Dr. Heidi Jones, a professor at the CUNY School of Public Health, and colleagues examined first trimester medication abortion practices in the United States and Canada. The work was published in the journal PLoS One.
[Photo: Dr. Heidi Jones]
The research team conducted a cross-sectional survey of abortion facilities from professional networks in the United States (n = 703) and Canada (n = 94) 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 (54.5 percent) US and 78 (83.0 percent) Canadian facilities who participated.
In the U.S., 95.3 percent offered first trimester medication abortion compared to 25.6 percent 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. Efforts to update practice based on the latest evidence for reducing in-person visits and increasing provision by advanced practice clinicians could strengthen these services and reduce barriers to access. The authors suggested that there is a need for more research on optimal antibiotic and analgesic use.