BACKGROUND: Abortions are common and associated with procedural pain. We aimed to evaluate benefits and harms of local anaesthesia given for pain control during surgical abortion at less than 14 weeks\' gestation.
METHODS: We searched a systematic review on local anaesthesia for pain control for surgical abortion at less than 14 weeks\' gestation using uterine aspiration. We searched multiple databases through December 2022. We evaluated study quality using the Cochrane Risk of Bias 2 (RoB2) instrument and assessed the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Outcomes included intraoperative pain (with dilation, aspiration or procedure), patient satisfaction and adverse events.
RESULTS: Thirteen studies with 1992 participants met the inclusion criteria and the majority were judged as low risk of bias. Intervention protocols were heterogeneous, limiting meta-analysis. A 20 mL 1% lidocaine paracervical block (PCB) reduced pain with dilation compared with sham PCB (mean difference (MD) -37.00, 95% CI -45.64 to -28.36) and aspiration (MD -26.00, 95% CI -33.48 to -18.52; 1 randomised controlled trial (RCT), n=120; high-certainty evidence). A PCB with 14 mL 1% chloroprocaine was associated with a slight reduction in pain during aspiration compared with normal saline PCB injected at two or four sites (MD -1.50, 95% CI -2.45 to -0.55; 1 RCT, n=79; high-certainty evidence). Other RCTs compared a range of local anaesthetic types, PCB techniques and topical anaesthetics. Participants reported moderately high satisfaction with any type of pain control and studies reported few adverse events that were rarely medication-related.
CONCLUSIONS: RCT evidence supports PCB efficacy but was inconsistent and of low certainty for topical anaesthesia.

Violent social and political conflicts have caused several challenges to internally displaced persons (IDPs), especially girls and young women, among which is sexual violence (SV). Despite extensive records on SV in humanitarian contexts, studies to assess the level, examine the disclosure pattern (DP) and evaluate the availability of abortion care in these settings have received inadequate attention. This scoping review sought to synthesise the current African-based research on SV, DP, and abortion and post-abortion care (APAC) in humanitarian contexts. We conducted a systematic search of five databases: MEDLINE, PubMed, Scopus, Embase and Google Scholar, where the articles retrieved met the criteria for inclusion. The review adhered to PRISMA guidelines and the Critical Appraisal Skills Programme (CASP), containing ten questions to help confirm the validity of the research design and the originality of the results in comparison with similar studies. A series of inclusion and exclusion criteria were applied after the search, and 35 eligible articles from ten African countries with evidence of sexual violence, disclosure patterns, and APAC in camp settings were included in the study. Results described situations of SV in humanitarian settings in Africa as \"terrible\", \"bad\", \"an epidemic\", and \"severe\" as girls were used as sex objects, for profile enhancement and as a weapon of war. We also found that the illegality of APAC in Africa is causing a high occurrence of clandestine abortions in conflict contexts. Disclosing SV among IDPs in Africa did not follow a clear-cut pattern but was generally determined by socio-demographic characteristics. Sexual health is a fundamental right of all, as enshrined in SDG 3, which makes this topic a major public health issue. We therefore conclude that although disclosure may aggravate stigmatisation in some instances due to adverse reactions, it is still crucial to the healing processes.

This article is a systematic review (SR) and meta-analysis (MA) whose objective was to identify the association between induced abortion and the development of depression, based on the Cochrane guidelines for SRs. A systematic search was carried out in the WoS, PubMed and Scopus databases. Retrospective and prospective cohort studies, carried out until November 2020, that evaluated a population of women in childbearing age (12 to 46 years) with at least 1 induced and/or provoked abortion, including pharma-cological and surgical abortion. Only studies with healthy women at the beginning of the research were included, i.e., with absence of psychiatric pathology prior to induced abor-tion. The quality of the included studies was measured with the Newcastle-Ottawa Scale (NOS), and for the MA random-effects models were specified using the DerSimonian & Laird method, grouping them into follow-up after abortion before and after one year. The results of the SR were measured with relative risk (RR), hazard ratio (HR), odds ratio (OR), and the chi-square test, which assessed the intensity of the statistical relationship between population and exposure. Systematic review demonstrated an OR of 1.38 (95% CI 1.14-1.68) of depression after induced abortion. Meta-analysis demonstrated a statis-tically significant association between depression and induced abortion when the as-sessment after one year was performed OR: 1.37 (95% CI 1.09-1.71). The risks, harms and mental health consequences of induced abortion, such as depression, should be in-vestigated and warned.
El presente artículo es una revisión sistemática (RS) y metaanálisis (MA) cuyo objetivo fue identificar la asociación entre el aborto inducido y el desarrollo de depresión, con base en los lineamientos Cochrane para RS. Se hizo la búsqueda sistemática en las bases de datos WoS, PubMed y Scopus. Se incluyeron estudios de cohorte retrospectivos y prospectivos, hasta noviembre de 2020, que evaluaron una población de mujeres en edad fértil (12 a 46 años) con al menos un aborto inducido o provocado, incluido el aborto farmacológico y el quirúrgico. Solo se incluyeron estudios con mujeres sanas al inicio de la investigación, es decir, con ausencia de patología psiquiátrica previa al aborto inducido. La calidad de los estudios incluidos se midió con la Newcastle-Ottawa Scale (NOS) y para el MA se especificaron modelos de efectos aleatorios con el método de DerSimonian & Laird y se agruparon en seguimiento posterior al aborto antes y después de un año. Los resultados de la RS fueron medidos con riesgo relativo (RR), hazard ratio (HR), odds ratio (OR) y la prueba de chi cuadrado, que valoraron la intensidad de la relación estadística entre la población y la exposición. La RS demostró un OR 1.38 (IC 95% 1.14-1.68) de depresión tras el aborto inducido. El MA demostró una asociación estadísticamente significativa entre la depresión y el aborto inducido cuando se hizo la evaluación posterior a un año OR: 1.37 (IC 95% 1.09-1.71). Se deberían investigar y advertir los riesgos, daños y consecuencias en la salud mental, como la depresión, tras el aborto inducido.

OBJECTIVE: The last decade has seen a cascade of different telemedicine models for medical abortion (MA) being tested and implemented. Among these service delivery models is the \'no-test\' MA model, in which care is provided remotely and eligibility for the MA is based on history alone. The purpose of this review is to provide an overview of the existing evidence for no-test MA.
RESULTS: The evidence base for no-test MA relies heavily on cohort and noncomparative studies predominantly from high resource settings. Recent findings indicate that no-test MA is safe, effective, and highly acceptable. Diagnoses of ectopic pregnancy and underestimation of gestational age were rare. Identified advantages included shortening time to access MA and mitigating access barriers such as cost, and geographical barriers. Abortion seekers valued omitting the ultrasound citing reasons such as privacy concerns, costs, more flexibility, and control. The impacts of no-test MA on unscheduled postabortion contacts and visits and on contraceptive use were unclear due to limited evidence.
CONCLUSIONS: No-test MA can be provided to complement other care pathways including those with some or no in-person care. Further research is needed to allow for widespread adoption of no-test MA and scale-up in a variety of contexts, including low-resource settings.

BACKGROUND: Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women\'s Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021.
OBJECTIVE: This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care.
METHODS: We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic\'s policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits.
RESULTS: We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US $259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available.
CONCLUSIONS: Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available.

OBJECTIVE: Early abortion increasingly is provided in the primary care setting, allowing improved access, continuity of care, and contraception, if desired. We aimed in this retrospective chart review to describe postabortion contraception provision in a family medicine office.
METHODS: Participants were those patients who obtained an induced abortion during an 11-year period at a family medicine office. We documented contraception provision within 30 days of abortion and used simple proportions, Fisher exact tests, and χ2 tests to describe differences in contraceptive provision by type of abortion and continuity status.
RESULTS: Most of the patients who underwent abortions (254/353, 72%) had documentation of a contraceptive method within 30 days of abortion, which was similar for patients who had either a medication (124/166, 75%) or an aspiration abortion (130/187, 70%, P = 0.71). The most common contraceptives were contraceptive pills (104/353, 29%) or intrauterine devices (68/353, 19%). Patients who chose a tier 1 method were more likely to have a procedure abortion (50/87, 57%), whereas patients who chose a tier 2 method were likely to have a medication abortion (83/160, 52%). Fewer than half (45%, 158/353, P = 0.0002) were continuity patients and established patients in the primary care office. Most tier 1 contraceptive users were continuity patients (49/87, 60%), whereas most patients without a contraceptive method were noncontinuity patients (72/99, 73%).
CONCLUSIONS: The primary care setting is uniquely equipped for providing early abortion and postabortion contraception. Although the providers offered all contraceptive options to eligible patients, continuity patients were more likely to receive more effective contraception in their primary care office.

OBJECTIVE: Given Iran\'s recent shift towards pronatalist population policies, concerns have arisen regarding the potential increase in abortion rates. This review study examines the trends of (medical), intentional (illegal), and spontaneous abortions in Iran over the past two decades, as well as the factors that have contributed to these trends.
METHODS: This paper reviewed research articles published between 2005 and 2022 on abortion in Iran. The study employed the PRISMA checklist for systematic reviews. Articles were searched from international (Google Scholar, PubMed, Science Direct, and Web of Science) and national databases (Magiran, Medlib, SID). Once the eligibility criteria were applied, 42 records were included from the initial 349 records.
RESULTS: Abortion is influenced by a variety of socioeconomic and cultural factors and the availability of family planning services. Factors that contribute to unintended pregnancy include attitudes toward abortion, knowledge about reproductive health, access to reproductive health services, and fertility desires, among others. In addition to health and medical factors, consanguineous marriage plays an important role in spontaneous and therapeutic abortion. A higher number of illegal abortions were reported by women from more privileged socioeconomic classes. In comparison, a higher number of medical and spontaneous abortions were reported by women from less privileged socioeconomic classes.
CONCLUSIONS: Iranian policymakers are concerned about the declining fertility rate and have turned to pronatalist policies. From a demographic standpoint, this seems to be a reasonable approach. However, the new population policies, particularly, the Family Protection and Young Population Law, along with creating limitations in access to reproductive health services and prenatal screening tests as well as stricter abortion law could potentially lead to an increase in various types of abortions and their associated consequences.

BACKGROUND: Induced abortion is one of the most common gynecological procedures in the world, with as many as three in every ten pregnancies ending in abortion. It, however, remains controversial. The objective of this scoping review was to explore and map existing literature on the experiences of those who provide abortion care.
RESULTS: This exploratory review followed the Levac et al. guidelines and was reported in accordance with the PRISMA-ScR checklist. CINAHL, Cochrane, EMBASE, PsycInfo, PubMed, and Web of Science were used to identify peer-reviewed, original research articles published on providers\' experience of abortion. We identified 106 relevant studies, which include a total sample of 4,250 providers from 28 countries and six continents. Most of the studies were qualitative (n = 83), though quantitative (n = 15) and mixed methods (n = 8) studies were also included. We identified two overarching themes: (1) Providers\' experiences with abortion stigma and (2) Providers\' reflections on their abortion work. Our findings suggest that providers from around the world experience challenges within society and their communities and workplaces which reinforce the stigmatization and marginalization of abortion and pose questions about the morality of this work. Most, however, are proud of their work, believe abortion care to be socially important and necessary, and remain committed to the provision of care.
CONCLUSIONS: The findings of this review provide a comprehensive overview on the known experiences of providing abortion care. It is a key point of reference for international providers, researchers, and advocates to further this area of research or discussion in their own territories. The findings of this review will inform future work on how to support providers against stigmatization and will offer providers the chance to reflect on their own experiences.

BACKGROUND: However, misoprostol is often used to terminate a pregnancy, but it can also cause side effects. Isosorbide mononitrate (ISMN) can help the cervix mature by increasing the production of prostaglandin E2 and vasodilation. Considering that the results of studies in this field are contradictory, it is the purpose of this study to evaluate the efficacy and safety of vaginal ISMN plus misoprostol compared to misoprostol alone in the management of first- and second-trimester abortions.
METHODS: The search process was conducted for MEDLINE through the PubMed interface, Scopus, Web-of-Science, Science Direct, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform until November 10, 2023. Our assessment of bias was based on version 2 of the risk-of-bias tool (RoB2) for randomized trials and our level of evidence quality was determined by GRADE. Meta-analysis of all data was carried out using Review Manager (RevMan) version 5.1.
RESULTS: Seven randomized clinical trials were included in the systematic review and three in the meta-analysis, with mixed quality. The results of the meta-analysis revealed that in the second-trimester abortion, the inclusion of ISMN in conjunction with vaginal misoprostol results in a noteworthy reduction in the induction abortion interval, specifically by 4.21 h (95% CI: -7.45 to -0.97, P = 0.01). The addition of vaginal ISMN to misoprostol, compared to vaginal misoprostol alone, increased the odds of a completed abortion by 3.76 times. (95% CI: 1.08 to 13.15, P = 0.04).
CONCLUSIONS: The findings of this study can offer valuable insights aimed at enhancing counseling and support for non-surgical methods of medication abortion within professional settings. Moreover, it improves the effectiveness of clinical treatment and reduces the occurrence of unnecessary surgical interventions in the abortion management protocol.

OBJECTIVE: Existing evidence of the relationship between induced abortion and ectopic pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation to examine whether induced abortion (IA) can increase the rate of ectopic pregnancy (EP).
METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane, CNKI, WanFang, and Sinomed databases since their inception until February 2023. Eligibility criteria included case-control studies and cohort studies that analyzed induced abortion associated with ectopic pregnancy. Data analyses were conducted by using R-studio Version 1.1.383 software.
RESULTS: A total of 33 case-control studies and 7 cohort studies involving 132,926 participants were included. In case-control studies, there was a significant association between induced abortion and ectopic pregnancy by using single-factor analysis data (OR = 2.32, 95% CI = 1.81-2.98). Subgroup analysis by region suggested no statistical significance in the Americas (OR = 1.15, 95% CI = 0.92-1.43) and Eastern Mediterranean (OR = 3.64, 95% CI = 0.88-15.18). The relationship was significant by using multiple regression analysis data (OR = 1.97, 95% CI = 1.38-2.80). In cohort studies, statistical significance was found (OR = 1.42, 95% CI = 1.001-2.018) after omitting one study in sensitivity analysis. The combined results of the two types of studies suggested that induced abortion would increase the risk of ectopic pregnancy to some degree, but the conclusion needs to be considered with caution.
CONCLUSIONS: This study indicated that IA could increase the risk of EP to some degree and the times of IA had a negative impact on the risk. Safe abortion and avoiding repeat abortion due to unintended pregnancy could protect women\'s fertility.