Safe and Accessible Medication Abortion Care Trends
Medication abortion care, specifically the use of mifepristone, is a safe and effective option for ending early pregnancies. Data from 2018 shows that medication abortion accounted for a significant percentage of abortions before 9 weeks gestation in the U.S. Telehealth services have made accessing medication abortion easier, allowing patients to safely receive care at home. The FDA recently reviewed the Risk Evaluation and Mitigation Strategy (REMS) for mifepristone, including requirements for prescribing clinicians and patient agreements. States differ in allowing APCs and MDs to dispense abortion pills. Overall, medication abortion continues to be a vital option for reproductive healthcare.
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Infographic: The Availability and Use of Medication Abortion Care October 2021
The Availability and Use of Medication Abortion Care In 2018, medication abortion accounted for 54% of abortions before 9 weeks gestation in the U.S. SOURCE: Kortsmit K, Jatlaoui TC, Mandel MG, et al. Abortion Surveillance United States, 2018. MMWR Surveill Summ 2020;69(No. SS-7):1 29.
Medication Abortion Care is a Safe and Effective Option to End an Early Pregnancy SOURCE: Ireland LD, Gatter M, Chen AY. Medical Compared With Surgical Abortion for Effective Pregnancy Termination in the First Trimester. Obstet Gynecol. 2015 Jul;126(1):22-8. Raymond EG, Shannon C, Weaver MA, Winikoff B. First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review. Contraception. 2013 Jan;87(1):26- 37. doi: 10.1016/j.contraception.2012.06.011.
The FDA is Reviewing the Risk Evaluation and Mitigation Strategy (REMS) in Place for Mifepristone REMS Requirements: The prescribing clinician must be certified by a mifepristone distributor. The prescriber may only dispense to patients in-person in health care settings. FDA enforcement suspended during the COVID-19 emergency The prescriber must obtain a patient agreement form from the patient before dispensing mifepristone. The REMS limits distribution of mifepristone to certified providers and bans retail pharmacies and all other providers from dispensing the medication. SOURCE: U.S. Food and Drug Administration, Mifeprex (mifepristone) Information, current as of 4/13/2021.
18 States and DC Allow Both Advance Practice Clinicians (APCs) and MDs to Dispense Abortion Pills Studies have documented that mifepristone can be safety dispensed by both APCs (e.g nurse practitioners, physician associates, and nurse midwives) and MDs. APCs also permitted to dispense (18 states and DC) Only MDs permitted to dispense (32 states) SOURCE: KFF Analysis of State Laws, October 2021; KFF Private Communications with the American Association of Nurse Practitioners (AANP), 2020; Guttmacher Institute, Medication Abortion, October 2021; Advancing New Standards in Reproductive Health (ANSIRH), the National Abortion Federation (NAF) and RhN, Providing Abortion Care: A Professional Toolkit for Nurse-Midwives, Nurse Practitioners, and Physician Assistants, 2018.
Telehealth for Medication Abortion Has Been Available on a Trial Basis for Years, and More Broadly During the Pandemic Research shows that medication abortion via telehealth is as safe and effective as in-person dispensing. appointments and mail mifepristone to patients to access abortion care safely in their homes. 78% of patients who have obtained medication abortion via telehealth have been very satisfied with their experience. SOURCE: Meurice, M., Whitehouse, K., Blaylock, R., Chang, J., Lohr, P. Client satisfaction and experience of telemedicine and home use of mifepristone and misoprostol for abortion up to B : -sectional evaluation. Contraception. 2021 May;104(1): 61-66. Upadhyay UD, Koenig LR, Meckstroth KR. Safety and Efficacy of Telehealth Medication Abortions in the US During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(8). Raymond, E., Chong, E., Winikoff, B., Bednarek, P., Keady, M. & Priegue, E. TelAbortion: evaluation of a direct to patient telemedicine abortion service in the United States. Contraception. 2019 September; 100(3):173-177.
19 States Ban the Use of Telehealth for Abortion or Require a Doctor to be Present When Dispensing the Medication No ban on telemedicine for abortion Physical presence of prescribing clinician required Ban on the use of telehealth for abortion SOURCE: KFF Analysis of State Policies, October 2021; "Medication Abortion and Telemedicine: Innovations and Barriers During the COVID-19 Emergency" KFF, June 2021.
