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

objective: to compare medical abortion practised at home and in clinics in terms of effectiveness, safety and acceptability. methods: 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. findings: 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. conclusion: 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.