Medical Abortion Research Articles

Transient rise in medical abortions at Michigan clinic during SARS-CoV-2 “stay-at-home” order

Background In response to the SARS-CoV-2 (COVID-19) pandemic, the State of Michigan enacted a “stay-at-home” executive order detailing social distancing guidelines on March 24, 2020, with an expiration date of June 1, 2020. Objectives Given that medical abortions allow for pregnancy tissue to be passed in the privacy of one’s home, the authors hypothesized that there would be an increase in medical abortions over first trimester surgical abortions in 2020 compared to 2019 due to social distancing guidelines. Study Design Retrospective data was collected from an abortion clinic in Southeastern Michigan between January 1, 2019 and December 31, 2020 (n=4,703). A negative binomial statistical model compared the number of medical abortions in 2019 to 2020. Each year was divided into quartile (Q) periods of three consecutive months. Analysis focused on the frequency and percentage of medical abortions in 2020 compared to 2019, with a focus on the relationship between quartiles. Results Medical abortions increased from a count of 702 in 2019, to 979 in 2020 (p-value=0.00499). There were statistically significant differences between 2019 and 2020 for Q2 (31.47% to 40.89%, p-value<0.001) and Q3 (33.15% to 53.70%, p-value<0.001), as well as a return-to-baseline in Q4, which is demonstrated by pre-executive order 2020 Q1 at 33.91% and post-executive order 2020 Q4 at 37.19%. Conclusions Statistically significant differences between 2019 and 2020 for Q2 and Q3 support the hypothesis that an increase in preference towards medical abortions over surgical abortions coincided with Michigan’s stay-at-home mandates; it was further supported by insignificant differences in 2019 and 2020 for Q1 and Q4. Understanding trends in patient choices for abortion access provides vital information for policymakers and healthcare providers to expand medical abortion care using remote options.

A qualitative study of perspectives on research participation among individuals who recently experienced an abortion in Hawaiʻi

ObjectivesThe United States Code of Federal Regulations mandates extra protections for research involving pregnant participants seeking abortions. This study aims to understand the perspectives of abortion patients regarding recruitment, decision-making, and participation in research. Study designWe recruited adults in Hawaiʻi who reported at least one induced abortion in the previous 6 months. Recruitment strategies included online advertisements and flyers posted in reproductive health clinics. We conducted in-person, semistructured interviews exploring research preferences. The authors collaboratively reviewed the resulting transcripts and created a code dictionary. We reviewed, organized, condensed, and diagrammed the resulting data to identify dominant themes. ResultsBetween February and November 2019, we interviewed 25 participants aged 18–41 years who had medication (n = 14) or procedural (n = 11) abortions. Interviews ranged from 32 to 77 minutes (mean = 48 minutes). Four themes emerged: (1) people having abortions are capable of making informed decisions about research participation, (2) abortion-related stigma influences research decision-making, (3) people having abortions prefer to learn about study opportunities early and through participant-driven recruitment methods, and (4) the ideal role of the abortion provider in research is unclear. ConclusionsAbortion patients in this study want to be informed of research opportunities and feel capable of deciding about participation in research studies. Current federally mandated protections and common research practices could be revisited and revised to better reflect these preferences. ImplicationsRevision of federal regulations and optimization of recruitment methods may allow researchers to improve the research experience for patients having an abortion.

Clinical outcomes of medication abortion using misoprostol-only: A retrospective chart review at an abortion provider organization in the United States

ObjectivesThis study aimed to evaluate the effectiveness and safety of medication abortion with misoprostol-only among patients treated by an abortion provider organization in the United States during the COVID-19 pandemic. Study designWe abstracted data from patients receiving misoprostol-only for abortion from December 2020 to December 2021. Two regimens were used, both allowing three to four doses of misoprostol 800 mcg every 3 hours but differing in the recommended administration routes (vaginal, buccal, or sublingual). We estimated the proportions of patients who had complete abortion and ongoing pregnancy in the two regimen groups in complete case analyses and after imputing missing outcomes based on pretreatment characteristics. We also estimated maximum effectiveness, assuming that all patients without known treatment failures had complete abortions. We tabulated serious adverse events. ResultsWe ascertained abortion outcomes for 476 (52%) of the total 911 treated patients. Of the 476 patients, 389 (82%) had complete abortion confirmed by test or history, and 45 (9%) had ongoing pregnancies detected after the provision of treatment. These proportions did not differ significantly between the two regimen groups in adjusted complete case analyses (p > 0.44). The results of imputed analyses were similar. Of the total 911 patients, at most 90% (95% confidence interval 88%, 92%) had complete abortion, and at least 5% (95% confidence interval 4%, 7%) had ongoing pregnancy. Serious adverse events were reported in three patients (0.6% of 487 patients with data for this outcome). ConclusionsOur analysis suggests that the misoprostol-only regimens studied were safe and effective for most patients. Due to high loss to follow-up, observations from patients contacted after treatment likely somewhat underestimate true effectiveness. ImplicationsMedication abortion with misoprostol-only was safe and produced complete abortion in most patients with follow-up. If loss to follow-up is high, effectiveness observed by clinics may misestimate true treatment efficacy.

Back to Square One: Attempted Legal Amendments and Abortion Practices in Sri Lanka

The Sri Lankan law only permits induced or iatrogenic abortion to save the life of the mother. Despite the restricted law, law enforcement mechanisms, and reported high national contraceptive prevalence rate, a significant proportion of pregnant women terminate their pregnancy outside the law. Despite the existence of restrictions and inertia, numerous stakeholders concerned about women’s health have made several attempts to liberalize the abortion law in Sri Lanka. Although several amendments were proposed to rationalize the abortion law in Sri Lanka, nothing has been successful – we are back to square one.
 Expansion of legal exceptions for induced abortions and improved safe abortion with the revolutionized medical abortion (MA) were observed in numerous countries globally during the past decade. On the other hand, some countries with broadly liberal laws, including the United States, have added restrictions. How these global changes have affected countries like Sri Lanka is worth studying. This article assesses the response of the Sri Lankan government and the society towards those global changes in terms of the policies and practices on induced abortion. Authors argue that the paradigm shift in abortion practices in Sri Lanka, driven by the emerging occurrence of medical abortion, has highlighted the disparity between the existing legal status and the aspirations of most Sri Lankans. Given the widespread support for legalizing abortion in cases of rape, incest, and fetal abnormalities, it is imperative the government seriously consider legal amendments.

Unsupervised Medical Abortions: A Cause for Concern of Safety

Unsupervised Medical Abortions: A Cause for Concern of Safety

In brief: Alternatives to mifepristone for medication abortion.

The possibility that use of mifepristone (Mifeprex, and generics) may be restricted has led to questions about alternatives for medication abortion.

Association between social vulnerability profiles, prenatal care use and pregnancy outcomes

BackgroundEvaluating social vulnerability is a challenging task. Indeed, former studies demonstrated an association between geographical social deprivation indicators, administrative indicators, and poor pregnancy outcomes.ObjectiveTo evaluate the association between social vulnerability profiles, prenatal care use (PCU) and poor pregnancy outcomes (Preterm birth (PTB: <37 gestational weeks (GW)), small for gestational age (SGA), stillbirth, medical abortion, and late miscarriage).MethodsRetrospective single center study between January 2020 and December 2021. A total of 7643 women who delivered a singleton after 14 GW in a tertiary care maternity unit were included. Multiple component analysis (MCA) was used to assess the associations between the following social vulnerabilities: social isolation, poor or insecure housing conditions, not work-related household income, absence of standard health insurance, recent immigration, linguistic barrier, history of violence, severe dependency, psychologic vulnerability, addictions, and psychiatric disease. Hierarchical clustering on principal component (HCPC) from the MCA was used to classify patients into similar social vulnerability profiles. Associations between social vulnerability profiles and poor pregnancy outcomes were tested using multiple logistic regression or Poisson regression when appropriate.ResultsThe HCPC analysis revealed 5 different social vulnerability profiles. Profile 1 included the lowest rates of vulnerability and was used as a reference. After adjustment for maternal characteristics and medical factors, profiles 2 to 5 were independently associated with inadequate PCU (highest risk for profile 5, aOR = 3.14, 95%CI[2.33–4.18]), PTB (highest risk for profile 2, aOR = 4.64, 95%CI[3.80–5.66]) and SGA status (highest risk for profile 5, aOR = 1.60, 95%CI[1.20–2.10]). Profile 2 was the only profile associated with late miscarriage (adjusted incidence rate ratio (aIRR) = 7.39, 95%CI[4.17–13.19]). Profiles 2 and 4 were independently associated with stillbirth (highest association for profile 2 (aIRR = 10.9, 95%CI[6.11–19.99]) and medical abortion (highest association for profile 2 (aIRR = 12.65, 95%CI[5.96–28.49]).ConclusionsThis study unveiled 5 clinically relevant social vulnerability profiles with different risk levels of inadequate PCU and poor pregnancy outcomes. A personalized patient management according to their profile could offer better pregnancy management and reduce adverse outcomes.

Characterizing two models for abortion care in Argentina pre-Law 27.610: 2016-2019.

Explore the use of two abortion care models in Argentina over the period 2016-2019: pro-rights private medical service providers and abortion accompaniment (via self-management and via health institutions); and compare the profile of who accesses these models and when. We used data from accompaniment collectives in the Socorristas en Red and private service providers. We estimated annual abortion rates via these service models and compared the profile of the populations by type of service and gestational age (2019) using descriptive statistics and chi-square tests. In 2016, 37 people per 100,000 women of reproductive age obtained accompanied self-managed abortions, and the number increased to 111 per 100,000 in 2019, a threefold increase. The rate of abortions via care providers was 18 per 100,000 in 2016 and 33 in 2019. Higher proportions of those who obtained abortion via care providers were 30 years or older. A higher proportion of those accompanied were 19 years or younger; 11% of those who obtained accompanied self-managed abortions were more than 12 weeks gestation compared with 7% among those who had accompanied abortions via health institutions and 0.2% among those who had abortions with private providers. A higher proportion of those who accessed accompanied abortions after 12 weeks gestation had lower educational levels, did not work or have social security coverage, had more past pregnancies, and attempted to terminate their pregnancies prior to contacting the Socorristas compared to those who had accompanied abortions at 12 weeks or earlier. In Argentina, prior to Law 27.610 models of care guaranteed access to safe abortion. It is important to continue making visible and legitimizing these models of care so that all those who decide to have an abortion, whether inside or outside health institutions, have safe and positive experiences.

P-530 Which evacuation method for missed abortion is preferred by women with recurrent pregnancy loss?

Abstract Study question Is medical or surgical evacuation for missed abortion (MA) preferred by women with recurrent pregnancy loss (RPL)? Which factors are determining for the women’s preference? Summary answer Sixty-seven percent of the participants preferred surgical evacuation. Side effects and a history of unsuccessful medical evacuation in their first MA were determining factors. What is known already Guidelines currently recommend medical rather than surgical evacuation after MA. The success rates defined as adequate evacuation of the uterine cavity after MA without further intervention are reported to be 80% and 97% for medical and surgical evacuation, respectively. Medical evacuation is associated with heavier and longer duration of bleeding and higher intensity of pain. Surgical evacuation increases the risk of uterine perforation and Asherman’s syndrome. Studies have found that women are more satisfied and have better subsequent mental health when they can decide themselves which method they would choose. Study design, size, duration An online questionnaire was sent October 5th, 2022, to 157 RPL patients who had experienced both medical and surgical evacuation for MA admitted to a center for RPL between January 2016 and September 2022. Eighty-seven (55.4%) patients completed the survey before deadline after being sent reminders. Sixty (69%) of the women had received a medical evacuation and 27 (31%) surgical evacuation for their first MA. Participants/materials, setting, methods The mean age of the respondents was 37 years (SD ± 0.5) and they had had at least three pregnancy losses. The questionnaire featured questions regarding the women’s experiences with medical and surgical evacuation, preferred evacuation method if they would have another MA, and determining factors for their preference. Categorical variables were compared using χ2 test and Wilcoxon Signed Rank Test. Analyses were conducted to determine associations between potential determining factors for preferred evacuation method. Main results and the role of chance A significantly higher intensity of pain was experienced, and analgesics were required for a significantly longer period after a first medical evacuation compared to a first surgical evacuation (p &amp;lt; 0.001 and p = 0.006). Bleeding, pain, sick leave, and mental discomfort had a significant impact on the choice of another evacuation method at the time of next MA in women who experienced a medical abortion first. As many as 40% had experienced failure of the first medical evacuation with need for subsequent surgical evacuation for complete evacuation; this was confirmed by consulting the patient’s medical records. The odds ratio (OR) for preferring medical evacuation at next MA was 3.3 if the women had given birth before (p = 0.011). The OR for preferring medical evacuation at next MA was 0.3, if the women had received medical evacuation for their first MA (p = 0.015). There were no statistically significant associations between preferring medical evacuation and the following factors: BMI, age at first evacuation and menstrual pain. Two thirds (66.7%) of the women would prefer surgical evacuation for their next MA, while the remaining women (33.3%) would prefer medical evacuation. Limitations, reasons for caution The response rate of 55.4% was lower than expected 70% which implicates a risk of sampling bias such as a predominance of patients with a history of complicated evacuations responding to the questionnaire. Due to the retrospective design, recollection bias could also impact the results. Wider implications of the findings In this study population, medical evacuation was associated with a stronger experience of side effects and a higher failure rate than expected, which may explain why more women preferred surgical evacuation for their next MA. This may suggest current evacuation recommendations for MAs should become more individualized than currently. Trial registration number Not applicable

P-536 The comparison of luteal phase support in modified natural cycle-frozen embryo transfer in young patients with high quality embryos -vaginal versus vaginal and subcutaneous progesterone.

Abstract Study question Does adding subcutaneous progesterone to vaginal administration affect pregnancy outcomes in young patients undergoing modified natural-frozen embryo transfer (mNC-FTET) with top-good quality, single blastocyst ? Summary answer Adding subcutaneous progesterone supplementation to vaginal administration after frozen-thawed embryo transfer in modified natural cycles does not improve live birth rates. What is known already Vaginal progesterone supplementation during frozen-thawed embryo transfer in modified natural cycles during luteal phase may increase the rate of live birth rate and decrease the rate of miscarriage. Study design, size, duration 245 participants were included in this retrospective cohort study conducted at a single IVF center between November 2020and January 2022.The primary outcome was the live birth rate; secondary outcomes included pregnancy, clinical pregnancy and biochemical and clinical abortion rates. Participants/materials, setting, methods 245 women aged 20-35 years in mNC-FTET cycles with a single top-good quality blastocyst embryo transfer were included. Patients with fibroids, synechiae, recurrent implantation failure, recurrent pregnancy loss were excluded. After thawing embryos were evaluated for quality, hCG(Ovitrelle-Merck) triggered; 129 patients received 200 mg vaginal progesterone (Lutinus-Merck)(group I), while 116 received 200 mg. vaginal and 25 mg subcutaneous progesterone (Progestan-Dex-Kocak Pharma) (group II). The main outcome was live birth rate(LBR), secondary outcome was miscarriage rate. Main results and the role of chance Baseline demographics and background characteristics were similar in the study groups. The live birth rate in group I is 86 of 106 (66.6%) compared 74 of 116 (63.7%) in group II (odds ratio 1,135, 95% confidence interval [CI]: 0.670-0.922, P = 0.637). There were 106 pregnant patients out of 129 in group I (82.17%) and 93 pregnant patients out of 116 in group II (odds ratio 0.877, 95 CI: 0.462-1,666, P = 0.68). The clinical pregnancy rate is 95 out of 129 patients (73.6%) in group I and 90 out of 116 patients in group II (odds ratio of 0.807, 95% confidence interval [CI]: 0.449-1.45, P = 0.474). The rate of biochemical abortion in group II was 10 of 129 patients (7.75%) and 4 of 116 (3.45%) (odds ratio 2.35, 95 CI: 0.717–7.718, P = 0.687). The clinical abortion rate was 6 of 129 patients (4.6%) and 6 of 116 patients (5.17%) in group II (odds ratio 2.35, 95 CI: 0.717-7.718; P = 0.687). According to primary and secondary outcomes, there were no significant differences between the groups. Limitations, reasons for caution To avoid bias, patients older than 35 years were excluded. Subcutaneous progesterone may be beneficial for older patients undergoing euploid embryo transfer. To reduce confounding factors, the number of patients was limited. Wider implications of the findings For luteal phase support, both vaginal and subcutaneous progesterone supplementation did not increase live birth rates following frozen-thawed embryo transfer in modified natural cycles in young patients. Trial registration number not applicable

Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC

BackgroundThe Democratic Republic of Congo (DRC) legalized abortion in 2018 to preserve health and pledged to provide quality postabortion care (PAC), yet little is known about the availability of abortion care services and if facilities are prepared to provide them; even less is known about the accessibility of these services. Using facility and population-based data in Kinshasa and Kongo Central, this study examined the availability of abortion services, readiness of facilities to provide them, and inequities in access.MethodsData on 153 facilities from the 2017–2018 DRC Demographic and Health Survey Service Provision Assessment (SPA) were used to examine signal functions and readiness of facilities to provide services across three abortion care domains (termination of pregnancy, basic treatment of abortion complications, and comprehensive treatment of abortion complications). To examine PAC and medication abortion provision before and after abortion decriminalization, we compared estimates from the 2017–2018 SPA facilities to estimates from the Performance Monitoring for Action (PMA) data collected in 2021 (n = 388). Lastly, we assessed proximity to PAC and medication abortion using PMA by geospatially linking facilities to representative samples of 2,326 and 1,856 women in Kinshasa and Kongo Central, respectively.ResultsFew facilities had all the signal functions under each abortion care domain, but most facilities had many of the signal functions: overall readiness scores were > 60% for each domain. In general, readiness was higher among referral facilities compared to primary facilities. The main barriers to facility readiness were stock shortages of misoprostol, injectable antibiotics, and contraception. Overall, provision of services was higher post-decriminalization. Access to facilities providing PAC and medication abortion was almost universal in urban Kinshasa, but patterns in rural Kongo Central showed a positive association with education attainment and wealth.ConclusionMost facilities had many of the necessary signal functions to provide abortion services, but the majority experienced challenges with commodity availability. Inequities in accessibility of services also existed. Interventions that address supply chain challenges may improve facility readiness to provide abortion care services, and further efforts are needed to narrow the gap in accessibility, especially among poor women from rural settings.

The effect of induced fetal demise on induction to expulsion interval during later medication abortion: A retrospective cohort

ObjectivesTo investigate the effect of induced fetal demise on the induction to expulsion interval during later trimester medication abortion. Study designThis retrospective cohort was conducted at St. Paul’s Hospital Millennium Medical College, Ethiopia. Later medication abortion cases that had induced fetal demise were compared to matching cases with no induced fetal demise. Data were collected by reviewing maternal charts and analyzed using SPSS version 23. Simple descriptive analysis, χ2 test, and multiple logistic regression analysis were used as appropriate. Odds ratio, 95% CI, and p-value<0.05 were used to present the significance of the findings. ResultsA total of 208 patient charts were analyzed. Seventy-nine patients were provided with intra-amniotic digoxin, 37 patients were provided with intracardiac lidocaine, and 92 had no induced demise. The mean induction to expulsion interval was 17.8 hours in the intra-amniotic digoxin group, which is not statistically different than 19.3 hours in the intracardiac lidocaine and 18.5 hours in the group without induced fetal demise (p-value = 0.61). Expulsion rate after 24 hours was not statistically different among the three groups (5.1% in the digoxin group vs 10.6% intracardiac lidocaine group vs 7.8% in the no induced fetal demise group, p-value = 0.82). Multivariate regression analysis demonstrated that inducing fetal demise was not associated with successful expulsion at<24 hours (adjusted odds ratio [AOR] = 0.19, 95% CI, 0.03–1.29 and AOR = 0.62, 95% CI, 0.11–3.48, for digoxin and lidocaine, respectively) from induction. ConclusionsIn this study, inducing fetal demise using digoxin or lidocaine prior to later medication abortion was not associated with a reduction in the induction to expulsion interval. ImplicationsDuring later medication abortion with mifepristone and misoprostol, inducing fetal demise may not be associated with a change in the length of the procedure. Induced fetal demise may be required for other reasons.

Society of Family Planning Committee Statement: Abortion nomenclature

Models of abortion care are continually evolving and expanding. Historically, advocates, lawyers, journalists, clinicians, and researchers have used a variety of terms to refer to different types of abortion. In 2004, Weitz and colleagues published an editorial laying out the need to develop consensus on standard terms because, “the terminology used to describe abortion procedures influences political, legislative and medical institutions” [ [1] Weitz T.A. Foster A. Ellertson C. Grossman D. Stewart F.H. “Medical” and “surgical” abortion: rethinking the modifiers. Contraception. 2004; 69: 77-78 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar ]. Standardization of abortion nomenclature and terms used to refer to different types of abortion will increase uniformity and accuracy in communication about abortion care. The Society of Family Planning’s recommendation is to use the terms medication abortion and procedural abortion for common use in clinical guidance, journal articles, print materials, websites, media, advocacy, policy briefs, and other communication about abortion care. These recommendations align with recommendations from several other organizations including the American College of Obstetricians and Gynecologists [ [2] Heuser C.C. Sagaser K.G. Christensen E.A. Johnson C.T. Lappen J.R. Horvath S. Society for Maternal-Fetal Medicine Special Statement: A critical examination of abortion terminology as it relates to access and quality of care. American Journal of Obstetrics and Gynecology. 2023; 228: B2-B7https://doi.org/10.1016/j.ajog.2022.12.302 Abstract Full Text Full Text PDF Scopus (1) Google Scholar ], the Society of Maternal-Fetal Medicine [ [3] American College of Obstetricians and GynecologistsGuide to Language and Abortion. 2022; : 1-2 Google Scholar ], and the COMS Project [ [4] COMS ProjectAbortion Terminology Recommendations. 2023; : 1 Google Scholar ]. We recognize the importance of language and its role in providing access to care that is both equitable and that centers the patient experience. We also recognize that language is complex and nuanced. We encourage medical societies and others in sexual and reproductive health, rights, and justice fields, to use these terms, while also inviting discussion and continued research on the optimal approach to abortion nomenclature.

Restrictive points of entry into abortion care in Ireland: a qualitative study of expectations and experiences with the service

This article focuses on access to early medical abortion care under Section 12 of the Health (Regulation of Termination of Pregnancy) Act 2018, in Ireland and identifies existing barriers resulting from gaps in current policy design. The article draws primarily on qualitative interviews with 24 service users, 20 primary healthcare providers in the community and 27 key informants, including from grassroots groups that work with women from different migrant communities, to examine service users’ experiences accessing early medical abortions on request up to 12 weeks gestation. The interviews were part of a wider mixed-methods study from 2020-2021 examining the barriers and facilitators to the implementation of abortion policy in Ireland. Our findings highlight care seekers’ experiences with the GP-led service provision, including delays, facing non-providers, the mandatory three-day waiting period, and oversubscribed women’s health and family planning clinics. Our findings also highlight the compounding challenges for migrants and additional barriers posed by the geographical distribution of the service and the 12-week gestational limit. Finally, it focuses on the remaining challenges for racialised and other marginalised groups. In order to provide a “thick description” of women’s lives and the complexity of their experiences with abortion services in Ireland, we also present two narrative vignettes of service users, and their experiences with delays and navigating the healthcare system as migrants. To this effect, this article applies a reproductive justice framework to the results to highlight the compounding effects of these barriers on people located along multiple axes of social inequality.

Self-managed medication abortion: What nurse practitioners need to know

Given the evolving legal landscape of abortion access in the United States, the author discusses what nurse practitioners should know about their legal considerations and how to keep patients seeking their care safe when they undergo self-managed medication abortion.

Dispensing mifepristone for medical abortion in Canada: Pharmacists' experiences of the first year.

Mifepristone for medical abortion was first dispensed by community pharmacists in Canada directly to patients in January 2017. We asked about pharmacists' experiences over their first year dispensing mifepristone in order to evaluate the frequency of the new practice and assess availability in urban/rural pharmacies. From August to December 2019, we invited 433 community pharmacists who had completed a baseline survey at least 1 year prior to participate in a follow-up online survey. We summarized categorical data using counts and proportions and conducted a qualitative thematic analysis of open-ended responses. Among 122 participants, 67.2% had dispensed the product, and 48.4% routinely stocked mifepristone. Pharmacists reported a mean of 26 and median of 3 (interquartile range, 1, 8) mifepristone prescriptions filled in their pharmacies in the previous year. Participants perceived that the benefits of making mifepristone available in pharmacies included increased abortion access for patients (n = 115; 94.3%), reduced pressure on the health care system (n = 104; 85.3%), increased rural and remote abortion access (n = 103; 84.4%) and increased interprofessional collaborations (n = 48; 39.3%). Few participants reported challenges to maintaining adequate stock of mifepristone, but these challenges included low demand (n = 24; 19.7%), short expiry dating (n = 12; 9.8%) and drug shortages (n = 8; 6.6%). The overwhelming majority, 96.7%, reported that their communities did not resist the provision of mifepristone by their pharmacy. Participating pharmacists reported many benefits and very few barriers to stocking and dispensing mifepristone. Both urban and rural communities responded positively to enhanced access to mifepristone in their community. Mifepristone is well accepted by pharmacists within the primary care system in Canada.

Use of Abortion Pills as a Family Planning Method among Women Living in Urban Slum of North India – A Mixed-Method Study

ABSTRACT Introduction: Unsafe abortions account for about 5% maternal deaths in India. A very small proportion of induced abortions takes place at registered facilities, and many women prefer taking abortion pills as a method of contraception. The current study was planned to explore the factors related to use of abortion pills and knowledge about various contraceptives among slum-dwelling women. Materials and Methods: A community-based cross-sectional study was carried out in the urban slum area catered by a public health dispensary for 2 months among 22 females. Data collection was performed using a semistructured interview schedule for quantitative data, and focused group discussion (FGD) was performed for qualitative data collection. Thematic data analysis was performed for FGD. Themes pertaining to knowledge, ease of use, and source and side effects of abortion pills, knowledge, use, and fears/myths for modern contraceptive methods were identified. Results: A total of 35 unwanted pregnancies were reported by 22 women study participants, out of which only three were continued. Most study participants came to know about abortion pills from their neighborhood friends or maternal relatives such as sisters, and 90% of them preferred either chemists or local private practitioners for getting abortion pills. Fears and myths for modern contraceptive methods, their non-regular supply, and easy availability of abortion pills were the main reason for their use. Conclusion: The study highlights women’s perspective of using abortion pills over modern contraceptive methods as a method to limit their family size or for spacing and highlights the lack of family planning counseling. Such a situation calls for enhanced counseling services for modern contraceptive methods and health promotion programs to alleviate fears about contraceptive methods.

Reworking Emergency Medicine Resident Education Post-Dobbs v Jackson Women's Health Organization.

Reworking Emergency Medicine Resident Education Post-Dobbs v Jackson Women's Health Organization.

Dobbs Decision Is Undue Burden on the Most Marginalized Women

Back to table of contents Previous article ViewpointsFull AccessDobbs Decision Is Undue Burden on the Most Marginalized WomenMollie Gordon, M.D.Mollie GordonSearch for more papers by this author, M.D.Published Online:25 May 2023https://doi.org/10.1176/appi.pn.2023.06.6.28The Dobbs v. Jackson Women’s Health Organization decision has sparked debate about the right to privacy regarding health care, violations of civil liberties, and compelling interest. What has received less attention, however, is the burden that the Dobbs decision imposes on the most vulnerable women in this country—women who have preexisting social, economic, medical, legal, and personal obstacles.At the Anti-Human Trafficking Program at Baylor College of Medicine in Houston, we care for some of the most vulnerable and marginalized women in our communities. Many sex-trafficked women are initiated into trafficking through sexual violence and sold sometimes up to a dozen times a day. Women and children may be trafficked by their families or romantic partners. Trafficked women may lose autonomy over reproductive decision making, being forced into pregnancy or forced into pregnancy termination. Many of the women have serious mental illness.Texas does not make an exception to allow abortion in cases of rape and incest, even when victims are very young children. Victims may experience reproductive coercion as a form of control and may not be able to travel out of state for abortions. In Texas, suicide and homicide account for 13% of pregnancy-related deaths. Inability to terminate a pregnancy keeps patients in contact with violent partners, putting women and their children at risk. In addition, leaving the state for an abortion may result in retaliation violence. Black women have a threefold higher pregnancy-associated homicide rate compared with White and Hispanic women.Among nontrafficked women, social determinants, work commitments, and medical comorbidities restrict access to out-of-state abortion services. The Dobbs decision adversely impacts U.S. women in the military, women with chronic medical conditions who may be confined to their homes, and women who are homeless or financially impoverished and whose access to abortion decreases as abortion clinics are placed farther from their communities. Some women can’t travel out of state because they have no one to care for their children or other dependent family members. And of course, women who are detained or incarcerated have restricted freedom of movement.Even in states where abortion is legal, women may be vulnerable due to their psychiatric conditions, with variable ability to consent and a vulnerability to exploitation and harm, especially if they suffer from a concurrent cognitive disturbance. In cognitively impaired women, a guardian may not consent to abortion or a potentially sterilizing procedure. In some circumstances, it may take weeks or months for patients to be stabilized and regain their mental capacity.Many women seek medical abortions, which are also limited or banned by law in some states. Medical abortions may increase the risk of self-managed abortion through unsafe means. No state mandates health care professionals to report self-managed abortions, even in the case of minors.Most psychiatrists are familiar with The Turnaway Study, which found that compared with women who are denied an abortion, women who have the procedure are not more likely to experience depression, anxiety, or suicidal ideation; however, being denied an abortion results in worse financial, health, and family outcomes. “Turning away” women who are already marginalized is cruel and unethical and may cause moral distress to health care professionals. If a society is judged on how it treats its most vulnerable individuals, then we are failing miserably. ■ResourcesThe Turnaway Study“Undue Burdens Created by the Texas Abortion Law for Vulnerable Pregnant Women”Mollie Gordon, M.D., is an associate professor of psychiatry and behavioral sciences and medical director of the Anti-Human Trafficking Program at Baylor College of Medicine. She is a co-author of “Undue Burdens Created by the Texas Abortion Law for Vulnerable Pregnant Women.” ISSUES NewArchived

Failed Successive Attempts at Medical Abortion of A 26 Weeks Intrauterine Fetal Death and The Discovery of Rudimentary Horn Pregnancy

We report a case of primigravida at 26 weeks of pregnancy with intrauterine fetal death (IUFD) on ultrasound who underwent repeated unsuccessful attempts at medical induction of abortion until exploratory laparotomy with right intact rudimentary horn removal was undertaken with nonviable female fetus . This is an example of unicornuate uterus with rudimentary horn pregnancy (RHP) which has an overall incidence of 1 in 1, 50000 to 1 in 76000 and stresses the understanding of the sonographic appearance of early pregnancy within the rudimentary horn of unicounuate uterine configuration being imperative for appropriate and timely clinical management. In Conclusion: Rudimentary horn pregnancy (RHP) must be kept as strong clinical suspicion if there is no response to repeated failed attempts at the induction of abortion.