School of Public Health, University of Alberta, 3-330 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
Department of Sociology, University of Alberta, 6-14 Henry Marshall Tory Building, Edmonton, AB T6G 2H4.
Eur J Obstet Gynecol Reprod Biol. 2020 Jun;249:21-31. doi: 10.1016/j.ejogrb.2020.04.003. Epub 2020 Apr 8.
Globally, a growing proportion of induced abortions are medical abortions. The procedure has been hailed as a revolutionary technology, which, according to experts, has the potential to transform women's experiences of abortion and the way abortion services are accessed. Noticeably absent in the discourse, however, are women's voices. More specifically, there is a lack of understanding about what shapes women's preferences for medical abortion and the challenges they experience in accessing the drugs for the procedure. We conducted a systematic review of the literature to draw attention to these important issues which exist, but are often embedded within research highlighting other dominating aspects of medical abortions. A comprehensive search of four databases - supplemented by searching reference sections of selected articles, tracking their citations, and hand searching special editions on medical abortion - was conducted. A total of 45 peer-reviewed studies met our inclusion criteria. The studies were assessed for quality and analyzed using a critical interpretive synthesis approach. The findings revealed significant variations in women's preferences for surgical versus medical abortions. Country-specific abortion laws, implementing protocols, side-effects, rates of failures, and the need to verify the abortion shaped women's preference for abortion methods. Overall, women who preferred medical abortions did so because they perceived it as a 'natural' and safe procedure that can be self-conducted at home, thereby reducing their dependency on the health system. However, women face significant barriers to medical abortion care. These include legal requirements around type of provider, site of service, need for follow-up, providers' limited knowledge of the procedure, and preferences for surgical abortions. Borderless internet-based services have enabled some women to circumvent these barriers. Our review suggests that medical abortions are used by women either in countries where the health system is fully supportive or where the health system is completely disengaged, usually due to restricted abortion laws. In those countries where abortions are legal but often difficult to access due to health system barriers, women tend to prefer surgical abortions.
全球范围内，越来越多的人工流产是药物流产。该手术被誉为一项革命性的技术，专家认为它有可能改变女性的堕胎体验和获得堕胎服务的方式。然而，在相关讨论中却明显缺失了女性的声音。更具体地说，人们缺乏对女性选择药物流产偏好的形成因素以及她们在获取该手术药物时所面临的挑战的理解。我们对文献进行了系统回顾，以引起人们对这些重要问题的关注，这些问题虽然存在，但往往被嵌入在突出药物流产其他主导方面的研究中。我们全面检索了四个数据库——并通过检索选定文章的参考文献部分、跟踪其引用情况以及手动搜索关于药物流产的特刊来补充检索——共检索到 45 篇符合纳入标准的同行评议研究。对这些研究进行了质量评估，并使用批判性解释性综合方法进行了分析。研究结果表明，女性对手术流产和药物流产的偏好存在显著差异。各国的堕胎法、实施协议、副作用、失败率以及对堕胎的验证需求都影响了女性对堕胎方法的偏好。总体而言，更喜欢药物流产的女性之所以这样做，是因为她们认为这是一种“自然”且安全的手术，可以在家中自行进行，从而减少对医疗系统的依赖。然而，女性在获得药物流产护理方面面临着重大障碍。这些障碍包括对提供服务的提供者类型、服务地点、随访需求、提供者对该程序的有限了解以及对手术流产的偏好的限制。无边界的互联网服务使一些女性能够规避这些障碍。我们的综述表明，药物流产要么在医疗系统完全支持的国家使用，要么在医疗系统完全不参与的国家使用，通常是由于堕胎法限制所致。在那些堕胎合法但由于医疗系统障碍而难以获得的国家，女性往往更倾向于选择手术流产。
