Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden

Abstract

Rachel K. Jones is senior research associate, and Stanley K. Henshaw is senmorfellow, both at The Alan Guttmacher Institute, New York. In September 2000, the Food and Drug Administration (FDA) approved mifepristone (also known by the trade name Mifeprex or its original French name, RU-486) for use along with a prostaglandin for ending pregnancies up to 49 days from the onset of a woman's last menstrual period. The FDA-approved protocol involves the administration of 600 mg of mifepristone followed two days later by 400 mg of oral misoprostol administered at a medical facility. Many abortion providers soon adopted the method, at least on a trial basis, but it is not universally available. As of early 2002, two-thirds of providers belonging to the National Abortion Federation (NAF) were offering the method to eligible patients. 1 NAF members perform about half of all abortions in the United States, they include the majority of Planned Parenthood Federation of America facilities that provide abortions. The brief U.S. experience with mifeprnstone leaves many questions unanswered about its ultimate level of acceptance: How many abortion providers and physicians who have not previously offered abortion services will provide medical abortions using mifepristone? What proportion of abortion patients will choose medical abortion? How will the availability of mifepristone affect the overall abortion rate? Other questions concern the appropriate protocols that most providers in the United States will ultimately use for early medical abortion involving mifepristone. Experience in other countries indicates that protocols can vary in mifepristone dosage, the gestational limits that determine whether women are eligible for the method and whether the prostaglandin used to stimulate uterine contractions is administered at a medical facility or at a woman's home. The experience of European countries can shed light on these issues. Mifepristone is approved for use in most of Europe,* and three countries have had a decade or more of experience with its use: France, Great BritainT and Sweden. In this report, we synthesize information from national abortion statistics, professional guidelines and interviews with experts in these three countries to describe levels of