{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T15:04:23Z","timestamp":1751036663225,"version":"3.40.5"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T00:00:00Z","timestamp":1692835200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>In 2018, the Department of Health and Social Care in England approved the use of misoprostol at home for early medical abortions, following administration of mifepristone at clinic. The objective of the present study was to assess the impact of the approval of home administration of misoprostol in England on access to medical abortion, assessed through proxy measures of the proportion of all abortions that were medical and gestational age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study uses the clinical data from the British Pregnancy Advisory Service on abortions in England in years 2018\u20132019, containing demographic and procedure characteristics of patients. We conducted an interrupted time series analysis to establish the differences before and after the approval in access to medical abortion, measured by the proportion of all abortions that were medical, and gestational age. The analysis also examined whether these changes were equitable, with focus on area\u2010level deprivation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The analysis of the data (145\u2009529 abortions) suggested that there was an increase in the proportion of medical abortions and decrease in gestational age of abortions after the approval. Compared with the situation if former trends had continued, the actual proportion of early medical abortions was 4.2% higher in December 2019, and the mean gestational age 3.4\u2009days lower. We found that the acceleration of existing trends in increase in proportion of medical abortions and decrease in gestational age were larger in the most deprived quintiles and in those reporting a disability, but not equal across ethnic groups, with Black and Black British women experiencing little change in trajectories post\u2010approval.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The approval of home use of misoprostol as part of an early medical abortion regimen in England was associated with material and equitable improvements in abortion access. Pre\u2010approval trends toward greater uptake of medical abortion and declining gestational age were accelerated post\u2010approval and were greatest in the most deprived areas of England, but not across all racial\/ethnic groups. The present findings strongly support the continuation or introduction of home management of medical abortions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.15044","type":"journal-article","created":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T06:40:49Z","timestamp":1692945649000},"page":"286-297","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of approval of home use of misoprostol in England on access to medical abortion: An interrupted time series analysis"],"prefix":"10.1002","volume":"164","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3012-1132","authenticated-orcid":false,"given":"Maria","family":"Lewandowska","sequence":"first","affiliation":[{"name":"Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6323-5291","authenticated-orcid":false,"given":"Daniel J.","family":"Carter","sequence":"additional","affiliation":[{"name":"Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2271-3568","authenticated-orcid":false,"given":"Antonio","family":"Gasparrini","sequence":"additional","affiliation":[{"name":"Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1862-5730","authenticated-orcid":false,"given":"Patricia A.","family":"Lohr","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Research and Communication British Pregnancy Advisory Service  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1053-8640","authenticated-orcid":false,"given":"Kaye","family":"Wellings","sequence":"additional","affiliation":[{"name":"Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,8,24]]},"reference":[{"volume-title":"Abortion Care","year":"2020","author":"National Institute for Health and Care Excellence, Royal College of Obstetricians and Gynaecologists","key":"e_1_2_11_2_1"},{"key":"e_1_2_11_3_1","first-page":"2002","volume-title":"Abortion Statistics","author":"Office for National Statistics","year":"2001"},{"key":"e_1_2_11_4_1","unstructured":"British Society of Abortion Care Providers Royal College of Obstetricians and Gynaecologists Faculty of Sexual and Reproductive Health.Clinical Guidelines for Early Medical Abortion at Home \u2010 England2018:1\u20137."},{"key":"e_1_2_11_5_1","first-page":"1","volume-title":"Abortion Statistics, England and Wales: 2011","author":"Department of Health","year":"2012"},{"volume-title":"Abortion Statistics, England and Wales: 2019","year":"2020","author":"Department of Health and Social Care","key":"e_1_2_11_6_1"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-003934"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.10.084046"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0209991"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2020-200612"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1783\/147118910793048719"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14118"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2017.09.003"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2020-200661"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14690"},{"key":"e_1_2_11_16_1","unstructured":"National Institute for Health and Care Excellence.Abortion Care NICE Guideline.2019."},{"key":"e_1_2_11_17_1","unstructured":"Guttmacher Institute.Abortion Worldwide 2017: Uneven Progress and Unequal Access.2017."},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17033"},{"volume-title":"Medical Management of Abortion","year":"2018","author":"World Health Organization","key":"e_1_2_11_19_1"},{"volume-title":"Abortion\u2014Improvement to Existing Services\u2014Approval for Misoprostol to be Taken at Home","year":"2017","author":"Chief Medical Officer Directorate","key":"e_1_2_11_20_1"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2019.11.008"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/1933719116669055"},{"key":"e_1_2_11_23_1","unstructured":"Department of Health and Social Care.Abortion statistics 2019: clinic data tables.2019. 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