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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.