Harvesting the evidence: Medicinal plant and herb use in abortion care worldwide

Anecdotal evidence from traditional healers, midwives and doulas indicate a growing interest in abortifacient medicinal plants and report that demand for herbal abortion is on the rise in certain populations in the United States. Despite the increasing sociopolitical threat to accessing clinical abortion care,  herbal abortion remains an under-recognized and under-researched abortion method and there is a lack of accurate information about herbal abortion in academic, medical and public health settings.The objective of this systematic review is to evaluate the evidence on worldwide medicinal plant and herb use in abortion care .

The investigator used PubMed, Embase and Cochrane Review databases to identify articles dating from 1980 to 2015 that included specific mention of herb and plant use for abortion care. Search terms included both clinical and colloquial terms that indicated an elective abortion using herbal or plant agents.  Specific abstracted key data items included country of study, data source and sampling method, study design, data collection method and dates, age and characteristics of the sample population, the reported herbal and plant methods of abortion, the regimen and route of use for each reported method, reported cases of attempted herbal abortion, reported number of pregnancy terminations using herbal methods and reported side effects/complications. Initial results yielded 2124 articles.  After a title, abstract and full-text review, 33 studies were chosen for the final review.

Initial findings report inconsistent defining of terms, sampling, data collection and data reporting across studies and there was significant selection bias at data source, most often excluding cases of complete abortion without complications outside medical settings. Abstracting accurate data was challenging as herbal methods were very often grouped under the umbrella term “unsafe” with other methods, including household chemical poisoning and insertion of instruments into the uterus. Approximately half of the studies accurately reported on key data items.

There are large research gaps in medicinal plant and herb use in abortion care. Significant discrepancies exist across studies in measuring and defining important aspects of using these methods. It is difficult to draw conclusions about the safety and effectiveness of using medicinal plants and herbs to terminate pregnancy. Further research should focus on specific differences between studies and include the perspectives of people who have successfully used these methods.