“There’s only one use for it”: Stigma as a Barrier to Mifepristone Use for Early Pregnancy Loss [A31

Abstract

INTRODUCTION: Mifepristone combined with misoprostol has superior efficacy for early pregnancy loss (EPL) treatment compared to misoprostol alone. Mifepristone access is restricted by the U.S. Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy program, and its use may be further limited by logistical and interpersonal barriers due to its association with abortion, especially in states with restrictive policies. Understanding barriers to incorporation of mifepristone in EPL care is key for developing interventions to improve care quality. METHODS: We conducted semi-structured interviews with 19 obstetrician-gynecologists in Alabama who manage EPL. Interviews explored participants’ knowledge of and experience with mifepristone use for EPL and abortion, along with barriers to and facilitators of clinical mifepristone use. Interviews were coded by multiple study staff using inductive and deductive thematic coding. This study was deemed exempt by the Harvard Medical School Institutional Review Board. RESULTS: Nearly all interviewees identified abortion-related stigma as a barrier to mifepristone use. Interviewees often attributed stigma to a lack of knowledge about the clinical use of mifepristone for EPL. Stigmatization of mifepristone due to its association with abortion was related to religious and politic objections. Many also described stigma associated with misoprostol use. Although providers believed mifepristone use for abortion would not be accepted in their practice, most felt that mifepristone could be successfully used for EPL after practice-wide education on its use. CONCLUSION: Mifepristone is strongly associated with abortion stigma, which is a barrier to its use for EPL. Interventions to increase clinical knowledge of mifepristone use and decrease stigma are needed to optimize EPL care.