Reducing the Harms of Unsafe Abortion: A Systematic Review of the Safety, Effectiveness and Acceptability of Harm Reduction Counselling for Pregnant Persons Seeking Induced Abortion

Authors

Bianca Maria Stifani, Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, USA bianca.stifani@wmchealth.org.
Roopan Gill, Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada.
Caron Rahn Kim, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.

Author Type(s)

Faculty

DOI

10.1136/bmjsrh-2021-201389

Journal Title

BMJ Sexual & Reproductive Health

First Page

137

Last Page

145

Document Type

Article

Publication Date

4-1-2022

Department

Obstetrics and Gynecology

Abstract

BACKGROUND: Globally, access to safe abortion is limited. We aimed to assess the safety, effectiveness and acceptability of harm reduction counselling for abortion, which we define as the provision of information about safe abortion methods to pregnant persons seeking abortion. METHODS: We searched PubMed, EMBASE, ClinicalTrials.gov, Cochrane, Global Index Medicus and the grey literature up to October 2021. We included studies in which healthcare providers gave pregnant persons information on safe use of abortifacient medications without providing the actual medications. We conducted a descriptive summary of results and a risk of bias assessment using the ROBINS-I tool. Our primary outcome was the proportion of pregnant persons who used misoprostol to induce abortion rather than other methods among those who received harm reduction counselling. RESULTS: We included four observational studies with a total of 4002 participants. Most pregnant persons who received harm reduction counselling induced abortion using misoprostol (79%-100%). Serious complication rates were low (0%-1%). Uterine aspiration rates were not always reported but were in the range of 6%-22%. Patient satisfaction with the harm reduction intervention was high (85%-98%) where reported. We rated the risk of bias for all studies as high due to a lack of comparison groups and high lost to follow-up rates. DISCUSSION: Based on a synthesis of four studies with serious methodological limitations, most recipients of harm reduction counselling use misoprostol for abortion, have low complication rates, and are satisfied with the intervention. More research is needed to determine abortion success outcomes from the harm reduction approach. FUNDING: This work did not receive any funding. PROSPERO REGISTRATION NUMBER: We registered the review in the PROSPERO database of systematic reviews (ID number: CRD42020200849).

Recommended Citation

Stifani, B. M., Gill, R., & Kim, C. R. (2022). Reducing the Harms of Unsafe Abortion: A Systematic Review of the Safety, Effectiveness and Acceptability of Harm Reduction Counselling for Pregnant Persons Seeking Induced Abortion. BMJ Sexual & Reproductive Health, 48 (2), 137-145. https://doi.org/10.1136/bmjsrh-2021-201389