Bulletin of the World Health Organization

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

Thoai D Ngo, Min Hae Park, Haleema Shakur & Caroline Free

Volume 89, Number 5, May 2011, 360-370

Table 2. Studies comparing home-based and clinic-based medical abortion included in systematic review

Study Mifepristone dose (mg); misoprostol dose (µg), [supplementary dose]; routea No. of women recruited (no. lost to follow up)
Complete abortion, no. (%)
Complete abortion, OR (95% CI)b Maximum gestational age (days) Contact with health services Women accompanied during home administration of misoprostol (%) Comparative participant characteristics at baseline
H C H C
Akin et al. 2004,9 Turkey 200; 400; oral 104 (4) 104 (3) 92 (88.5) 83 (79.8) 1.94 (0.90–4.18) 56 11.5% of clinic users vs 3.8% of home users made unscheduled clinic visits (P < 0.04) 55 No difference in age, education, marital status (married: n = 98 home; n = 96 clinic), gestational age, gravidity or abortion history
Bracken et al. 2006,24 Albania 200; 400; oral 361; 6 48 (1) 345 (97.2) 46 (97.9) 0.94 (0.21–4.21) 56 4.2% of women made unscheduled clinic visits, no difference between groups; 27.1% called hotline, no difference between groups 67.8 No difference in age, education, marital status (married: n = 260 home; n = 36 clinic), gestational age, gravidity or abortion history
Bracken et al. 2010,25 India 200; 400; oral 530 (21) 69 (3) 453 (85.5) 61 (88.41) 0.77 (0.36–1.68) 56 Not reported 84.2 No difference in gestational age, gravidity or abortion history. Home users were 1.6 y older than clinic users on average (P = 0.008); marital status not reported
Dagousset et al. 2004,26 France 600; 400 [400]; oral 120 (0) 289 (0) 114 (95) 286 (99)* 0.20 (0.05–0.81) 49 21.7% of home users called gynaecologist All women (inclusion criterion) Home users were older and more educated and fewer of them were primigravida; marital status not reported
Elul et al. 2001,27 Viet Nam 200; 400; oral 106 (8) 14 (0) 102 (96) 11 (80) 6.96 (1.38–35.18) 56 27% of clinic users vs 31% of home users made unscheduled clinic visits; 7% of clinic users vs 8% of home users called the clinic 78 No comparison reported; marital status not reported
Elul et al. 2001,27 Tunisia 200; 400; oral 170 (4) 25 (0) 158 (93) 22 (88) 1.80 (0.47– 6.87) 56 18% of clinic users vs 8% of home users made unscheduled clinic visits; 24% of clinic users vs 18% of home users called the clinic 76 No comparison reported; marital status not reported
Hajri et al. 2004,28 Tunisia 200; 400; oral 241 (9) 82 (0) 233 (96.7) 76 (92.7) 2.30 (0.77–6.84) 56 12.3% of clinic users vs 5.4% of home users made unscheduled clinic visits; 18.5% of clinic users vs 14.6% of home users called study hotline ~75 No difference in age, marital status (married: n = 193 home; n = 193 clinic), gestational age, parity or abortion history. Home users were more educated than clinic users by an average of 1.4 y (P = 0.02)
Karki et al. 2009,29 Nepal 200; 400; oral 323 (31) 77 (2) 267 (91.4) 68 (90.7) 0.63 (0.30–1.34) 56 16.9% of clinic users vs 11.1% of home users made unscheduled clinic visits; 20.8% of clinic users vs 19.5% of home userscalled the clinic hotline 77.9 Similar in age, education, gestational age and abortion history (no statistical test reported); marital status not reported
Ngoc et al. 2004,30 Viet Nam 200; 400; oral 1380 (24) 174 (0) 1231 (88.6) 164 (94.3)* 0.50 (0.26–0.98) 56 4.6% of clinic users vs 9.0% of home users made unscheduled clinic visits (P = 0.047); 6.9% of clinic users vs 15.5% of home users called hotline (P = 0.002) 73.4 No difference in age, marital status (married: n = 1 244 home; n = 158 clinic) and abortion history. Home users were more educated (< 0.001), had lower maximum gestational age (0.001) and higher gravidity (< 0.001), and fewer of them were primigravida (0.001)
Provansal et al. 2009,31 France 600; 400 [400]; oral 143 (30) 162 (64) 124 (86.7) 155 (95.8)* 0.30 (0.12– 0.72) 49 Not reported All women (inclusion criterion) No difference in abortion history. Home users were older (P < 0.001) and had higher gravidity (< 0.001) and higher parity (P < 0.001); fewer of them were primigravida (< 0.01). Marital status not reported
Total 3478 1044 3119 (89.7) 972 (93.1)

C, clinic; CI, confidence interval; H, home; OR, odds ratio; *P < 0.05.

a Delay to misoprostol is 48 hours except in Provansal et al. (36–48 hours) and Dagousset et al. (unspecified); supplementary dose of misoprostol administered to women in clinic-based groups if no expulsion of product within 3 hours of first misoprostol dose.

b Odds ratio: odds of complete abortion without surgery in women who used home-based relative to the odds in women who underwent clinic-based abortion.