UK: Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic

This study involved a systematic search for randomized controlled trials and prospective cohort studies comparing home-based and clinic-based medical abortion. From Bulletin of the World Health Organisation. 

The study set out to compare medical abortion practised at home and in clinics in terms of effectiveness, safety and acceptability.

A systematic search for randomized controlled trials and prospective cohort studies comparing home-based and clinic-based medical abortion was conducted. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE and Popline were searched. Failure to abort completely, side-effects and acceptability were the main outcomes of interest. Odds ratios and their 95% confidence intervals (CIs) were calculated. Estimates were pooled using a random-effects model.

Nine studies met the inclusion criteria (n = 4522 participants). All were prospective cohort studies that used mifepristone and misoprostol to induce abortion. Complete abortion was achieved by 86-97% of the women who underwent home-based abortion (n = 3478) and by 80-99% of those who underwent clinic-based abortion (n = 1044). Pooled analyses from all studies revealed no difference in complete abortion rates between groups (odds ratio = 0.8; 95% CI: 0.5-1.5). Serious complications from abortion were rare. Pain and vomiting lasted 0.3 days longer among women who took misoprostol at home rather than in clinic. Women who chose home-based medical abortion were more likely to be satisfied, to choose the method again and to recommend it to a friend than women who opted for medical abortion in a clinic.

The authors concluded that home-based abortion is safe under the conditions in place in the included studies. Prospective cohort studies have shown no differences in effectiveness or acceptability between home-based and clinic-based medical abortion across countries.

The full text of this article is available to read for free here.

Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, England, UK.

Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review. Ngo TD, Park MH, Shakur H, Free C. Bulletin of the World Health Organisation. 2011 May 1;89(5):360-70. Epub 2011 Mar 4.