract

“…The protocol for this review was published on 5 May 2020, DOI: https://doi.org/10.7910/DVN/NPG1GK/E5XNMJ 18 …”

Section: Methodsmentioning

confidence: 99%

“…org/ 10. 7910/ DVN/ NPG1GK/ E5XNMJ 18 Data analysis Three independent reviewers (KG, KAN, CG) extracted data from eligible studies using a data abstraction form the review authors designed and piloted. Reviewers requested data from study authors via email as needed.…”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

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

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

Is the Right to Abortion at Risk in Times of COVID-19? The Italian State of Affairs within the European Context

et al. 2021

View full text Add to dashboard Cite

The COVID-19 health emergency has thrown the health systems of most European countries into a deep crisis, forcing them to call off and postpone all interventions deemed not essential or life-saving in order to focus most resources on the treatment of COVID-19 patients. To facilitate women who are experiencing difficulties in terminating their pregnancies in Italy, the Ministry of Health has adapted to the regulations in force in most European countries and issued new guidelines that allow medical abortion up to 63 days, i.e., 9 weeks of gestational age, without mandatory hospitalization. This decision was met with some controversy, based on the assumption that the abortion pill could “incentivize” women to resort to abortion more easily. In fact, statistical data show that in countries that have been using medical abortion for some time, the number of abortions has not increased. The authors expect that even in Italy, as is the case in other European countries, the use of telemedicine is likely to gradually increase as a safe and valuable option in the third phase of the health emergency. The authors argue that there is a need to favor pharmacological abortion by setting up adequately equipped counseling centers, as is the case in other European countries, limiting hospitalization to only a few particularly complex cases.

show abstract

Effectiveness, safety, and acceptability of medical abortion at home vs. in the clinic: An updated systematic review in response to COVID-19

Cited by 2 publications

References 0 publications

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

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

Is the Right to Abortion at Risk in Times of COVID-19? The Italian State of Affairs within the European Context

Contact Info

Product

Resources

About