Mifepristone for early medical abortion: experiences in France, Great Britain and Sweden - Special Report

Perspectives on Sexual and Reproductive Health, May-June, 2002 by Rachel K. Jones, Stanley K. Henshaw

Provider Knowledge and Acceptance Are Key

Physicians and facility staff are critical to determining whether women adopt medical abortion and how the option is presented to eligible patients. As providers gain more experience with medical abortion and interact with colleagues who have had success with the method, they are likely to become increasingly interested in providing this option for their patients. The European experience demonstrates that providers who are favorably disposed to the method find that larger proportions of patients make it their choice, while those whose attitudes are unfavorable have few patients who choose the method. (60)

In the United States, large abortion facilities, which account for most abortions, will play an important role in determining use and acceptance of mifepristone. Most of these facilities are part of networks, such as NAF and the Planned Parenthood Federation of America, that offer providers training and advice for integrating mifepristone into their practices. Emerging research indicates that acceptance among these clinics is substantial and that the proportion of eligible abortions involving mifepristone is increasing. For example, several Planned Parenthood affiliates offering mifepristone for early medical abortion report that more than one-third of pregnancies at eligible gestations (less than 49 days from the last menstrual period) are terminated using mifepristone. (61)

Protocols Can Be Flexible

European countries' experiences suggest that the medical abortion protocol can safely and effectively vary in ways that could affect the method's availability. Preliminary reports in the United States suggest that some providers of medical abortion have begun to use alternatives to the FDA-approved protocol--for example, using the 200 mg regimen and permitting women to administer the prostaglandin at home. (62)

While medical abortion is approved only up to 49 days from the last menstrual period in the United States, some providers in Great Britain and Sweden allow women the choice of medical abortion up to 63 days from the onset of their last menstrual period. On the basis of clinical studies, some providers in the United States are extending use up to 63 days as well. (63) Staff oversight of medical abortion services can be flexible. For example, at many facilities in France, Great Britain and Sweden, nurses and midwives are responsible for many aspects of the medical abortion process. Physicians often play a less-important role than they do for surgical abortion procedures. If U.S. providers were to implement this practice, the cost of the method to patients could potentially be reduced, and the method could be available to more women. Experiences in Europe also indicate that early medical abortion is safe in terms of women's health even if some women do not return for a follow-up visit. Although 10-20% of women in Europe do not return for their follow-up visit, providers do not see it as a problem because these women have not returned seeking treatment for complications.