- Medication abortion (MAB) is technically simple – skills include assessment of eligibility, counseling, evaluation of successful passage of the pregnancy, and evaluation and management of rare complications.
- MAB is increasing globally. In 2020, over 50% of eligible U.S. patients chose MAB (Jones 2022). MAB increases access to abortion services, and 1 in 4 U.S. abortion providers offer only MAB (Jones 2019).
- Combined mifepristone/misoprostol regimens are more effective than misoprostol alone or methotrexate/misoprostol (Kulier 2011, NAF 2022).
- Misoprostol alone can be used in multiple doses for MAB when mifepristone is not readily available (Ipas 2021).
- Mifepristone 200 mg followed by misoprostol 800 mcg (buccal or vaginal) or 400 to 800 mcg (sublingual) is an effective regimen. A second dose of misoprostol 800 mcg appears to extend efficacy through 77 days gestation (Dzuba 2020; NAF 2022).
- MAB can be offered to patients who desire an abortion in cases of pregnancies of unknown location, with close follow-up. See Chapter 3 for details.
- MAB regimens up to (and over) 24 weeks of gestational age are being used in various global settings (Ipas 2021).
- MAB is safe and effective, with over 95% success rate without need for further intervention (Reeves 2016). Rarely, incomplete abortion or heavy bleeding may require outpatient treatment or uterine aspiration up to several weeks later.
- MAB can be provided in office or via telemedicine in most U.S. states (KFF 2022). Medications can be mailed, sent via mail order pharmacy, or prepared for drive-by pick up with demonstrated safety and efficacy (Aiken 2021, Upadhyay 2022).
- Self-managed medication abortion (SMMA) includes the use of abortion medications without licensed clinician oversight. Evidence demonstrates safety and efficacy of SMMA (WHO 2022; Aiken 2017; Murtagh 2017). U.S. abortion care sites increasingly report seeing one or more patients who had attempted SMMA (18%) (Jones 2019), and SMMA demand increased after Texas Senate Bill 8 in 2021 (Aiken 2022). No states require providers to report known or suspected SMMA. Patients in some states may face prosecution if reported.
- MAB can easily be integrated into your clinical practice and help expand access to abortion care.