Medical abortion is a nonsurgical procedure in which drugs are used to induce abortion. The most effective and safest medical abortion regimen requires the use of two medications, mifepristone and misoprostol. Mifepristone blocks the action of progestin to enhance the contractility of the uterus and prompt the detachment of the implanted embryo. It also acts to soften and dilate the cervix. Misoprostol stimulates strong contractions of the uterus, expelling the products of conception. This process is very similar to that of a spontaneous abortion or miscarriage. Repeated administration of misoprostol alone may lead to an abortion, but results in lower effectiveness rates and higher rates of side effects. However, misoprostol-only abortions may be an appropriate option in settings where mifepristone is not available.
Quality abortion care should include counseling; confirmation of pregnancy; estimation of length of gestation; and screening for ectopic pregnancy by the patient’s history, bimanual exam, or with ultrasound—although ultrasound is not required. Some settings offer a second visit to confirm the pregnancy is terminated. Contraceptive-options counseling should be provided at the time of the abortion or afterwards. The provision of safe abortion is an important component of reproductive health services. Medical abortion options have made abortion more available to women in a variety of health care settings.
Based on extensive research, mifepristone and misoprostol as a combined regimen have a success rate of complete abortion at 96 percent and a rate of continued pregnancies at less than 1 percent. Cramping and vaginal bleeding are associated and expected effects of medical abortions. Under medical supervision, the use of mifepristone and misoprostol is very safe. Medical abortion has not been associated with long-term health impacts and is statistically less risky than continuation of pregnancy. Medical abortion may be preferable to surgical abortion for some women, largely due to the avoidance of risks associated with such procedures (e.g., complications of anesthesia), and also the fact that medical abortion is a less invasive and more private procedure.
There are a number of political, logistical, cultural, religious, financial, and other barriers that limit universal access to medical abortion. Abortion is legally restricted in many countries. Where abortion is legal, challenges may arise in terms of health-system restrictions on where the services can be provided, procurement of the drugs (mifepristone products can be expensive, but lower cost products are becoming available), and provider training in order to properly inform and counsel patients about their options, the procedure, risks, and benefits. However, mifepristone and misoprostol are currently registered and being made available to women in numerous countries. The level of use in countries such as the United States suggests that women appreciate having an alternative to surgical abortion. Over 1 million women have used Mifeprex since it was registered in the United States in 2000.
