title: Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review.
abstract: 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, England, UK. Thoai.Ngo@lshtm.ac.uk
authors.forename: Thoai D
authors.initials: TD
authors.lastname: Ngo
authors.forename: Min Hae
authors.initials: MH
authors.lastname: Park
authors.forename: Haleema
authors.initials: H
authors.lastname: Shakur
authors.forename: Caroline
authors.initials: C
authors.lastname: Free
mesh_terms: D000021:Abortifacient Agents, Steroidal / Q000627:therapeutic use; D000028:Abortion, Induced / Q000009:adverse effects* / Q000379:methods*; D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D057186:Comparative Effectiveness Research; D004359:Drug Therapy, Combination; D005260:Female; D006699:Home Care Services; D006801:Humans; D008875:Middle Aged; D015735:Mifepristone / Q000627:therapeutic use; D016595:Misoprostol / Q000627:therapeutic use; D017060:Patient Satisfaction; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone