Self-administered versus provider-administered medical abortion

Area of Science:

• Reproductive Health
• Medical Interventions
• Evidence-Based Medicine

Background:

• Medical abortion offers improved access to safe procedures, utilizing mifepristone and misoprostol.
• Self-administered medical abortion allows women autonomy but raises questions about effectiveness and safety.
• Understanding self-administration is crucial, especially in resource-limited settings with provider shortages.

Purpose of the Study:

• To compare the effectiveness, safety, and acceptability of self-administered versus provider-administered medical abortion.
• To evaluate outcomes such as successful abortion and ongoing pregnancy.
• To assess the need for surgical intervention following medical abortion.

Main Methods:

• Searched multiple databases including Cochrane, MEDLINE, Embase, and Google Scholar up to July 2019.
• Included randomized controlled trials (RCTs) and prospective cohort studies comparing self-administered and provider-administered medical abortion.
• Performed meta-analysis on extracted data, assessing effectiveness (complete evacuation) and ongoing pregnancy, with heterogeneity and quality assessments (GRADE).

Main Results:

• No significant difference in successful abortion rates between self-administered and provider-administered groups (moderate certainty evidence from RCTs, very low from NRSs).
• Little or no difference in ongoing pregnancy rates, with low to very low certainty evidence.
• Uncertainty regarding differences in complications requiring surgical intervention due to lack of RCTs and very low certainty evidence from NRSs.

Conclusions:

• Self-administration of the second stage of early medical abortion is as effective as provider-administered procedures for abortion success.
• Evidence on ongoing pregnancy is uncertain, and evidence on complications requiring surgical intervention is of very low certainty.
• Insufficient evidence exists to determine the safety of self-administration compared to provider supervision; further research is needed on full self-administration protocols and support for women.