Follow‐up approaches after abortion at 14 gestation weeks or later

Objectives

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

To evaluate the effectiveness, safety, and acceptability of alternative follow‐up care approaches compared to routine, in‐person follow‐up for abortions occurring at 14 weeks or later gestation.

Background

Description of the condition

Uncertainty exists over the importance of routine, scheduled, in‐person follow‐up visits for women undergoing medical or surgical abortion at later gestational ages (at 14 weeks or later gestation). Routine follow‐up may not always be necessary, but can potentially be used to address post‐abortion contraception, emotional support or medical concerns, and is still recommended by the World Health Organization (WHO) for confirmation of successful abortion in some circumstances (WHO 2018). Follow‐up visits after ambulatory healthcare procedures are frequently a norm based on little evidence for their utility in the identification of post‐procedure complications (Chen 2014; Halonen 2020). For procedures with low complication rates (e.g. abortions, intrauterine device insertion), routine follow‐up may pose an extra burden on patients and be a misuse of limited healthcare resources (CDC 2016; WHO 2018). Following ambulatory surgery, the use of shared decision making around ideal timing of follow‐up may improve patient satisfaction (Jaensson 2019). Routine follow‐up is also not necessary to address post‐abortion contraception, as this service can also be provided the same day as the abortion (WHO 2018). 

In 2012, the WHO changed their global abortion guidance to no longer recommend a routine scheduled in‐person follow‐up for women undergoing abortion at less than 12 to 14 weeks, except in specific situations or if desired by the woman (WHO 2012; WHO 2018). Post‐abortion complications increase slightly at later gestational ages (Calvert 2018), which may increase the benefit of routine follow‐up visits for abortions after 14 weeks but follow‐up visits may not need to be in person. The COVID‐19 global pandemic has highlighted that alternative approaches to care and follow‐up besides an in‐person visit (e.g. phone, telehealth, text messages) may achieve the same quality of outcome (Monaghesh 2020). 

Description of the intervention

In‐person follow‐up

In addition to advice to contact the health provider on signs or symptoms of concern (e.g. bleeding, fever), a routine, in‐person follow‐up appointment may be scheduled for all women on the day of the procedure to occur in the coming days to weeks. This appointment may include assessment for infection, bleeding, other complications, ongoing pregnancy, patient satisfaction, or contraception need. 

Alternatives to in‐person follow‐up

Alternatives to in‐person appointments may include scheduled telephone calls, text messages, home visits, or virtual visits to assess women for symptoms or needs following an abortion (e.g. contraception). Routine telehealth (i.e. use of audio and video technology for real‐time communication) encounters are also eligible. Additionally, women may be allocated to self‐monitoring, where after receiving counseling and education on routine aftercare, symptoms of concern and how to contact the clinic at the time of the abortion, follow‐up would be as needed, not routinely scheduled. 

How the intervention might work

Providers anecdotally justify a routine, in‐person, scheduled follow‐up at approximately two weeks post‐procedure to identify complications. Patients may also not fully understand their discharge instructions at the time of their procedure, thus the follow‐up visit provides another opportunity to review this information and answer questions (Zavala 2011). The follow‐up visit can also be utilized for other preventive health care, like evaluating for social or psychological needs, discussing pregnancy plans, or addressing contraception counseling, initiation, or maintenance (WHO 2019), but this may not be the case for all patients. The disadvantages to a routine, scheduled in‐person follow‐up is the overutilization of scarce healthcare resources, space, visit availability and staff time, as well as burdens to the woman, who may need to travel, take time off work or find childcare. If a routine follow‐up visit is beneficial, then alternative approaches via phone, text, or telehealth may be able to achieve the same health and patient outcomes.

Why it is important to do this review

Healthcare systems and providers often adopt standards of practice without any evidence regarding health and patient outcomes (Sigmund 2015). Routine in‐person, post‐procedure visits are an accepted norm for most procedural and surgical care but is it truly beneficial for outcomes when complication rates are low? Following ambulatory surgery, patients are expected to self‐manage symptoms (IASS 2021), and are able to self‐determine their appropriate follow‐up plan (Dahlberg 2019). Routine post‐procedure visits were found to be unnecessary for uncomplicated medical and surgical abortion at less than 14 weeks and this may or may not be true for abortion at later gestational ages (WHO 2018). If post‐procedure care is beneficial for health or patient outcomes, flexibility in visit type (phone, text, telehealth) may be less burdensome on patients and the healthcare system. 

Objectives

To evaluate the effectiveness, safety, and acceptability of alternative follow‐up care approaches compared to routine, in‐person follow‐up for abortions occurring at 14 weeks or later gestation.

Methods

Criteria for considering studies for this review

Types of studies

We will include randomized controlled trials (RCTs), including cluster‐RCTs, that compare in‐person follow‐up to any alternative after abortion at 14 weeks or later gestation. We will also include comparative non‐randomized studies of interventions (NRSIs) that include observational cohorts because we do not expect to find adequate evidence from RCTs to address the review objectives, and NRSIs provide the next best available data for testing comparisons between routine in‐person follow‐up and novel alternatives. We will limit NRSIs to those with contemporaneous comparison groups. We will include full‐text studies irrespective of their language of publication.

Types of participants

Pregnant women of any age undergoing abortion at 14 weeks or later gestation, who provide informed consent. 

Types of interventions

We will include studies that compare a range of follow‐up approaches as alternatives to the standard care, routine, in‐person clinic visit. We will not restrict studies according to the training background of the provider. Alternative follow‐up approaches may include telephone appointments, text messages, home visits or virtual visits, or no scheduled follow‐up with self‐management of symptoms (i.e. self‐monitoring). The main comparison is any alternative to routine in‐person clinic visits versus standard care. 

Types of outcome measures

The outcomes for this review were selected using the Procedural Abortion Incident Reporting and Surveillance (PAIRS) Framework (Taylor 2017). Abortion‐associated harms are often presented as composite variables, which we will consider in the absence of data on specific harms outcomes. We will include outcomes that occur within eight weeks of the abortion. 

Primary outcomes

1. Complete abortion (no need for additional surgical or medical intervention)

2. Blood loss requiring transfusion or surgical intervention

3. Infection requiring antibiotic treatment

Secondary outcomes

1. Hospitalization or hospital transfer to treat serious abortion complication (e.g. uterine or bowel perforation, hematometra, sepsis)

2. Death

3. Contraceptive receipt as documented by prescription, procedural documentation, or patient self‐report

4. Patient satisfaction or acceptability of abortion care using a validated survey or study defined measure 

Search methods for identification of studies

The Fertility Regulation Group Information Specialist will conduct a search for all published, unpublished, and ongoing studies, without restrictions on language or publication status. The search strategies for each database will be modeled on the search strategy designed for MEDLINE ALL (Ovid), available in Appendix 1.

Electronic searches

We will search the following databases from their inception.

1. Cochrane Central Register of Controlled Trials (CENTRAL; current year and issue) Ovid EBM Reviews

2. MEDLINE ALL (Ovid; from 1946 to present)

3. Embase.com (from 1974 to present)

4. CINAHL (EBSCOHost; from 1982 to present)

5. PsycINFO (Ovid; from 1806) to present

6. Global Health (Ovid; from 1973 to present)

7. Scopus [conference abstracts only] (from 2004 to present)

8. Google Scholar (from 1995 to present)

We will search the following trials registries.

1.  The WHO International Clinical Trials Registry Platform (ICTRP; www.who.int/trialsearch; from inception). (Please note: due to WHO ICTRP access issues during the COVID‐19 pandemic, it may be necessary to substitute direct searching of WHO ICTRP with CENTRAL searches to retrieve study records) 

2. ClinicalTrials.gov (www.clinicaltrials.gov; from 2008) 

Searching other resources

We will check the bibliographies of included studies and any relevant systematic reviews that we identify for further references to relevant studies. We will contact experts/organizations in the field to obtain additional information on relevant studies. If necessary, we will contact authors of included studies for data clarification and further information. We will consider adverse effects described in included studies only.

We will search the following gray literature sites.

1. Guttmacher Institute www.guttmacher.org/united-states/abortion 

2. Ibis Reproductive Health ibisreproductivehealth.org/ 

3. Women on Waves https://www.womenonwaves.org/ 

4. Marie Stopes International www.mariestopes.org/ 

5. Population Council www.popcouncil.org/ 

6. Population Services International www.psi.org/ 

7. Ipas www.ipas.org/ 

Data collection and analysis

Selection of studies

We will download all titles and abstracts retrieved by electronic searching to a reference management database and remove duplicates. Three review authors (ML, CH, MR) will independently screen titles and abstracts for inclusion. We will retrieve the full‐text study reports and two review authors (CH, MR) will independently screen the full‐text, identify studies for inclusion, and identify and record reasons for exclusion of the ineligible studies. We will resolve any disagreements through discussion or, if required, we will consult a third review author (VK). We will list studies that initially appeared to meet the inclusion criteria but that we later excluded in the 'Characteristics of excluded studies' table. We will collate multiple reports of the same study so that each study rather than each report is the unit of interest in the review. We will also provide any information we can obtain about ongoing studies. We will record the selection process in sufficient detail to complete a PRISMA flow diagram (Page 2021).

Data extraction and management

We will use a standard data collection form for study characteristics and outcome data. We will pilot the form on at least one study in the review. Two review authors (CH, MR) will independently extract the following study characteristics from the included studies.

1. Methods: study design, number of study centres and location, study setting, withdrawals, date of study, follow‐up, approach to adjustment for design effects or confounding

2. Participants: number, mean age, age range, gender, severity of condition, diagnostic criteria, inclusion criteria, exclusion criteria, other relevant characteristics

3. Interventions: intervention components, comparison, fidelity assessment

4. Outcomes: events, means, relative effects, time points reported, adjusted effect estimates and information about the confounders and design effects accounted for, intra‐cluster correlations (ICCs) for studies with clustering

5. Notes: funding for study, notable conflicts of interest of study authors, ethical approval

Three review authors (CH, VK, MR) will independently extract outcome data from included studies. We will note in the 'Characteristics of included studies' table if studies reported outcome data in an unusable way. We will resolve disagreements by consensus. 

Assessment of risk of bias in included studies

Our review aims to quantify the effect of assignment to the intervention and our risk of bias evaluations will align with this aim.

Two review authors (MR, VK) will independently assess risk of bias for each study. We will resolve any disagreements by discussion or by involving another review author (CH). We will assess the risk of bias for key outcome results of RCTs using the Cochrane RoB 2 tool (Sterne 2019). Our effect of interest will be the effect of assignment, also known as the ‘intention to treat’ (ITT). We will assess the outcomes defined in this protocol for risk of bias. We will assess the following domains on the basis of answers to signaling questions:

1. bias arising from the randomization process

2. bias due to deviations from intended interventions 

3. bias due to missing outcome data

4. bias in measurement of the outcome

5. bias in selection of the reported result

An additional domain is included for cluster‐RCTs:

1b. bias arising from identification or recruitment of individual participants within clusters.

We will use the variants of RoB2 for cluster‐RCTs if we identify eligible studies with these study designs.

For each outcome we will use the signaling questions to categorize each domain as low risk of bias, some concerns, or high risk of bias. Answers to the signaling questions will be recorded on the RoB 2 Excel tool and made available in an online repository. We will summarize the risk of bias judgments across different studies for each of the domains for each prespecified outcome. We will derive an overall judgement for each study from the tool, as follows.

1. Low risk of bias: the study is considered to show a low risk of bias.

2. Some concerns: a few concerns are expected to be associated with the study in at least one domain, but not warranting categorization as a study with a high risk of bias for any domain.

3. High risk of bias: the study is considered to be at high risk of bias in at least one domain; or a few concerns with regard to multiple domains are observed in the study such that these concerns significantly lower confidence in the study results.

Two review authors (MR, VK) will independently assess risk of bias for each included NRSIs using the ROBINS‐I tool (Sterne 2016). We will resolve any disagreements by discussion or by involving a third review author (CH). 

We will assess the risk of bias of NRSIs according to the following domains.

1. Pre‐intervention

   1. bias due to confounding; and

   2. bias in selection of participants into the study

2. At intervention

   1. bias in classification of interventions

3. Post‐intervention

   1. bias due to deviations from intended interventions;

   2. bias due to missing data;

   3. bias in measurement of outcomes; and

   4. bias in selection of the reported result

We will assess the risk of bias for the outcomes of the included studies that we will include in our summary of findings table (Higgins 2021a). 

We will record answers to the signaling questions and make them available in an online data repository (e.g. srdr.ahrq.gov, figshare.com, datadryad.org). Answers to the signaling questions will inform judgements about the risk of bias for each domain as assessed for each outcome obtained from each study. We will summarize the risk of bias judgments across different studies for each of the domains for each prespecified outcome. 

Where information on risk of bias relates to unpublished data or correspondence with a study author, we will note this in the risk of bias table. We will not exclude studies on the grounds of their risk of bias but will clearly report the risk of bias when presenting the results of the studies. When summarizing the evidence on treatment effects for different outcomes, we will consider the risk of bias for the studies that contributed to analyses for that outcome. 

We will describe the risk of bias for the studies that are used to estimate intervention effects and will provide figures to illustrate the risk of bias. We will conduct sensitivity analyses (see Sensitivity analysis section below) to assess whether estimated effects differ when we exclude studies at high risk of bias from analyses. The risk of bias assessment will inform GRADE and summary of findings tables. 

Measures of treatment effect

For included studies, we will estimate the effect of the intervention using risk ratios for dichotomous data, together with 95% confidence intervals and mean difference or standardized mean difference (SMD) for continuous data, together with 95% confidence intervals. We will use existing guidance for the interpretation of SMDs and effect (Cohen 1988). For included NRSIs, we will present the effects, as reported in the study, including adjustments for study design features and confounding or imbalance between study groups. If needed to facilitate pooling, we will calculate risk ratios.

Unit of analysis issues

The unit of analysis will be the individual having an abortion at 14 weeks or later gestation. Studies that involve more than 10% multiple gestations will be excluded from the review. We will incorporate published ICCs for data from similar cluster‐RCTs or estimate them based on available types of ICCs for similar studies (Higgins 2021b). 

Dealing with missing data

We will contact study authors in order to verify key study characteristics and obtain missing outcome data where possible (e.g. when a study is identified as abstract only). Missing data are to be expected however and to reduce bias we will perform an ITT analysis. We will reanalyze the data if the study authors did not perform an ITT analysis.

Assessment of heterogeneity

If we find a sufficient number of studies we will conduct a meta‐analysis. We will use the I² statistic (Higgins 2003), to measure heterogeneity among the studies in each analysis. Interpretation of I² values will follow the criteria in the Cochrane Handbook for Systematic Reviews of Interventions (Deeks 2021). If we identify substantial heterogeneity we will explore it by prespecified subgroup and sensitivity analyses.

1. 0% to 40%: might not be important

2. 30% to 60%: may represent moderate heterogeneity

3. 50% to 90%: may represent substantial heterogeneity

4. 75% to 100%: considerable heterogeneity

We will qualitatively evaluate included studies for clinical heterogeneity across interventions, comparison groups, population, and setting. 

Assessment of reporting biases

We will attempt to contact study authors, asking them to provide missing outcome data. Where this is not possible, and the missing data are thought to introduce serious bias, we will explore the impact of including such studies in the overall assessment of results. If we are able to pool more than 10 studies, we will create and examine a funnel plot to explore possible publication biases, interpreting the results with caution (Sterne 2011 ). 

Data synthesis

We will undertake random‐effects meta‐analyses only where this is meaningful, that is, if the treatments, participants, and the underlying clinical question are similar enough for pooling to make sense. A common way that study authors indicate when they have skewed data is by reporting medians and interquartile ranges. When we encounter this, we will note that the data are skewed and consider the potential implications. Where multiple study arms are reported in a single study, we will include only the relevant arms. If two comparisons (e.g. intervention A versus usual care and intervention B versus usual care) must be entered into the same meta‐analysis, we will halve the control group to avoid double counting.

Subgroup analysis and investigation of heterogeneity

If we detect substantial heterogeneity, we will explore possible explanations in subgroup analyses. When interpreting the results of the analyses we will account for statistical heterogeneity, particularly if there is any variation in the direction of the effect among subgroups.

We will conduct subgroup analyses for the primary outcome measures using random‐effects modeling and the Cochran Q test for interaction to evaluate differences in the intervention effects between the following subgroups (where data are available): 

1. Type of intervention used for follow‐up (e.g. phone, internet, hotline, home visit)

2. Method of termination: medical versus surgical abortion

3. Setting: low‐ to middle‐income settings versus high‐income settings (as defined by United Nations Human Development Index; UN 2020).

Sensitivity analysis

We will perform sensitivity analyses defined a priori to assess the robustness of our conclusions and explore its impact on effect sizes. This will involve the following. 

1. Restricting the analysis to studies with a low risk of bias

Summary of findings and assessment of the certainty of the evidence

We will create summary of findings tables for the main intervention comparison(s) and include the most important outcomes:

1. successful completion of abortion;

2. harms or adverse events for routine follow‐up compared to alternative.

In order to draw conclusions about the certainty of the evidence within the text of the review we will present the GRADE evaluations for RCTs and NRSIs separately, and if data are adequate we will provide an overall rating of the certainty for all included studies for each intervention and outcome. If during the review process, we become aware of an important outcome that we failed to list in our planned summary of findings table(s), we will include the relevant outcome and explain the reasons for this is the section 'Differences between protocol and review'. Two reviewers will independently assess the certainty of the evidence (high, moderate, low, and very low) using the five GRADE considerations (risk of bias, consistency of effect, imprecision, indirectness, and publication bias; Guyatt 2008). We will use methods and recommendations described in the Cochrane Handbook for Systematic Reviews of interventions (Schünemann 2021), and the EPOC worksheets (EPOC 2013), and using GRADEpro GDT software (GRADEpro GDT). We will resolve disagreements on certainty ratings by discussion and provide justification for decisions to down‐ or upgrade the ratings using footnotes in the table and make comments to aid readers' understanding of the review where necessary. We will use plain language statements to report these findings in the review (EPOC 2013).

We will consider whether there is any additional outcome information that we could not incorporate into meta‐analyses, note this in the comments and state if it supports or contradicts the information from the meta‐analyses. If it is not possible to meta‐analyse the data we will summarize the results in the text.

Appendices

Appendix 1. Search Strategies

Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 10) Ovid EBM Reviews
Date searched: 22 October 2020
1 (feticid* or foeticid* or ((drug or medical or medically or medication or medicinal or medicine or gestation* or pregnan*) adj2 (abortion or abortions or interrupt* or terminat*))).ti,ab. (2625)
2 (abortifacient* or MTOP or mifepristone or misoprostol).ti,ab. (3998)
3 (Abo‐pill or Colestone or Cytotec or Elmif or GyMiso or Korlym or Medabon or Mefeprin or Mefipil or Mifebort or Mifegest or Mifegyne or Mifeprex or Miferiv or Mifty or Misodel or Mtpill or Pitocin or RU‐486 or RU486 or Syntocinon or T‐Pill or Termipil).ti,ab. (499)
4 or/1‐3 (6001)
5 (second trimester or 2nd trimester or mid‐trimester or midtrimester or third trimester or 3rd trimester or ((late or later) adj2 (abortion* or gestation* or induct* or interrupt* or termination*)) or (("20" or "21" or "22" or "23" or "24" or "25" or "26" or "27" or "28" or "29" or "30" or "31" or "32" or "33" or "34" or "35") adj2 weeks) or ((twenty* or thirty*) adj2 weeks)).ti,ab. (52671)
6 (attempts or attempted or clandestine or complications or criminal* or illegal* or individual* or safe or self‐administ* or self‐assess* or self‐care or self‐efficacy or self‐evaluat* or self‐examination* or self‐induc* or self‐manag* or self‐medicat* or self‐sourced or self‐use or unsafe or unsupervised or herself or themselves or home or homes).ti,ab. (379114)
7 (aftercare or "after care" or ambulatory or center or centers or clinic or clinics or day or hospitaliz* or hospitalis* or hotline* or nonhospital or non‐hospital or office or offices or online or outpatient* or out‐patient* or outside or (primary adj2 (health* or care)) or supervision or telehealth* or telemedic* or video* or ((chat or distan* or mobile or phone or remote or telephone) adj2 consult*) or apothecar* or dispens* or druggist* or drugstore* or "drug store*" or pharmacy or pharmacies or OTC or "over‐the‐counter" or ((drug or medicine) adj4 (retail* or seller* or shop* or store* or vendor* or setting or "women on web"))).ti,ab. (1152620)
8 (chemist* or clinician* or doctor* or midwife* or midwives or nurse* or nursing or pharmacist* or physician*).ti,ab. (110574)
9 or/6‐8 (1250052)
10 and/4‐5,8 (70)
11 (((late or later or unsafe) adj2 (abortion* or "termination* of pregnanc*" or "pregnancy termination*" or "interrupt* of pregnanc*" or "pregnancy interrupt*")) or (("2nd‐trimester" or "second‐trimester" or "mid‐trimester" or midtrimester or "3rd‐trimester" or "third‐trimester") adj (induce or induced or inducing or induction or inductions))).ti,ab. (144)
12 or/10‐11 (212)

MEDLINE ALL (Ovid) 1946 to 21 October 2020
Date searched: 22 October 2020

1 Abortion, Induced/ or Abortion, Eugenic/ or Abortion, Legal/ or Abortion, Therapeutic/ or Abortion, Criminal/ or Abortion Applicants/ or Abortion, Missed/ or Abortion, Spontaneous/ (56357)
2 (feticid* or foeticid* or ((drug or medical or medically or medication or medicinal or medicine or gestation* or pregnan*) adj2 (abortion or abortions or interrupt* or terminat* or treatment))).tw,kf. (127450)
3 Abortifacient Agents/ or Abortifacient Agents, Nonsteroidal/ or Abortifacient Agents, Steroidal/ or Mifepristone/ or Misoprostol/ (11686)
4 (abortifacient* or MTOP or mifepristone or misoprostol).ti,ab,kf. (9243)
5 (Abo‐pill or Colestone or Cytotec or Elmif or GyMiso or Korlym or Medabon or Mefeprin or Mefipil or Mifebort or Mifegest or Mifegyne or Mifeprex or Miferiv or Mifty or Misodel or Mtpill or Pitocin or RU‐486 or RU486 or Syntocinon or T‐Pill or Termipil).ti,ab,kf. (4650)
6 or/1‐5 (185697)
7 Pregnancy Trimester, Second/ or Pregnancy Trimester, Third/ (26096)
8 (second trimester or 2nd trimester or mid‐trimester or midtrimester or third trimester or 3rd trimester or ((late or later) adj2 (abortion* or gestation* or induct* or interrupt* or termination*)) or (("20" or "21" or "22" or "23" or "24" or "25" or "26" or "27" or "28" or "29" or "30" or "31" or "32" or "33" or "34" or "35") adj2 weeks) or ((twenty* or thirty*) adj2 weeks)).ti,ab,kf. (159922)
9 or/7‐8 (171008)
10 Self‐administration/ or Self‐care/ or Self‐examination/ or Self‐management/ or Self‐medication/ or Diagnostic Self‐evaluation/ (55712)
11 (attempts or attempted or clandestine or complications or criminal* or illegal* or individual* or safe or self‐administ* or self‐assess* or self‐care or self‐efficacy or self‐evaluat* or self‐examination* or self‐induc* or self‐manag* or self‐medicat* or self‐sourced or self‐use or unsafe or unsupervised or herself or themselves or home or homes).ti,ab,kf. (3244653)
12 Aftercare/ or Outpatients/ or Outpatient Clinics, Hospital/ or Ambulatory Care/ or Ambulatory Care Facilities/ or Family Planning Services/ or Family Practice/ or International Planned Parenthood Federation/ or Midwifery/ or Nurse Midwives/ or exp Nurses/ or Pharmacies/ or Pharmacists/ or Pharmaceutical Services/ or Pharmacy Technicians/ or Community Pharmacy Services/ or exp Physicians/ or Primary Health Care/ or Remote Consultation/ or Reproductive Health Services/ or Telemedicine/ or Women's Health Services/ (532100)
13 (aftercare or "after care" or ambulatory or center or centers or clinic or clinics or day or hospitaliz* or hospitalis* or hotline* or nonhospital or non‐hospital or office or offices or online or outpatient* or out‐patient* or outside or (primary adj2 (health* or care)) or supervision or telehealth* or telemedic* or video* or ((chat or distan* or mobile or phone or remote or telephone) adj2 consult*) or apothecar* or dispens* or druggist* or drugstore* or "drug store*" or pharmacy or pharmacies or OTC or "over‐the‐counter" or ((drug or medicine) adj4 (retail* or seller* or shop* or store* or vendor* or setting or "women on web"))).ti,ab,kf. (2909276)
14 (chemist* or clinician* or doctor* or midwife* or midwives or nurse* or nursing or pharmacist* or physician*).ti,ab,kf. (1346241)
15 or/10‐14 (6584076)
16 and/6,9,15 (4444)
17 (((late or later or unsafe) adj2 (abortion* or "termination* of pregnanc*" or "pregnancy termination*" or "interrupt* of pregnanc*" or "pregnancy interrupt*")) or (("2nd‐trimester" or "second‐trimester" or "mid‐trimester" or midtrimester or "3rd‐trimester" or "third‐trimester") adj (induce or induced or inducing or induction or inductions))).ti,ab,kf. (2246)
18 or/16‐17 (6253)
19 randomized controlled trial.pt. (515552)
20 controlled clinical trial.pt. (93892)
21 random*.ab. (1132605)
22 placebo.ab. (211750)
23 drug therapy.fs. (2244366)
24 trial.ab. (523841)
25 groups.ab. (2104571)
26 or/19‐25 (5033164)
27 26 not ((exp animals/ not humans/) or (bovine or canine or capra or cat or cats or cattle or cow or cows or dog or dogs or equine or feline or goat or goats or horse or mice or mouse or ovine or pig or pigs or porcine or rabbit or rabbits or rat or rats or rattus or sheep or sow or sows or ewes).ti,ab,kf.) (4192054)
28 and/18,27 (1683)

Embase.com
Date searched: 22 October 2020
#1 'abortion'/de OR 'hormonal abortion'/de OR 'missed abortion'/de OR 'spontaneous abortion'/de OR 'therapeutic abortion'/de OR 'induced abortion'/exp OR 'illegal abortion'/de OR 'legal abortion'/de OR 'medical abortion'/de (100,007)
#2 feticid*:ti,ab,kw OR foeticid*:ti,ab,kw OR (((drug OR medical OR medically OR medication OR medicinal OR medicine OR gestation* OR pregnan*) NEAR/2 (abortion OR abortions OR interrupt* OR terminat* OR treatment)):ti,ab,kw) (185,037)
#3 'abortive agent'/exp OR 'mifepristone'/exp OR 'misoprostol'/exp (173,897)
#4 abortifacient*:ti,ab,kw OR mtop:ti,ab,kw OR mifepristone:ti,ab,kw OR misoprostol:ti,ab,kw (11,655)
#5 'abo pill':ti,ab,kw OR colestone:ti,ab,kw OR cytotec:ti,ab,kw OR elmif:ti,ab,kw OR gymiso:ti,ab,kw OR korlym:ti,ab,kw OR medabon:ti,ab,kw OR mefeprin:ti,ab,kw OR mefipil:ti,ab,kw OR mifebort:ti,ab,kw OR mifegest:ti,ab,kw OR mifegyne:ti,ab,kw OR mifeprex:ti,ab,kw OR miferiv:ti,ab,kw OR mifty:ti,ab,kw OR misodel:ti,ab,kw OR mtpill:ti,ab,kw OR pitocin:ti,ab,kw OR 'ru 486':ti,ab,kw OR ru486:ti,ab,kw OR syntocinon:ti,ab,kw OR 't pill':ti,ab,kw OR termipil:ti,ab,kw (5,489)
#6 #1 OR #2 OR #3 OR #4 OR #5 (450,839)
#7 'third trimester pregnancy'/de OR 'second trimester abortion'/de (30,365)
#8 'second trimester':ti,ab,kw OR '2nd trimester':ti,ab,kw OR 'mid trimester':ti,ab,kw OR midtrimester:ti,ab,kw OR 'third trimester':ti,ab,kw OR '3rd trimester':ti,ab,kw OR (((late OR later) NEAR/2 (abortion* OR gestation* OR induct* OR interrupt* OR termination*)):ti,ab,kw) OR ((('20' OR '21' OR '22' OR '23' OR '24' OR '25' OR '26' OR '27' OR '28' OR '29' OR '30' OR '31' OR '32' OR '33' OR '34' OR '35') NEAR/2 weeks):ti,ab,kw) OR (((twenty* OR thirty*) NEAR/2 weeks):ti,ab,kw) (255,268)
#9 #7 OR #8 (266,442)
#10 'drug self administration'/de OR 'self care'/de OR 'self examination'/de OR 'self evaluation'/de (105,955)
#11 attempts:ti,ab,kw OR attempted:ti,ab,kw OR clandestine:ti,ab,kw OR complications:ti,ab,kw OR criminal*:ti,ab,kw OR illegal*:ti,ab,kw OR individual*:ti,ab,kw OR safe:ti,ab,kw OR 'self administ*':ti,ab,kw OR 'self assess*':ti,ab,kw OR 'self care':ti,ab,kw OR 'self efficacy':ti,ab,kw OR 'self evaluat*':ti,ab,kw OR 'self examination*':ti,ab,kw OR 'self induc*':ti,ab,kw OR 'self manag*':ti,ab,kw OR 'self medicat*':ti,ab,kw OR 'self sourced':ti,ab,kw OR 'self use':ti,ab,kw OR unsafe:ti,ab,kw OR unsupervised:ti,ab,kw OR herself:ti,ab,kw OR themselves:ti,ab,kw OR home:ti,ab,kw OR homes:ti,ab,kw (4,324,257)
#12 'aftercare'/de OR 'outpatient'/de OR 'outpatient department'/de OR 'ambulatory care'/de OR 'general practice'/de OR 'midwife'/de OR 'nurse midwife'/de OR 'nurse'/de OR 'pharmacy (shop)'/de OR 'pharmacist'/de OR 'pharmacy technician'/de OR 'physician'/de OR 'primary health care'/de OR 'teleconsultation'/de OR 'health service'/de OR 'telemedicine'/de (1,049,622)
#13 aftercare:ti,ab,kw OR 'after care':ti,ab,kw OR ambulatory:ti,ab,kw OR center:ti,ab,kw OR centers:ti,ab,kw OR clinic:ti,ab,kw OR clinics:ti,ab,kw OR day:ti,ab,kw OR hospitaliz*:ti,ab,kw OR hospitalis*:ti,ab,kw OR hotline*:ti,ab,kw OR nonhospital:ti,ab,kw OR 'non hospital':ti,ab,kw OR office:ti,ab,kw OR offices:ti,ab,kw OR online:ti,ab,kw OR outpatient*:ti,ab,kw OR 'out patient*':ti,ab,kw OR outside:ti,ab,kw OR ((primary NEAR/2 (health* OR care)):ti,ab,kw) OR supervision:ti,ab,kw OR telehealth*:ti,ab,kw OR telemedic*:ti,ab,kw OR video*:ti,ab,kw OR (((chat OR distan* OR mobile OR phone OR remote OR telephone) NEAR/2 consult*):ti,ab,kw) OR apothecar*:ti,ab,kw OR dispens*:ti,ab,kw OR druggist*:ti,ab,kw OR drugstore*:ti,ab,kw OR 'drug store*':ti,ab,kw OR pharmacy:ti,ab,kw OR pharmacies:ti,ab,kw OR otc:ti,ab,kw OR 'over‐the‐counter':ti,ab,kw OR (((drug OR medicine) NEAR/4 (retail* OR seller* OR shop* OR store* OR vendor*)):ti,ab,kw) OR setting:ti,ab,kw OR 'women on web':ti,ab,kw (4,784,583)
#14 chemist*:ti,ab,kw OR clinician*:ti,ab,kw OR doctor*:ti,ab,kw OR midwife*:ti,ab,kw OR midwives:ti,ab,kw OR nurse*:ti,ab,kw OR nursing:ti,ab,kw OR pharmacist*:ti,ab,kw OR physician*:ti,ab,kw (1,787,519)
#15 #10 OR #11 OR #12 OR #13 OR #14 (9,316,527)
#16 #6 AND #9 AND #15 (9,267)
#17 (((late OR later OR unsafe) NEAR/2 (abortion* OR 'termination* of pregnanc*' OR 'pregnancy termination*' OR 'interrupt* of pregnanc*' OR 'pregnancy interrupt*')):ti,ab,kw) OR ((('2nd‐trimester' OR 'second‐trimester' OR 'mid‐trimester' OR midtrimester OR '3rd‐trimester' OR 'third‐trimester') NEAR/1 (induce OR induced OR inducing OR induction OR inductions)):ti,ab,kw) (2,821)
#18 #16 OR #17 (11,482)
#19 'crossover procedure':de OR 'double‐blind procedure':de OR 'randomized controlled trial':de OR 'single‐blind procedure':de OR random*:de,ab,ti OR factorial*:de,ab,ti OR crossover*:de,ab,ti OR ((cross NEXT/1 over*):de,ab,ti) OR placebo*:de,ab,ti OR ((doubl* NEAR/1 blind*):de,ab,ti) OR ((singl* NEAR/1 blind*):de,ab,ti) OR assign*:de,ab,ti OR allocat*:de,ab,ti OR volunteer*:de,ab,ti (2,634,690)
#20 #18 AND #19 (1,466)

CINAHL with Full Text (EBSCOHost)
Date searched: 22 October 2020 
S1 (MH "Abortion, Criminal") OR (MH "Abortion, Spontaneous") OR (MH "Abortion, Induced") OR (MH "Attitude to Abortion") OR (MH "Abortion, Incomplete") (15,483)
S2 TI ( (feticid* OR foeticid* OR ((drug OR medical OR medically OR medication OR medicinal OR medicine OR gestation* OR pregnan*) N2 (abortion OR abortions OR interrupt* OR terminat* OR treatment))) ) OR AB ( (feticid* OR foeticid* OR ((drug OR medical OR medically OR medication OR medicinal OR medicine OR gestation* OR pregnan*) N2 (abortion OR abortions OR interrupt* OR terminat* OR treatment))) ) (135)
S3 (MH "Misoprostol") OR (MH "Mifepristone") OR (MH "Carboprost") OR (MH "Abortifacient Agents") (2,911)
S4 TI ( (abortifacient* OR MTOP OR mifepristone OR misoprostol) ) OR AB ( (abortifacient* OR MTOP OR mifepristone OR misoprostol) ) (2,397)
S5 TI ( (Abo‐pill OR Colestone OR Cytotec OR Elmif OR GyMiso OR Korlym OR Medabon OR Mefeprin OR Mefipil OR Mifebort OR Mifegest OR Mifegyne OR Mifeprex OR Miferiv OR Mifty OR Misodel OR Mtpill OR Pitocin OR RU‐486 OR RU486 OR Syntocinon OR T‐Pill OR Termipil) ) OR AB ( (Abo‐pill OR Colestone OR Cytotec OR Elmif OR GyMiso OR Korlym OR Medabon OR Mefeprin OR Mefipil OR Mifebort OR Mifegest OR Mifegyne OR Mifeprex OR Miferiv OR Mifty OR Misodel OR Mtpill OR Pitocin OR RU‐486 OR RU486 OR Syntocinon OR T‐Pill OR Termipil) ) (303)
S6 S1 OR S2 OR S3 OR S4 OR S5 (17,921)
S7 (MH "Pregnancy Trimester, Second") OR (MH "Pregnancy Trimester, Third") (6,898)
S8 TI ( (second trimester OR 2nd trimester OR mid‐trimester OR midtrimester OR third trimester OR 3rd trimester OR ((late OR later) N2 (abortion* OR gestation* OR induct* OR interrupt* OR termination*)) OR (("20" OR "21" OR "22" OR "23" OR "24" OR "25" OR "26" OR "27" OR "28"OR "29" OR "30" OR "31" OR "32" OR "33" OR "34" OR "35") N2 weeks) OR ((twenty* OR thirty*) N2 weeks)) ) OR AB ( (second trimester OR 2nd trimester OR mid‐trimester OR midtrimester OR third trimester OR 3rd trimester OR ((late OR later) N2 (abortion* OR gestation* OR induct* OR interrupt* OR termination*)) OR (("20" OR "21" OR "22" OR "23" OR "24" OR "25" OR "26" OR "27" OR "28"OR "29" OR "30" OR "31" OR "32" OR "33" OR "34" OR "35") N2 weeks) OR ((twenty* OR thirty*) N2 weeks)) ) (9,900)
S9 S7 OR S8 (13,055)
S10    (MH "Self Assessment") OR (MH "Self Administration") OR (MH "Self‐Management") OR (MH "Self Medication") OR (MH "Self Care") OR (MH "Self‐Efficacy") (74,947)
S11    TI ( (attempts OR attempted OR clandestine OR complications OR criminal* OR illegal* OR individual* OR safe OR self‐administ* OR self‐assess* OR self‐care OR self‐efficacy OR self‐evaluat* OR self‐examination* OR self‐induc* OR self‐manag* OR self‐medicat* OR self‐sourced OR self‐use OR unsafe OR unsupervised OR herself OR themselves OR home OR homes) ) OR AB ( (attempts OR attempted OR clandestine OR complications OR criminal* OR illegal* OR individual* OR safe OR self‐administ* OR self‐assess* OR self‐care OR self‐efficacy OR self‐evaluat* OR self‐examination* OR self‐induc* OR self‐manag* OR self‐medicat* OR self‐sourced OR self‐use OR unsafe OR unsupervised OR herself OR themselves OR home OR homes) ) (921,731)
S12    (MH "After Care") OR (MH "Outpatients") OR (MH "Outpatient Service") OR (MH "Ambulatory Care Facilities") OR (MH "Pharmacy, Retail") OR (MH "Ambulatory Care") OR (MH "Ambulatory Care Nursing") OR (MH "Family Planning") OR (MH "Family Planning: Unplanned Pregnancy (Iowa NIC)") OR (MH "Midwifery") OR (MH "Lay Midwifery") OR (MH "Nurse‐Midwifery Service") OR (MH "Midwifery Service") OR (MH "Nurses+") OR (MH "Pharmacy Service") OR (MH "Pharmacy Technicians") OR (MH "Physicians+") OR (MH "Primary Health Care") OR (MH "Remote Consultation") OR (MH "Women's Health Services") OR (MH "Telemedicine") OR (MH "Telehealth")    (527,375)
S13    TI ( (aftercare OR "after care" OR ambulatory OR center OR centers OR clinic OR clinics OR day OR hospitaliz* OR hospitalis* OR hotline* OR nonhospital OR non‐hospital OR office OR offices OR online OR outpatient* OR out‐patient* OR outside OR (primary N2 (health* OR care)) OR supervision OR telehealth* OR telemedic* OR video* OR ((chat OR distan* OR mobile OR phone OR remote OR telephone) N2 consult*) OR apothecar* OR dispens* OR druggist* OR drugstore* OR "drug store*" OR pharmacy OR pharmacies OR OTC OR "over‐the‐counter" OR ((drug OR medicine) N4 (retail* OR seller* OR shop* OR store* OR vendor* OR setting OR "women on web"))) ) OR AB ( (aftercare OR "after care" OR ambulatory OR center OR centers OR clinic OR clinics OR day OR hospitaliz* OR hospitalis* OR hotline* OR nonhospital OR non‐hospital OR office OR offices OR online OR outpatient* OR out‐patient* OR outside OR (primary N2 (health* OR care)) OR supervision OR telehealth* OR telemedic* OR video* OR ((chat OR distan* OR mobile OR phone OR remote OR telephone) N2 consult*) OR apothecar* OR dispens* OR druggist* OR drugstore* OR "drug store*" OR pharmacy OR pharmacies OR OTC OR "over‐the‐counter" OR ((drug OR medicine) N4 (retail* OR seller* OR shop* OR store* OR vendor* OR setting OR "women on web"))) )    (904,020)
S14    TI ( (chemist* OR clinician* OR doctor* OR midwife* OR midwives OR nurse* OR nursing OR pharmacist* OR physician*) ) OR AB ( (chemist* OR clinician* OR doctor* OR midwife* OR midwives OR nurse* OR nursing OR pharmacist* OR physician*) ) (854,525)
S15    S10 OR S11 OR S12 OR S13 OR S14 (2,408,027)
S16    S6 AND S9 AND S15 (460)
S17    TI ( (((late OR later OR unsafe) N2 (abortion* OR "termination* OR pregnanc*" OR "pregnancy termination*" OR "interrupt* of pregnanc*" OR "pregnancy interrupt*")) OR (("2nd‐trimester" OR "second‐trimester" OR "mid‐trimester" OR midtrimester OR "3rd‐trimester" OR "third‐trimester") N1 (induce OR induced OR inducing OR induction OR inductions))) ) OR AB ( (((late OR later OR unsafe) N2 (abortion* OR "termination* OR pregnanc*" OR "pregnancy termination*" OR "interrupt* of pregnanc*" OR "pregnancy interrupt*")) OR (("2nd‐trimester" OR "second‐trimester" OR "mid‐trimester" OR midtrimester OR "3rd‐trimester" OR "third‐trimester") N1 (induce OR induced OR inducing OR induction OR inductions))) )    (0)
S18    S16 OR S17 (460)
S19    (MH "animals+") OR (MH "animal studies") OR TI ("animal model*") (216,978)
S20    (MH "human") (2,267,028)
S21    S19 NOT S20 (188,576)
S22    (MH "randomized controlled trials") OR (MH "double‐blind studies") OR (MH "single‐blind studies") OR (MH "random assignment") OR (MH "pretest‐posttest design") OR (MH "cluster sample") OR TI (randomised OR randomized) OR AB (random*) OR TI (trial) OR ((sample size) AND AB (assigned OR allocated OR control) OR (MH "placebos") OR PT (randomized controlled trial) OR AB (control W5 group) OR (MH "crossover design") OR MH ("comparative studies") OR AB (cluster W3 RCT) (801,252)
S23    S22 NOT S21 (762,564)
S24    S18 AND S23 (120)

PsycInfo (Ovid) 1806 to October Week 2 2020
Date searched: 22 October 2020

1 Induced Abortion/ (2666)
2 (feticid* or foeticid* or ((drug or medical or medically or medication or medicinal or medicine or gestation* or pregnan*) adj2 (abortion or abortions or interrupt* or terminat*))).ti,ab. (1571)
3 (abortifacient* or MTOP or mifepristone or misoprostol).ti,ab. (355)
4 (Abo‐pill or Colestone or Cytotec or Elmif or GyMiso or Korlym or Medabon or Mefeprin or Mefipil or Mifebort or Mifegest or Mifegyne or Mifeprex or Miferiv or Mifty or Misodel or Mtpill or Pitocin or RU‐486 or RU486 or Syntocinon or T‐Pill or Termipil).ti,ab. (297)
5 or/1‐4 (4194)
6 (second trimester or 2nd trimester or mid‐trimester or midtrimester or third trimester or 3rd trimester or ((late or later) adj2 (abortion* or gestation* or induct* or interrupt* or termination*)) or (("20" or "21" or "22" or "23" or "24" or "25" or "26" or "27" or "28" or "29" or "30" or "31" or "32" or "33" or "34" or "35") adj2 weeks) or ((twenty* or thirty*) adj2 weeks)).ti,ab. (11079)
7 Drug Self Administration/ or Self‐efficacy/ or Self‐management/ or Self‐monitoring/ (34542)
8 (attempts or attempted or clandestine or complications or criminal* or illegal* or individual* or safe or self‐administ* or self‐assess* or self‐care or self‐efficacy or self‐evaluat* or self‐examination* or self‐induc* or self‐manag* or self‐medicat* or self‐sourced or self‐use or unsafe or unsupervised or herself or themselves or home or homes).ti,ab. (1140899)
9 (aftercare or "after care" or ambulatory or center or centers or clinic or clinics or day or hospitaliz* or hospitalis* or hotline* or nonhospital or non‐hospital or office or offices or online or outpatient* or out‐patient* or outside or (primary adj2 (health* or care)) or supervision or telehealth* or telemedic* or video* or ((chat or distan* or mobile or phone or remote or telephone) adj2 consult*) or apothecar* or dispens* or druggist* or drugstore* or "drug store*" or pharmacy or pharmacies or OTC or "over‐the‐counter" or ((drug or medicine) adj4 (retail* or seller* or shop* or store* or vendor* or setting or "women on web"))).ti,ab. (642661)
10 (chemist* or clinician* or doctor* or midwife* or midwives or nurse* or nursing or pharmacist* or physician*).ti,ab. (276669)
11 or/7‐10 (1744554)
12 and/5‐6,10 (28)
13 (((late or later or unsafe) adj2 (abortion* or "termination* of pregnanc*" or "pregnancy termination*" or "interrupt* of pregnanc*" or "pregnancy interrupt*")) or (("2nd‐trimester" or "second‐trimester" or "mid‐trimester" or midtrimester or "3rd‐trimester" or "third‐trimester") adj (induce or induced or inducing or induction or inductions))).ti,ab. (176)
14 or/12‐13 (191)
15 Treatment Effectiveness Evaluation/ or exp Treatment Outcomes/ or Placebo/ or Followup Studies/ (160262)
16 (placebo* or random* or comparative stud* or (clinical adj3 trial*) or (research adj3 design) or (evaluat* adj3 stud*) or (prospectiv* adj3 stud*) or ((singl* or doubl* or trebl* or tripl*) adj3 (blind* or mask*))).ti,ab. (366574) 
17 or/15‐16 (487913)
18 and/14,17 (16)

Global Health 1973 to 2020 Week 41
Date searched: 22 October 2020
1 (feticid* or foeticid* or ((drug or medical or medically or medication or medicinal or medicine or gestation* or pregnan*) adj2 (abortion or abortions or interrupt* or terminat*))).ti,ab. (2831)
2 (abortifacient* or MTOP or mifepristone or misoprostol).ti,ab. (1263)
3 (Abo‐pill or Colestone or Cytotec or Elmif or GyMiso or Korlym or Medabon or Mefeprin or Mefipil or Mifebort or Mifegest or Mifegyne or Mifeprex or Miferiv or Mifty or Misodel or Mtpill or Pitocin or RU‐486 or RU486 or Syntocinon or T‐Pill or Termipil).ti,ab. (159)
4 or/1‐3 (3967)
5 (second trimester or 2nd trimester or mid‐trimester or midtrimester or third trimester or 3rd trimester or ((late or later) adj2 (abortion* or gestation* or induct* or interrupt* or termination*)) or (("20" or "21" or "22" or "23" or "24" or "25" or "26" or "27" or "28" or "29" or "30" or "31" or "32" or "33" or "34" or "35") adj2 weeks) or ((twenty* or thirty*) adj2 weeks)).ti,ab. (31064)
6 (attempts or attempted or clandestine or complications or criminal* or illegal* or individual* or safe or self‐administ* or self‐assess* or self‐care or self‐efficacy or self‐evaluat* or self‐examination* or self‐induc* or self‐manag* or self‐medicat* or self‐sourced or self‐use or unsafe or unsupervised or herself or themselves or home or homes).ti,ab. (503710)
7 (aftercare or "after care" or ambulatory or center or centers or clinic or clinics or day or hospitaliz* or hospitalis* or hotline* or nonhospital or non‐hospital or office or offices or online or outpatient* or out‐patient* or outside or (primary adj2 (health* or care)) or supervision or telehealth* or telemedic* or video* or ((chat or distan* or mobile or phone or remote or telephone) adj2 consult*) or apothecar* or dispens* or druggist* or drugstore* or "drug store*" or pharmacy or pharmacies or OTC or "over‐the‐counter" or ((drug or medicine) adj4 (retail* or seller* or shop* or store* or vendor* or setting or "women on web"))).ti,ab. (497768)
8 (chemist* or clinician* or doctor* or midwife* or midwives or nurse* or nursing or pharmacist* or physician*).ti,ab. (122259)
9 or/6‐8 (962439)
10 and/4‐5,8 (43)
11 (((late or later or unsafe) adj2 (abortion* or "termination* of pregnanc*" or "pregnancy termination*" or "interrupt* of pregnanc*" or "pregnancy interrupt*")) or (("2nd‐trimester" or "second‐trimester" or "mid‐trimester" or midtrimester or "3rd‐trimester" or "third‐trimester") adj (induce or induced or inducing or induction or inductions))).ti,ab. (828)
12 or/10‐11 (863)
13 randomized controlled trials/ or clinical trials/ or drug therapy/ or (placebo or random* or trial).ti,ab. (433152)
14 12 and 13 (85)

Scopus
Search date: 22 October 2020

clinicaltrials.gov/ct2/results?show_xprt=Y&xprt=%28+EXPAND%5BConcept%5D+%22second+trimester%22+OR+EXPAND%5BConcept%5D+%222nd+trimester%22+OR+mid‐trimester+OR+midtrimester+OR+EXPAND%5BConcept%5D+%22third+trimester%22+OR+EXPAND%5BConcept%5D+%223rd+trimester%22+OR+late+OR+later+OR+%2220+weeks%22+OR+%2221+weeks%22+OR+%2222+weeks%22+OR+%2223+weeks%22+OR+%2224+weeks%22+OR+%2225+weeks%22+OR+%2226+weeks%22+OR+%2227+weeks%22+OR+%2228+weeks%22+OR+%2229+weeks%22+OR+%2230+weeks%22+%29+AND+%28+attempts+OR+attempted+OR+clandestine+OR+criminal+OR+illegal+OR+individually+OR+safe+OR+self+OR+unsafe+OR+unsupervised+OR+herself+OR+themselves+OR+home+OR+homes+OR+aftercare+OR+EXPAND%5BConcept%5D+%22after+care%22+OR+ambulatory+OR+clinic+OR+hotline+OR+nonhospital+OR+non‐hospital+OR+office+OR+offices+OR+online+OR+outpatient+OR+out‐patient+OR+outside+OR+EXPAND%5BConcept%5D+%22primary+care%22+OR+EXPAND%5BConcept%5D+%22primary+health%22+OR+supervision+OR+telehealth+OR+telemedicine+OR+video+OR+chat+OR+remote+OR+telephone+OR+phone+OR+mobile+OR+apothecary+OR+dispensary+OR+druggist+OR+drugstore+OR+EXPAND%5BConcept%5D+%22drug+store%22+OR+pharmacy+OR+pharmacies+OR+OTC+OR+EXPAND%5BConcept%5D+%22over‐the‐counter%22+OR+retail+OR+seller+OR+shop+OR+store+OR+vendor+OR+setting+OR+EXPAND%5BConcept%5D+%22women+on+web%22+OR+chemist+%29+AND+AREA%5BConditionSearch%5D+%28+abortion+OR+EXPAND%5BConcept%5D+%22termination+of+pregnancy%22+OR+EXPAND%5BConcept%5D+%22pregnancy+termination%22+%29+AND+AREA%5BInterventionSearch%5D+%28+abortion+OR+EXPAND%5BConcept%5D+%22termination+of+pregnancy%22+OR+EXPAND%5BConcept%5D+%22pregnancy+termination%22+%29

( TITLE‐ABS‐KEY ( placebo  OR  random*  OR  trial ) )  AND  ( ( ( TITLE‐ABS‐KEY ( ( late  OR  later  OR  unsafe )  W/2  ( abortion*  OR  "termination* of pregnanc*"  OR  "pregnancy termination*"  OR  "interrupt* of pregnanc*"  OR  "pregnancy interrupt*" ) )  OR  TITLE‐ABS‐KEY ( ( "2nd‐trimester"  OR  "second‐trimester"  OR  "mid‐trimester"  OR  midtrimester  OR  "3rd‐trimester"  OR  "third‐trimester" )  W/1  ( induce  OR  induced  OR  inducing  OR  induction  OR  inductions ) ) ) )  OR  ( ( ( TITLE‐ABS‐KEY ( ( feticid*  OR  foeticid*  OR  ( ( drug  OR  medical  OR  medically  OR  medication  OR  medicinal  OR  medicine  OR  gestation*  OR  pregnan* )  W/2  ( abortion  OR  abortions  OR  interrupt*  OR  terminat* ) ) ) ) )  OR  ( TITLE‐ABS‐KEY ( ( abortifacient*  OR  mtop  OR  mifepristone  OR  misoprostol ) ) )  OR  ( TITLE‐ABS‐KEY ( ( abo‐pill  OR  colestone  OR  cytotec  OR  elmif  OR  gymiso  OR  korlym  OR  medabon  OR  mefeprin  OR  mefipil  OR  mifebort  OR  mifegest  OR  mifegyne  OR  mifeprex  OR  miferiv  OR  mifty  OR  misodel  OR  mtpill  OR  pitocin  OR  ru‐486  OR  ru486  OR  syntocinon  OR  t‐pill  OR  termipil ) ) ) )  AND  ( ( TITLE‐ABS‐KEY ( second  AND trimester  OR  2nd  AND trimester  OR  mid‐trimester  OR  midtrimester  OR  third  AND trimester  OR  3rd  AND trimester  OR  ( ( late  OR  later )  W/22  ( abortion*  OR  gestation*  OR  induct*  OR  interrupt*  OR  termination* ) ) )  OR  TITLE‐ABS‐KEY ( ( ( "20"  OR  "21"  OR  "22"  OR  "23"  OR  "24"  OR  "25"  OR  "26"  OR  "27"  OR  "28"  OR  "29"  OR  "30"  OR  "31"  OR  "32"  OR  "33"  OR  "34"  OR  "35" )  W/2  weeks ) )  OR  TITLE‐ABS‐KEY ( ( ( twenty*  OR  thirty* )  W/2  weeks ) ) ) )  AND  ( ( ( TITLE‐ABS‐KEY ( attempts  OR  attempted  OR  clandestine  OR  complications  OR  criminal*  OR  illegal*  OR  individual*  OR  safe  OR  self‐administ*  OR  self‐assess*  OR  self‐care  OR  self‐efficacy  OR  self‐evaluat*  OR  self‐examination*  OR  self‐induc*  OR  self‐manag*  OR  self‐medicat* )  OR  TITLE‐ABS‐KEY ( self‐sourced  OR  self‐use  OR  unsafe  OR  unsupervised  OR  herself  OR  themselves  OR  home  OR  homes ) ) )  OR  ( ( TITLE‐ABS‐KEY ( aftercare  OR  "after care"  OR  ambulatory  OR  center  OR  centers  OR  clinic  OR  clinics  OR  day  OR  hospitaliz*  OR  hospitalis*  OR  hotline*  OR  nonhospital  OR  non‐hospital  OR  office  OR  offices  OR  online  OR  outpatient*  OR  out‐patient*  OR  outside )  OR  TITLE‐ABS‐KEY ( ( primary  W/2  ( health*  OR  care ) )  OR  supervision  OR  telehealth*  OR  telemedic*  OR  video*  OR  ( ( chat  OR  distan*  OR  mobile  OR  phone  OR  remote  OR  telephone )  W/2  consult* )  OR  apothecar*  OR  dispens*  OR  druggist*  OR  drugstore*  OR  "drug store*" )  OR  TITLE‐ABS‐KEY ( pharmacy  OR  pharmacies  OR  otc  OR  "over‐the‐counter"  OR  ( ( drug  OR  medicine )  W/4  ( retail*  OR  seller*  OR  shop*  OR  store*  OR  vendor*  OR  setting  OR  "women on web" ) ) ) ) )  OR  ( TITLE‐ABS‐KEY ( ( chemist*  OR  clinician*  OR  doctor*  OR  midwife*  OR  midwives  OR  nurse*  OR  nursing  OR  pharmacist*  OR  physician* ) ) ) ) ) )  AND  ( LIMIT‐TO ( DOCTYPE,  "cp" ) ) (77)

Contributions of authors

Conceiving the protocol: MR 

Designing the protocol: MR, CH

Co‐ordinating the protocol: MR

Designing search strategies: Cochrane Fertility Regulation Information Specialist, CH 

Writing the protocol: MR 

Providing general advice on the protocol: VK, CH, ML

Securing funding for the protocol: not‐applicable 

Performing previous work that was the foundation of the current study: not applicable

Sources of support

Internal sources

• No internal sources of support, Other

External sources

• No external sources of support, Other

Declarations of interest

Curtis Harrod: none known

Mwansa Lubeya: none known

Moira Ray: none known

Valerie King: none known

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