Study examines first trimester medication abortion practices in U.S. and Canada

The work was published in the journal PLoS One.

The research team conducted a cross-sectional survey of abortion facilities from professional networks in the United States and Canada to estimate the prevalence of medication abortion practices in these settings and to look at regional differences. Administrators responded to questions on gestational limits, while up to five clinicians per facility reported on 2012 medication abortion practice. At the time the survey, mifepristone was not approved in Canada. There were 383 facilities in the US and 78 Canadian facilities that participated in the study.

In the U.S., 95.3% of the facilities offered first trimester medication abortion compared to 25.6% in Canada. While 100 percent of providers were physicians in Canada, just under half (49.4 percent) were advanced practice clinicians in the U.S., which was more common in Eastern and Western states. All Canadian providers used misoprostol; 85.3 percent with methotrexate. 91.4 percent of U.S. providers used 200 mg of mifepristone and 800 mcg of misoprostol, with 96.7 percent reporting home misoprostol administration. More than three-quarters of providers in both countries required an in-person follow-up visit, generally with ultrasound. 87.7 percent of U.S. providers routinely prescribed antibiotics compared to 26.2 percent in Canada. Nonsteroidal anti-inflammatory drugs were the most commonly reported analgesic, with regional variation in opioid narcotic prescription.

The research team concluded that medication abortion practice followed evidence-based guidelines in the U.S. and Canada. Dr. Jones explains, “We found that providers in both countries generally have uniform practice that follows evidence-based guidelines. However, based on the latest evidence, facilities could reduce required in-person visits for patients, such as through use of telemedicine prior to medication abortion prescription and home pregnancy tests to confirm completion of abortion. Additionally, medication abortion provision by advanced practice clinicians could be expanded to increase access, especially in regions that do not have many abortion providers.”

Efforts to update practices to reducing in-person visits and increasing provision by advanced practice clinicians could strengthen these services and reduce barriers to access. Dr. Jones and colleagues also found that more research is needed on optimal antibiotic prophylaxis and approaches to pain management for medication abortions to include in future evidence-based guidelines.

Jones, H., O”Connell White, K., Norman, W., Guilbert, E., Lichtenberg, E. and Paul, M. (2017). First trimester medication abortion practice in the United States and Canada. PLOS ONE, 12(10), p.e0186487.