First trimester medication abortion practice in the United States and Canada

Abstract

We conducted a cross-sectional survey of abortion facilities from professional networks in the United States (US, n = 703) and Canada (n = 94) to estimate the prevalence of medication abortion practices in these settings and to look at regional differences. Administrators responded to questions on gestational limits, while up to five clinicians per facility reported on 2012 medication abortion practice. At the time of fielding, mifepristone was not approved in Canada. 383 (54.5%) US and 78 (83.0%) Canadian facilities participated. In the US, 95.3% offered first trimester medication abortion compared to 25.6% in Canada. While 100% of providers were physicians in Canada, just under half (49.4%) were advanced practice clinicians in the US, which was more common in Eastern and Western states. All Canadian providers used misoprostol; 85.3% with methotrexate. 91.4% of US providers used 200 mg of mifepristone and 800 mcg of misoprostol, with 96.7% reporting home misoprostol administration. More than three-quarters of providers in both countries required an in-person follow-up visit, generally with ultrasound. 87.7% of US providers routinely prescribed antibiotics compared to 26.2% in Canada. Nonsteroidal anti-inflammatory drugs were the most commonly reported analgesic, with regional variation in opioid narcotic prescription. In conclusion, medication abortion practice follows evidence-based guidelines in the US and Canada. Efforts to update practice based on the latest evidence for reducing in-person visits and increasing provision by advanced practice clinicians could strengthen these services and reduce barriers to access. Research is needed on optimal antibiotic and analgesic use.

Differences in Abortion Service Delivery in Hostile, Middle-ground, and Supportive States in 2014

“…Nationally, 40% of clinics reported that APCs provided at least some abortions. APCs were involved in abortion care in approximately two-thirds of clinics in supportive states, compared with 3% in hostile ones, and this pattern corresponds with a recent study finding that APC provision of medication abortion was substantially higher in the Eastern and Western United States than in the South and Midwest ( Jones et al, 2017 ). These patterns are likely a direct consequence of abortion restrictions combined with the impact of state practice regulations.…”

Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers

“…For example, in the USA, mifepristone may be dispensed only by the prescriber and not by a pharmacist. Ten years after the introduction of mifepristone in the USA, first-trimester medical abortions only represented 36% of all abortions compared to over 80% of first-trimester abortions in many European countries [10,18]. Furthermore, in Australia, where pharmacists may dispense mifepristone, women must pay $560 AUD upfront and attend a mandatory follow-up visit 1 week later [17], and abortion remains legally restricted or prohibited in some jurisdictions [19][20][21].…”

Comparison of Mifepristone plus Misoprostol with Misoprostol Alone for First Trimester Medical Abortion: A Systematic Review & Meta -Analysis Protocol

“…Medical management (procedure that institute drugs) is the preferred method of dealing with emergency abortions as studies suggest [6][7][8]. It was reported that medication based abortion reduces the occurrence of complications.…”

“…The drugs can be self-administered with a maximal success rate as compared to manual aspirations [8][9][10]. In the US alone, medication abortion using mifepristone and misoprostol is practiced by 92% of the providers [6]. Similarly, about 75% of the providers in Canada and 98% of the providers in the US offered medication abortion to people less than 18 years of age [6].…”