Self-Managed vs. Provider-Managed Medical Abortion: A Review of Success and Safety
Table of Contents
A new analysis examines the effectiveness and safety of women managing their own early medical abortions compared to those managed by healthcare providers.
WASHINGTON, D.C.- A comprehensive review of 18 studies, including two randomized controlled trials (RCTs) and 16 non-randomized studies (NRSs), encompassing data from 11,043 women across 10 countries, has shed light on the effectiveness and safety of self-managed medical abortions compared to those administered under the supervision of healthcare providers. The studies focused on early medical abortions (≤ 9 weeks gestation).
The research, primarily conducted in low-to-middle income resource settings (16 studies), with two studies in high-resource settings, explored the landscape of medical abortion practices. Notably, one NRS study received analgesics from a pharmaceutical company, while funding sources for other studies varied, including anonymous donors, government agencies, private foundations, and non-profit bodies.
The analysis centered on interventions where women took mifepristone,often in the presence of a healthcare provider,followed by self-administration of misoprostol,typically at home.
Key findings: Success Rates and Ongoing Pregnancies
The review found no significant difference in the rates of successful abortions between the self-administered and provider-administered groups. Two RCTs showed a risk ratio (RR) of 0.99, with a 95% confidence interval (CI) of 0.97 to 1.01, based on 919 participants and moderate certainty of evidence. Sixteen NRSs also indicated a similar result, with an RR of 0.99, 95% CI 0.97 to 1.01, involving 10,124 participants, though with very low certainty of evidence.
“There is no evidence of a difference in rates of successful abortions between self-administered and provider-administered groups.”
Regarding ongoing pregnancies, the data suggested little to no difference between the two groups. One RCT reported an RR of 1.69,95% CI 0.41 to 7.02, with 735 participants and low certainty of evidence. Eleven NRSs showed an RR of 1.28, 95% CI 0.65 to 2.49, involving 6691 participants, with very low certainty evidence.
Complications Requiring Surgical Intervention
The review indicated uncertainty regarding differences in complications requiring surgical intervention due to the absence of RCTs. Evidence from three NRSs, assessed as very low certainty, showed an RR of 2.14, 95% CI 0.80 to 5.71, based on 2452 participants.
