{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T16:58:29Z","timestamp":1775667509580,"version":"3.50.1"},"reference-count":31,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2021,12,11]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Globally, access to safe abortion is limited. We aimed to assess the safety, effectiveness and acceptability of harm reduction counselling for abortion, which we define as the provision of information about safe abortion methods to pregnant persons seeking abortion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We searched PubMed, EMBASE, ClinicalTrials.gov, Cochrane, Global Index Medicus and the grey literature up to October 2021. We included studies in which healthcare providers gave pregnant persons information on safe use of abortifacient medications without providing the actual medications. We conducted a descriptive summary of results and a risk of bias assessment using the ROBINS-I tool. Our primary outcome was the proportion of pregnant persons who used misoprostol to induce abortion rather than other methods among those who received harm reduction counselling.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We included four observational studies with a total of 4002 participants. Most pregnant persons who received harm reduction counselling induced abortion using misoprostol (79%\u2013100%). Serious complication rates were low (0%\u20131%). Uterine aspiration rates were not always reported but were in the range of 6%\u201322%. Patient satisfaction with the harm reduction intervention was high (85%\u201398%) where reported. We rated the risk of bias for all studies as high due to a lack of comparison groups and high lost to follow-up rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Based on a synthesis of four studies with serious methodological limitations, most recipients of harm reduction counselling use misoprostol for abortion, have low complication rates, and are satisfied with the intervention. More research is needed to determine abortion success outcomes from the harm reduction approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Funding<\/jats:title>\n                  <jats:p>This work did not receive any funding.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>We registered the review in the PROSPERO database of systematic reviews (ID number: CRD42020200849).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsrh-2021-201389","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T13:47:19Z","timestamp":1641908839000},"page":"137-145","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Reducing the harms of unsafe abortion: a systematic review of the safety, effectiveness and acceptability of harm reduction counselling for pregnant persons seeking induced abortion"],"prefix":"10.1136","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9740-4703","authenticated-orcid":false,"given":"Bianca Maria","family":"Stifani","sequence":"first","affiliation":[{"name":"Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine \/ Montefiore Medical Center, Bronx, NY, USA"},{"name":"Obstetrics & Gynecology, New York Medical College \/ Westchester Medical Center, Valhalla, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roopan","family":"Gill","sequence":"additional","affiliation":[{"name":"Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caron Rahn","family":"Kim","sequence":"additional","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"2025090510162281000_48.2.137.1","doi-asserted-by":"crossref","first-page":"2372","DOI":"10.1016\/S0140-6736(17)31794-4","article-title":"Global, regional, and subregional classification of abortions by safety, 2010\u201314: estimates from a Bayesian hierarchical model","volume":"390","author":"Ganatra","year":"2017","journal-title":"The Lancet"},{"key":"2025090510162281000_48.2.137.2","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1097\/AOG.0000000000002491","article-title":"Harm reduction for abortion in the United States","volume":"131","author":"Tasset","year":"2018","journal-title":"Obstet Gynecol"},{"key":"2025090510162281000_48.2.137.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12954-017-0196-4","article-title":"Harm reduction principles for healthcare settings","volume":"14","author":"Hawk","year":"2017","journal-title":"Harm Reduct J"},{"key":"2025090510162281000_48.2.137.4","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.ijgo.2006.07.013","article-title":"A risk reduction strategy to prevent maternal deaths associated with unsafe abortion","volume":"95","author":"Briozzo","year":"2006","journal-title":"Int J Gynaecol Obstet"},{"key":"2025090510162281000_48.2.137.5","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1002\/ijgo.12677","article-title":"From harm reduction to legalization: the Uruguayan model for safe abortion","volume":"143 Suppl 4","author":"Stifani","year":"2018","journal-title":"Int J Gynaecol Obstet"},{"key":"2025090510162281000_48.2.137.6","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.2105\/AJPH.2016.303446","article-title":"Quality of care in a safe-abortion hotline in Indonesia: beyond harm reduction","volume":"106","author":"Gerdts","year":"2016","journal-title":"Am J Public Health"},{"key":"2025090510162281000_48.2.137.7","first-page":"1907027","article-title":"Abortion hotlines around the world: a mixed-methods systematic and descriptive review","volume":"29","author":"Gill","year":"2021","journal-title":"Sex Reprod Health Matters"},{"key":"2025090510162281000_48.2.137.8","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.contraception.2017.09.004","article-title":"Medical abortion can be provided safely and effectively by pharmacy workers trained within a harm reduction framework: Nepal","volume":"97","author":"Tamang","year":"2018","journal-title":"Contraception"},{"key":"2025090510162281000_48.2.137.9","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ijgo.2013.10.004","article-title":"Facilitating women's access to misoprostol through community-based advocacy in Kenya and Tanzania","volume":"125","author":"Coeytaux","year":"2014","journal-title":"Int J Gynaecol Obstet"},{"key":"2025090510162281000_48.2.137.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"2025090510162281000_48.2.137.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"2025090510162281000_48.2.137.12","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1016\/j.ijgo.2016.06.008","article-title":"A replication of the Uruguayan model in the province of Buenos Aires, Argentina, as a public policy for reducing abortion-related maternal mortality","volume":"134","author":"Mat\u00eda","year":"2016","journal-title":"Int J Gynaecol Obstet"},{"key":"2025090510162281000_48.2.137.13","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/j.ijgo.2016.06.004","article-title":"Overall and abortion-related maternal mortality rates in Uruguay over the past 25 years and their association with policies and actions aimed at protecting women\u2019s rights","volume":"134","author":"Briozzo","year":"2016","journal-title":"Int J Gynaecol Obstet"},{"key":"2025090510162281000_48.2.137.14","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1016\/j.ijgo.2016.06.007","article-title":"Implementation of the risk and harm reduction strategy against unsafe abortion in Uruguay: from a university hospital to the entire country","volume":"134","author":"Labandera","year":"2016","journal-title":"Int J Gynaecol Obstet"},{"key":"2025090510162281000_48.2.137.15","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1002\/ijgo.12035","article-title":"Provision of harm-reduction services to limit unsafe abortion in Tanzania","volume":"136","author":"Kahabuka","year":"2017","journal-title":"Int J Gynaecol Obstet"},{"key":"2025090510162281000_48.2.137.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0189195","article-title":"A harm-reduction model of abortion counseling about misoprostol use in Peru with telephone and in-person follow-up: a cohort study","volume":"13","author":"Grossman","year":"2018","journal-title":"PLoS One"},{"key":"2025090510162281000_48.2.137.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-017-0438-7","article-title":"Comparative satisfaction of receiving medical abortion service from nurses and auxiliary nurse-midwives or doctors in Nepal: results of a randomized trial","volume":"14","author":"Tamang","year":"2017","journal-title":"Reprod Health"},{"key":"2025090510162281000_48.2.137.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0968-8080(15)43825-X"},{"key":"2025090510162281000_48.2.137.19","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000897"},{"key":"2025090510162281000_48.2.137.20","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1097\/AOG.0000000000003017","article-title":"Efficacy of misoprostol alone for first-trimester medical abortion: a systematic review","volume":"133","author":"Raymond","year":"2019","journal-title":"Obstet Gynecol"},{"key":"2025090510162281000_48.2.137.21","doi-asserted-by":"crossref","first-page":"212","DOI":"10.2307\/2673784","article-title":"Choice of and satisfaction with methods of medical and surgical abortion among U.S. clinic patients","volume":"33","author":"Harvey","year":"2001","journal-title":"Fam Plann Perspect"},{"key":"2025090510162281000_48.2.137.22","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15684"},{"key":"2025090510162281000_48.2.137.23","doi-asserted-by":"crossref","first-page":"e117","DOI":"10.1016\/j.whi.2012.12.002","article-title":"Women\u2019s and providers\u2019 experiences with medical abortion provided through telemedicine: a qualitative study","volume":"23","author":"Grindlay","year":"2013","journal-title":"Women's Health Issues"},{"key":"2025090510162281000_48.2.137.24","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1002\/ijgo.13086","article-title":"Effect of a smartphone intervention on self-managed medication abortion experiences among safe-abortion hotline clients in Indonesia: a randomized controlled trial","volume":"149","author":"Gerdts","year":"2020","journal-title":"Int J Gynaecol Obstet"},{"key":"2025090510162281000_48.2.137.25","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.contraception.2017.07.170","article-title":"Accompaniment of second-trimester abortions: the model of the feminist Socorrista network of Argentina","volume":"97","author":"Zurbriggen","year":"2018","journal-title":"Contraception"},{"key":"2025090510162281000_48.2.137.26","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.contraception.2017.09.007","article-title":"Developing a forward-looking agenda and methodologies for research of self-use of medical abortion","volume":"97","author":"Kapp","year":"2018","journal-title":"Contraception"},{"key":"2025090510162281000_48.2.137.27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60914-3"},{"key":"2025090510162281000_48.2.137.28","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1111\/j.1600-0412.2011.01285.x","article-title":"Regional differences in surgical intervention following medical termination of pregnancy provided by telemedicine","volume":"91","author":"Gomperts","year":"2012","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025090510162281000_48.2.137.29","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.contraception.2013.11.005","article-title":"Provision of medical abortion using telemedicine in Brazil","volume":"89","author":"Gomperts","year":"2014","journal-title":"Contraception"},{"key":"2025090510162281000_48.2.137.30","doi-asserted-by":"crossref","first-page":"441","DOI":"10.3109\/13625187.2013.824564","article-title":"Medical abortion: a path to safe, high-quality abortion care in Latin America and the Caribbean","volume":"18","author":"Dzuba","year":"2013","journal-title":"Eur J Contracept Reprod Health Care"},{"key":"2025090510162281000_48.2.137.31","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.contraception.2021.07.004","article-title":"Standardizing abortion research outcomes (STAR): results from an international consensus development study","volume":"104","author":"Whitehouse","year":"2021","journal-title":"Contraception"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2021-201389","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T17:24:06Z","timestamp":1757093046000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2021-201389"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,11]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,4,8]]},"published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1136\/bmjsrh-2021-201389"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2021-201389","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,11]]}}}