First trimester medication abortion practice in the United States and Canada.

Heidi E. Jones,Maureen Paul,Wendy V. Norman,Katharine O’Connell White,E. Steve Lichtenberg,Edith Guilbert,Ganesh Dangal

doi:10.1371/journal.pone.0186487

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.

Highlights

Medication abortion ranks among the most important advances in women’s reproductive health in the last several decades
Of the 703 clinical sites identified in the United States (US), 383 (54.5%) participated; 223 administrators responded for 381 facilities, and for two facilities only clinicians responded
Most clinics (95%) in the US provided medication abortions in 2012, an increase from 87% from 2001,[11] with the vast majority using the evidence-based regimen of mifepristone 200 mg combined with misoprostol 800 mcg

Summary

Introduction

Medication abortion ranks among the most important advances in women’s reproductive health in the last several decades This non-invasive option for pregnancy termination is convenient, effective, and safe.[1] Currently registered in more than 60 countries worldwide,[2]. The proportion of early abortions ( 8 weeks gestation) that were medication abortions rose from 4.6% in 2001 [7] to 30.8% in 2012.[8] Health Canada approved mifepristone for medication abortion in 2015. Prior to this approval, Canadian providers used methotrexate-misoprostol or misoprostol alone. We compare first trimester medication abortion practice for the US and Canada and, within the US, by region

Materials and methods

Results

Discussion