Background Despite its overall safety and efficacy, early medical abortion (EMA) may result in complications. Understanding factors predicting these complications is essential for improving clinical risk assessment by healthcare providers and guiding effective management of complications associated with EMA. The purpose of this scoping review is to systematically map the existing evidence of predictors and prediction models of complications associated with EMA. Methods We conducted a comprehensive literature search using databases with Embase (OVID), Medline (OVID), Scopus and Web of Science. Studies were included if they presented evidence on the predictors and prediction models of complications associated with EMA. Retrieved articles were screened using Covidence. A descriptive and narrative synthesis of the included studies was conducted to summarise findings across studies. Results Thirteen studies were included in the final synthesis. Pain, incomplete abortion and retained products of conception, continuing pregnancy, heavy bleeding requiring transfusion and infection were the most frequently addressed complications associated with EMA. Gestational age was identified as a key determinant across major complications of EMA. Two studies included the development of a model to predict surgical intervention following EMA demonstrating moderate discriminatory performance (AUC 63%). Conclusions This review highlights an evidence gap in the identification of predictors and the development of clinical prediction models for complications associated with EMA. Future research using larger prospective studies is needed to identify the predictors and develop individualised prediction models for assessing the risk of complications in patients undergoing EMA to support evidence-based clinical decision-making in post-abortion care.
BACKGROUND:Early medical abortion (EMA) in Ireland is delivered through general practitioners (GPs) operating within a nationally standardised, three-visit care protocol. Since 2020, a blended model has emerged in which the initial consultation and follow-up may be conducted by telemedicine, with in-person attendance required for medication administration. We describe the development and implementation of the Activity Data on Abortion in General Practice (ADAPT) data collection tool and present the first GP-level evidence on the integration of telemedicine into Irish GP-delivered EMA. METHODS:ADAPT was developed in 2025 by a subcommittee of the Southern Taskforce on Abortion and Reproductive Topics (START) and researchers at Trinity College Dublin to fill a critical void in abortion data collection in Ireland. The tool collects 49 prospective anonymous patient- and practice-level measures. Descriptive, provider-level statistics were reviewed. RESULTS:Between August 2025 and April 2026, 124 GPs expressed interest in ADAPT, 112 signed consent and data-sharing agreements and 64 submitted at least one complete patient record. Of these 64 GPs, 48.4% provided mixed (both remote and in-person) consultation modalities, 32.8% delivered fully in-person care and 18.8% provided fully remote care at Visit 1, with no significant differences by provider characteristics. CONCLUSIONS:ADAPT provides the first structured GP-level evidence base for EMA in Ireland. Our early data show that telemedicine is not a marginal or exceptional feature of Irish GP-delivered EMA: the majority of participating GPs offer it in some form.
Introduction Home-managed medical abortions are the most common method of abortion in the UK. Although self-reported satisfaction is high, a minority of patients would not choose home management for a future abortion, and qualitative research on patient experiences reveals key areas where care could be improved. The aim of this scoping review was to present an overview of non-pharmacological interventions for home-managed medical abortion that could improve patient acceptability of the process in the UK. Methods We searched Medline, Embase, CINAHL Complete, Web of Science and Global Index Medicus databases in June 2023 for peer reviewed literature published in English between January 2013 and June 2023. We included primary research on non-pharmacological interventions for patients having a first-trimester medical abortion with home management. We charted study characteristics, intervention details and acceptability results and reported our findings by intervention type. Results We identified 10 studies that met our inclusion criteria. We described these interventions as abortion information-seeking, individual autonomy, social and community support, self-management of side effects and self-assessment of completion. Studies either presented findings about participants’ acceptability of the intervention or the intervention’s impact on abortion experience. One reported both. Two studies found significant improvements in patient experience—one in anxiety, emotional stress and preparedness during the abortion, and another in pain. Conclusion There are limited data on non-pharmacological interventions for home-managed medical abortion. Emerging evidence on patient experience in the UK should inform the design of novel interventions and the choice of indicators to assess an acceptable abortion experience.
BACKGROUND:To avoid unplanned, rapid repeat pregnancies, women are recommended to use effective contraception by day 21 postpartum. This study describes postpartum contraception use, impact of contraception counselling, and structural barriers to access from the perspective of doctor-mothers who have knowledge of health systems and high health-literacy. METHODS:This is a secondary analysis of a survey which compared postpartum contraception use in women who had conceived spontaneously versus with in vitro fertilisation, using data from doctor-mothers who conceived spontaneously. Contraception use over time is presented as a Sankey plot. Chi-squared or Fisher's exact tests compared contraception effectiveness by sociodemographics and pregnancy planning. Qualitative data on contraception counselling experience were analysed using thematic analysis. RESULTS:Of 634 records, 177 participants were eligible for analysis, with 72 providing qualitative data. Most (146/177, 82.5%) reported vaginal sex post-birth, and 19.8% had had sex within 6 weeks. Only 11.6% (17/146) of sexually active participants used very effective methods as first contraception. Greater contraception effectiveness was associated with earlier initiation (p<0.001). Of sexually active participants who initiated contraception within 3 weeks postpartum, 92.3% (12/13) used effective or very effective methods. Counselling only at place of birth was associated with initiation of effective contraception (p=0.041). Qualitative analysis of counselling experience generated three themes: (1) counselling style, (2) multidisciplinary working and (3) need for self-advocacy. CONCLUSIONS:Use of effective postpartum contraception was low overall, despite a highly health-literate population. Counselling at place of birth has a potentially significant impact on the individual. Of those who initiated contraception before 3 weeks, almost all chose effective methods indicating acceptability where available.
OBJECTIVES:To examine longitudinal trends in the provision of medication abortion (MA) in Australian general practice. STUDY DESIGN:Retrospective study of Australian females aged 14-49 years attending Australian general practices between 2014 and 2021. Data were sourced from the national general practice dataset, MedicineInsight. We calculated rates of MA provision and reported characteristics of those receiving and providing MA services. RESULTS:We identified 4306 instances of MA provision to 3980 unique individuals. The rate of MA provision increased from 0.11 per 1000 females in 2014/15 to 2.10 per 1000 females in 2020/21. A greater absolute increase in the rate of MA was evident among those aged 25-29 years, those residing in regional areas or those in areas of lower socioeconomic status. The proportion of general practices providing MA increased from 4.4% in 2014 to 22.7% in 2021. The proportion of general practices providing MA was higher among those located outside of major cities and in higher socioeconomic status areas. CONCLUSIONS:Despite modest increases in the rates of MA provision in general practice over time, less than one third of general practices provide MA. Significant geographical variation in MA provision is also evident according to remoteness, socioeconomic status and state/territory. The findings emphasise the need for additional initiatives to ensure equitable access to abortion care within the general practice setting, and future research should examine the underlying reasons for differences in MA uptake by patient characteristics and geographical location, informing targeted interventions and service planning.
BACKGROUND:Cervical cancer is one of the most preventable cancers. Screening uptake may be lower among women affected by sexual violence and abuse (SV&A), although evidence remains mixed. These women face unique barriers to accessing intimate healthcare, reflecting deep-rooted inequities. This systematic review examined how experiences of SV&A influence engagement with cervical screening and identified approaches that improve access to and experiences of screening care for this population. METHODS:Medline, Embase, ASSIA, CINAHL, PsycINFO and the Cochrane Library were searched. English-language studies and grey literature published from 2000 onwards exploring barriers and prevalence of cervical screening among women living with the impact of SV&A across OECD (Organisation for Economic Co-operation and Development) countries were included. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were used by two independent reviewers to search, screen, data extract, critically appraise and narratively synthesise included studies. RESULTS:30 studies met the inclusion criteria. Three overarching themes were identified: (1) engagement with cervical screening care, (2) influential factors and (3) compassionate care. Practical, emotional and structural barriers influenced attendance, with experiences of SV&A often leading to avoidance of intimate examinations. Compassionate and trauma-informed approaches emphasising trust, communication, choice and control were linked to improved engagement and more positive screening experiences. CONCLUSIONS:Understanding barriers to accessing cervical screening care for women who have experienced SV&A can enhance access to intimate screening care. Enhancing care at each stage of the screening process may better respond to women's individual experiences. Further research is needed to explore models of compassionate care and their longer-term impact on quality of life and health outcomes.
BACKGROUND:Medication abortion can expand access by shifting services to primary care; however, few resources exist to strengthen knowledge and confidence among abortion providers and supporting teams. In this study, we evaluated the acceptability and usefulness of a co-created online resource designed to support primary care providers and community workers in providing medication abortion. METHODS:We conducted virtual qualitative interviews with 26 healthcare professionals and community workers using the 'think-aloud' method. Participants were recruited from abortion clinics and community organisations in Canada. Data were analysed inductively using thematic analysis. RESULTS:Participants generally found the resource to becomprehensive, thorough and effective for navigating diverse abortion practices. Key strengths included clarity of writing, intuitive layout and engaging visual elements. However, findings revealed that certain design choices-specifically a blue-grey colour palette and an overemphasis on side effects-could unintentionally reinforce abortion-related stigma. Furthermore, specific terminology and graphics were identified as lacking inclusivity for patients from diverse or underserved backgrounds. CONCLUSIONS:While comprehensive online resources are vital for integrating abortion into primary care, design and language must be carefully selected to avoid perpetuating stigma. Future clinical tools should prioritise inclusive word choices, brighter colour schemes and diverse iconography. Engaging community workers and patients in the design process is essential to ensure resources are non-stigmatising and inclusive.
BACKGROUND:Sexual well-being is rarely prioritised as a distinct goal in national or international sexual health strategies. A major barrier is the absence of a widely accepted definition of sexual well-being. This study aimed to establish consensus on a definition and framework to inform public policy in Scotland and internationally. METHODS:A two-stage, online, modified Delphi process involving Scottish and international experts from government, non-governmental organisations and academia. Panellists rated and commented on the clarity and importance (scale: 1-9) of a proposed definition and domains of sexual wellbeing. Consensus was defined as ≥70% participants rating 7-9. Qualitative comments were synthesised and revised statements were re-rated. Statements were further refined via a consensus meeting. RESULTS:Ninety-five panellists completed Round 1 (53% Scotland-based; 65% >10 years' professional experience) and 66 completed Round 2 (69.5% retention). Panellists reached consensus on a definition of sexual wellbeing as "feeling respected, safe, at ease and supported, while also having a sense of self-worth and agency in relation to sex and sexuality" (>90% consensus). Definition statements for six domains of sexual wellbeing also achieved high consensus: sexual respect, safety, agency and support (>90% consensus) and comfort with sexuality and sexual self-esteem (>80% consensus). CONCLUSIONS:This is the first consensus definition and framework of sexual wellbeing for population health. It provides a foundation for goals and indicators to support multisector efforts aimed at promoting positive sexuality alongside mitigation of negative outcomes. Further work is required to understand the framework's transferability across diverse cultural and policy environments.
BACKGROUND:Young people's adverse sexual experiences contribute to a significant global mental health burden and detract from their quality of life. Sexual wellbeing connects sexual and mental health and can offer a novel perspective on drivers and impacts of young people's sexual behaviour. It is a promising means through which to shift public health focus from risk to aspects of sex relevant to broader wellbeing. METHODS:This systematic review aimed to characterise sexual wellbeing for adolescents and emerging adults (aged 16-24 years). We searched four databases for peer-reviewed qualitative literature on young people's accounts relevant to sexual wellbeing published between 1988 and 2025. We intensity sampled and thematically synthesised studies against Mitchell et al's Sexual Wellbeing Conceptual Framework. PROSPERO registration: CRD42022315593. RESULTS:We thematically synthesised 93 papers, representing 3152 participants across 25 countries. Our synthesis characterises youth sexual wellbeing as feeling: congruence between one's sexual thoughts, feelings, values, behaviours and emerging identities; driven by curiosity or desire; capable of advocating for one's wants and boundaries; able to authentically express oneself; deserving of care, respect and support; and expectant of a positive sexual future. Women, sexual and gender minorities, sexual violence survivors, youth with disabilities or health conditions, and those in deprived or sexually conservative communities report additional barriers to wellbeing. CONCLUSIONS:This first-ever review of youth sexual wellbeing underscores its significance during this life stage, and outlines similarities and differences compared with adults. The findings demand a stronger focus on young people's priorities for sexual wellbeing to support their healthy development.
BACKGROUND:Most patients in Britain undergoing medical abortion under 10 weeks' gestation manage the entire process at home, with access to clinical support from qualified staff via telephone if needed. Artificial intelligence (AI) 'chatbots' are potential tools to support patients; however, little is known about patient views on their use in this regard. METHODS:We invited British Pregnancy Advisory Service (BPAS) patients who had a medical abortion under 10 weeks' gestation to participate in an online, English-language, cross-sectional questionnaire (August 2025-October 2025). The questionnaire assessed demographics, self-reported likelihood of using a potential AI chatbot, perceived appealing features, reasons for hesitation and preferred features. Descriptive analysis, Chi-square statistics and p values were used to analyse responses. The desired sample size was 380. RESULTS:Of the 4684 patients invited, 396 completed the questionnaire (8%). Overall, 22.4% self-reported as very likely to use an AI chatbot, 13.1% as likely, 20.8% as neutral, 17.5% as unlikely and 26.2% as very unlikely. Self-reported likelihood of use did not vary by demographics. Perceived appealing features included: 24-hour access (57.6%), reduced wait time (47%), anonymous care (25.7%) and access to reliable personalised information (17.2%). Reasons for hesitation included: misinformation (54.2%), preference for human interaction (51.9%), conversations that loop (42.2%), data privacy (40.4%) and lack of trust in AI (38.3%). Preferred features emphasised flexibility, customisation and ability to contact staff. CONCLUSIONS:Respondents' views on a potential AI chatbot for medical abortion support were mixed, shaped by trust, reliability, flexibility and access to clinical staff. Such tools may be most acceptable as optional adjuncts within existing care pathways, requiring real-world evaluation.
BACKGROUND:Psychological side effects are a frequent reason for discontinuation of hormonal contraception (HC), yet women with pre-existing mental health (MH) conditions are often excluded from studies despite their prevalence and needs. OBJECTIVES:To examine the effects of HC used for pregnancy prevention on anxiety and mood (affective) symptoms in women with established MH disorders. METHODS:MEDLINE, Embase and Cochrane CENTRAL were systematically searched for English-language studies published between 2015 and 2025. Randomised controlled trials, cohort and cross-sectional studies evaluating any HC type in women with clinically diagnosed or self-reported anxiety or mood (affective) disorders were included. Studies assessing HC for therapeutic indications were excluded. Screening and data extraction followed Cochrane Rapid Review guidance. Due to heterogeneity in study designs and outcomes, findings were narratively synthesised by contraceptive type and population (adult, adolescent, postpartum). RESULTS:Ten studies met inclusion criteria. HC use did not consistently worsen anxiety or mood symptoms in women with pre-existing MH disorders. Combined oral contraceptives (COCs) showed largely neutral effects, with some studies reporting increased mood symptoms, while progestogen-only methods and levonorgestrel intrauterine devices were associated with stable or improved symptoms. Negative associations were less pronounced in women with existing disorders than in those without prior MH conditions. CONCLUSIONS:HC appears generally safe for women with established anxiety or mood (affective) disorders. Symptoms were largely stable or modestly improved, with adverse effects reported more often with COCs, particularly among adolescents and first-time users. Individualised contraceptive counselling is recommended.
Introduction Period tracking applications (apps) are becoming an increasingly common tool used to predict cycles and plan or prevent pregnancy. We sought to evaluate if app users’ pregnancy dating by last menstrual period (LMP) and dating by ultrasound were more congruent than those who did not use apps. Methods We conducted a secondary analysis of data collected from the LMP-SURE study in the United States, which surveyed participants without prior ultrasound from abortion clinics in Alaska, Hawai‘i, Idaho and Utah about date and certainty of LMP and use of period tracking apps. We obtained subsequent ultrasound dating by chart review. We compared agreement between LMP and ultrasound dating between those who did and did not use period-tracking apps. Results Of the 1025 participants that started the survey, 730 had complete data including ultrasound dating and period tracking app use. Of those, 288 (39.5%) used a period tracking app. App users were more likely to be certain or fairly certain of LMP (279 (96.9%) vs 352 (79.6%) of non-app users, p<0.001). Of those who tracked their periods with an app, 163 (56.6%) had a gestational duration by LMP within 5 days of their gestational duration by ultrasound compared with 191 (43.2%) of non-app users (p<0.001). Conclusions Participants who used period tracking apps were significantly more likely than those who did not use apps to report an LMP-based gestational duration that was within 5 days of their gestational duration by ultrasound.
BACKGROUND:Abortion is a critical health service in Canada, yet access to evidence-based healthcare professional information remains limited. Our team developed a registration-based web platform in 2018, and subsequently an open-access platform in 2024 as an enhancement. The goal of these platforms was to disseminate reliable abortion-related healthcare professional information. This study examined the reach and utilisation of these platforms to assess their impact on improving access to evidence-based abortion information. METHODS:We analysed secondary data extracted from the two web-based platforms. We calculated the total subscribers and analysed the user-posted queries in the registration-based platforms. We also calculated the active users, page-level access statistics, average session duration, and resource download counts in the open-access platform. RESULTS:The registration-based platform (2018-2025) gained 1778 subscribers over 7 years, while the open-access platform (2024-2025) reached 1379 active users in just 1 year. The use of the registration-based platform was limited to Canada, whereas the open-access website attracted both Canadian (86.9%) and international users (13.1%). The registration-based platform generated 260 user queries across 10 thematic areas, primarily from medical doctors and nurse practitioners. On the open-access platform, users spent an average of 2 minutes per visit and viewed about 4.1 pages. CONCLUSIONS:Our analysis shows that while the open-access platform was accessible to a broad range of providers, it did not facilitate clinical queries or active engagement. This limits opportunities for providers to seek expert advice beyond the information available on the platform. Although integrating interactive features into open-access abortion platforms currently raises privacy and security concerns, future technological advancements may enable safe and confidential provider interactions in such settings.
Background Contragestion is a birth control method that works throughout the luteal phase or beyond by dislodging an implanted early embryo. This study aimed to investigate the sociodemographic characteristics and reproductive history factors that influence the hypothetical acceptability of contragestion among reproductive-aged women in Hong Kong. Methods This was a secondary analysis of a prospective questionnaire survey of 1448 women recruited from two community family planning services and the obstetrics and gynaecology unit of a university hospital. Results A total of 433 respondents (29.9%) expressed acceptability of contragestion. In the multivariate regression analysis, prior history of termination of pregnancy (OR 1.834, 95% CI 1.428 to 2.355; p<0.001), previous use of emergency contraception (OR 1.481, 95% CI 1.168 to 1.878; p=0.001) and future plans to use hormonal contraception (OR 1.615, 95% CI 1.26 to 2.07; p<0.001) were associated with a significantly higher acceptance of contragestion after controlling for age, having a sexual partner currently and monthly income. Meanwhile, having child(ren) (OR 0.692, 95% CI 0.52 to 0.92; p=0.01) was associated with a significantly lower acceptance rate. Conclusions About 30% of women in our survey expressed acceptability of contragestion hypothetically, and higher acceptability was observed in those without children, those having had a previous termination of pregnancy or previous use of emergency contraception, as well as those who planned to use hormonal contraception in the future.
BACKGROUND:Intrauterine devices (IUDs) are highly effective contraceptives, yet the procedures can be associated with discomfort, anxiety and pain, which deter uptake and continuation. By providing immersive, multisensory distraction, virtual reality (VR) use during IUD procedures has demonstrated multiple benefits, including reducing pain and anxiety. We evaluated the feasibility, acceptability and service impact of using VR during IUD procedures in a sexual and reproductive health clinic in London, UK. METHODS:VR was offered to patients attending IUD clinics between 20/11/24 and 05/11/25 . Patients and healthcare staff completed feedback questionnaires assessing their experience and perceived impact of VR, procedural anxiety and pain scores, and barriers and facilitators to implementation. Consultation durations were compared between the VR (20/11/24-05/11/25) and pre-VR (1/8/24-31/10/24) periods. RESULTS:Of 235 patients offered VR, 177 (75%) accepted. Among VR acceptors, 93% (165/177) would use it again, 96% (170/177) would recommend it and 86% (80/93) reported that it provided a superior experience to previous fitting(s). All staff reported that VR was helpful, improved care and increased positive feedback, and 80% (12/15) felt it helped them perform their role more effectively.Baseline anxiety scores were higher among VR acceptors (mean=56.7/100, SD=26.8) than decliners (mean=46.2/100, SD=30.6) (p=0.02) and 87% of VR acceptors felt it reduced their anxiety. Appointment durations did not appreciably differ between pre-VR (36.5 min) versus VR (37 min) periods. CONCLUSIONS:VR as a non-pharmacological adjunct in National Health Service IUD clinics was feasible and acceptable among patients and clinicians, without prolonging appointments. Patients who accepted VR reported higher baseline anxiety than decliners, and the majority perceived VR reduced anxiety and provided a superior experience.
