Scoping review of research on self-managed medication abortion in low-income and middle-income countries

Abstract

Background: We undertook a scoping review of recent studies on self-managed medical abortion (MA) or abortion where some or all of the process is led independently by the person having the abortion, in low-income and middle-income countries (LMICs) to uncover evidence gaps and help stakeholders leverage existing evidence.

Methods: We searched five bibliographic databases for all articles published on MA between 2007 and July 2020 in LMICs. The search yielded 1294 articles. We identified 107 articles in which one or more of the three WHO-defined subtasks for MA was self-led outside of a clinic setting, and use of drugs that are part of safe, evidence-based regimens was related to the study exposure or outcome. We classified these studies by subject area, study design, country, legal context, gestational age and other categories.

Results: The 107 studies covered research in 44 countries, of which 18 have liberal abortion laws. Seventy- four articles reported on quantitative research methods, of which 14 were randomised controlled trials. Fifty-two studies focused on MA in the first trimester. Sixty-two focused on WHO subtask two (drug administration) and 32 focused on subtask three (assessing and managing abortion completion). We found little research on self-management of the entire MA process, innovative approaches to supporting self-managed MA or the needs of underserved populations.

Conclusion: We recommend syntheses of evidence on safety and efficacy of self-managed MA and preferences of people undergoing self-managed MA. We also encourage new research on topics including self-management of the entire process, the needs and experiences of underserved populations and innovative approaches to supporting people undertaking self-managed MA. The time is opportune for amplifying and expanding evidence to inform programmes and policies on self-care.

Keywords: maternal health; review.

Figure 1

Scoping review screening process.

Figure 2

Included articles by topic area*. *Studies could be classified into more than one subtask or other topic area.

Figure 3

Legal context by number of studies. Nine papers covered more than one country and were counted once for each country they were set in. Two papers describing results from Mexico City have been counted separately, as Mexico City has a more liberal legal context than the rest of Mexico. One study took place on the Thailand-Burma border; we have counted it once toward each country. (We use the terminology ‘Burma’ as used by the authors of the two papers that took place there.) One paper described the global abortion context, it is not counted it here. One study covered Moldova, Mexico and USA, but we have excluded USA from the LMIC country counts. LMIC, low-income and middle-income countries.

Figure 4

Number of included articles, by year over the study period.