Summary of findings for the main comparison. Surgical abortion procedures: mid‐level providers compared to doctors.
| Surgical abortion procedures: mid‐level providers compared to doctors | ||||||
|
Patient or population: Patients requesting abortion procedures
Settings: Hospital or clinic
Intervention: Surgical abortion administered by mid‐level providers Comparison: Surgical abortion administered by doctors | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Mid‐level providers | |||||
| Failure/incomplete abortion (RCTs) Provider assessment Follow‐up: 10 to 14 days | 6 per 1000 | 17 per 1000 (1 to 241) | RR 2.97 (0.21 to 41.82) | 2789 (2 studies) | ⊕⊕⊝⊝ low3 | — |
| Failure/incomplete abortion (observational studies) Provider or supervisor assessment Follow‐up: 7 to 28 days | 3 per 1000 | 7 per 1000 (4 to 12) | RR 2.2 (1.34 to 3.6) | 13,715 (3 studies) | ⊕⊝⊝⊝ very low1 | — |
| Complications (RCTs) Provider assessment Follow‐up: 10 to 14 days | 1 per 1000 | 1 per 1000 (0 to 8) | RR 0.99 (0.17 to 5.7) | 2789 (2 studies) | ⊕⊕⊝⊝ low3 | — |
| Complications (observational studies) Provider or supervisor assessment Follow‐up: 7 to 28 days | 7 per 1000 | 10 per 1000 (5 to 19) | RR 1.38 (0.7 to 2.72) | 13,715 (3 studies) | ⊕⊝⊝⊝ very low1,2 | — |
| Total complications (RCTs) Provider assessment Follow‐up: 10 to 14 days | 7 per 1000 | 22 per 1000 (1 to 425) | RR 3.07 (0.16 to 59.08) | 2789 (2 studies) | ⊕⊕⊝⊝ low3 | — |
| Total complications (observational studies) Provider or supervisor assessment Follow‐up: 7 to 28 days | 13 per 1000 | 18 per 1000 (11 to 28) | RR 1.36 (0.86 to 2.14) | 16,173 (4 studies) | ⊕⊝⊝⊝ very low1,2 | — |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval;RCT: randomised controlled trial; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Quality of evidence was downgraded from Low to Very Low due to Risk of bias. The proportion of information from studies at high risk of bias is sufficient to affect the interpretation of results. All studies are observational studies. Blinding in abortion studies is not feasible (ethical) . 2 Quality of evidence was downgraded from Low to Very Low due to Study Limitations and Imprecision (Wide confidence intervals for Jejeebhoy 2011). 3No events in the doctors group in South Africa.