SUMMARY POINTS
Skills
- Medication abortion is technically simple, but necessitates skills including eligibility assessment, counseling, evaluation of successful passage of the pregnancy, and evaluation and management of rare complications.
- Medications commonly used for MAB (mifepristone and misoprostol) are also first line medications for early pregnancy loss using similar protocols (ACOG 2018; See Ch 8: EPL).
- MAB increases access to abortion services. As of 2021, 40% of sites offering abortion care offered only medication abortion (Jones 2024), up from 25% in 2017 (Jones 2019).
- MAB is increasing globally and accounted for 63% of all abortions occurring in the U.S. in 2023 (Jones 2024, Sedgh 2023).
- By 2024, 19% of U.S. abortions occurred by telehealth, without use of ultrasound, many by patients in states with abortion bans from clinicians in states with Shield Laws or from other countries (Verma 2023).
- MAB regimens >14 weeks are being used in many global settings (Ipas 2023; See Ch 12: Incremental Expansion: Medication Abortion >14 weeks).
Safety
- MAB is safe and effective, with > 95% success rate (Pearlman Shapiro 2023, Reeves 2016). Rarely, unsuccessful medication abortion or heavy bleeding may require outpatient treatment or uterine aspiration.
- Medication abortion with a combined regimen (mifepristone and misoprostol) is established to be safe across a range of situations, including:
- in the absence of screening ultrasound (Ralph 2024b),
- in the absence of Rh screening and testing prior to 12 weeks’ gestation (SFP 2022),
- when people self-manage without clinician involvement (Aiken 2024a, Moseson 2023, Ralph 2024, WHO 2022),
- when provided by advanced practice clinicians (Porsch 2020),
- in pregnancies of unknown location with closer follow-up (Goldberg 2022; See Ch 3: PUL),
- with gestations beyond 12 weeks (see Table),
- when provided via asynchronous or synchronous telehealth models (Updadhyay 2022, SFP 2025), and
- when mail ordered or dispensed by pharmacists (Grossman 2024).
Role
- MAB can easily be integrated into clinical practice and help expand access to abortion care.
- Many clinicians, including those in primary, urgent or emergency care facilities not providing abortion, are equipped to assess and manage MAB before and after medication use.