Independent Consultant in Reproductive and Sexual Health, Calle Agrarismo 65, Colonia Escandón II, Delegación Miguel Hidalgo, CP11800, Mexico City, Mexico.
Reprod Health. 2021 Feb 8;18(1):30. doi: 10.1186/s12978-021-01081-3.
Although medication abortion has become more common in high-income countries, the procedure has not yet met early expectations for widening access to abortion. High-quality evidence can serve as a catalyst for changes in policy and practice. To direct research priorities, it is important to understand where quality evidence is concentrated and where gaps remain. High-income countries have developed a body of evidence that may have implications for the future of medication abortion. This literature review assesses the characteristics and quality of published studies on medication abortion conducted in the last 10 years in high-income countries and indicates future areas for research to advance policy and practice, and broaden access.
A structured search for literature resulted in 207 included studies. A framework based upon the World Health Organization definition of sub-tasks for medication abortion was developed to categorize research by recognized stages of the medication abortion process. Using an iterative and inductive approach, additional sub-themes were created under each of these categories. Established quality assessment frameworks were drawn upon to gauge the internal and external validity of the included research.
Studies in the US and the UK have dominated research on MA in high-income countries. The political and social contexts of these countries will have shaped of this body of research. The past decade of research has focused largely on clinical aspects of medication abortion.
Researchers should consider refocusing energies toward testing service delivery approaches demonstrating promise and prioritizing research that has broader generalizability and relevance outside of narrow clinical contexts. Although medication abortion is more commonly available worldwide, it is not being used as often as people thought it would be, particularly in high income countries. In order to encourage changes in policy and practice that would allow greater use, we need good quality evidence. If we can understand where we do not have enough research and where we have good amounts of research, we can determine where to invest energies in further studies. Many high-income countries have produced research on medication abortion that could influence policy and practice in similarly resourced contexts. I conducted a literature review to be able to understand the type and quality of research on medication abortion conducted in high-income countries in the past 10 years. I conducted the review in an organized way to make sure that the papers reviewed discussed studies that I thought would be important for answering this question. The literature review found 207 papers. Each of these papers were reviewed and organized them by theme. I also used existing methods to determinine the quality of each study. Most of the research came from the US and the UK. Furthermore, most of the research conducted in the past 10 years was focused on clinical studies of medication abortion. In future studies, researchers should focus more on new ways of providing medication abortion to women that offers greater access. Also, the studies should be designed so that the results have meaning for a broader group of people or situations beyond where the study was done.
尽管药物流产在高收入国家已经变得更为常见，但该程序仍未达到扩大堕胎服务的早期预期。高质量的证据可以成为推动政策和实践变革的催化剂。为了明确研究重点，了解高质量证据集中的地方和仍存在差距的地方非常重要。高收入国家已经积累了一套可能对未来药物流产产生影响的证据。本文献综述评估了过去 10 年在高收入国家开展的关于药物流产的已发表研究的特点和质量，并指出了未来在推进政策和实践以及扩大服务对象方面开展研究的领域。
通过有针对性的文献搜索，共纳入 207 项研究。根据世界卫生组织对药物流产子任务的定义，建立了一个框架，以根据药物流产过程的公认阶段对研究进行分类。使用迭代和归纳的方法，在这些类别下创建了其他子主题。利用既定的质量评估框架来评估纳入研究的内部和外部有效性。
美国和英国的研究在高收入国家的药物流产研究中占据主导地位。这些国家的政治和社会背景将塑造这方面的研究。过去十年的研究主要集中在药物流产的临床方面。
研究人员应考虑将精力重新集中在具有发展前景的服务提供方法的测试上，并优先考虑具有更广泛的普遍性和除了狭隘的临床背景之外的相关性的研究。尽管药物流产在全球范围内更为普遍，但它的使用频率并不像人们预期的那么高，特别是在高收入国家。为了鼓励政策和实践的改变，以允许更多的使用，我们需要高质量的证据。如果我们能够了解我们缺乏研究的地方和我们有大量研究的地方，我们就可以确定在哪里投入精力进行进一步的研究。许多高收入国家已经开展了关于药物流产的研究，这些研究可能会影响类似资源背景下的政策和实践。我进行了一项文献综述，以了解过去 10 年在高收入国家进行的关于药物流产的研究的类型和质量。我以有组织的方式进行了综述，以确保所审查的论文讨论了我认为对回答这个问题很重要的研究。文献综述共发现 207 篇论文。对每篇论文进行了审查，并根据主题进行了组织。我还使用现有的方法来确定每项研究的质量。大部分研究来自美国和英国。此外，过去 10 年开展的大部分研究都集中在药物流产的临床研究上。在未来的研究中，研究人员应该更加关注为更多需要药物流产的女性提供新的服务方式，从而提供更大的服务机会。此外，研究设计应使研究结果对更广泛的人群或超出研究地点的情况具有意义。
