Medical abortion practices: a survey of National Abortion Federation members in the United States

Background

Little is known about clinical implementation of medical abortion in the United States following approval of mifepristone as an abortifacient by the Food and Drug Administration (FDA) in 2000. We collected information regarding medical abortion practices of National Abortion Federation (NAF) members for the year 2001.

Methods

Questionnaires were mailed to 337 active US NAF member facilities.

Results

A total of 258 facilities responded (77%); 252 nonhospital facilities were included in the analysis. Most of these facilities (87%) offered medical abortion in 2001, providing an estimated 28,400 medical abortions, approximately 52% of medical abortions in the US that year. Over 75% began offering mifepristone/misoprostol abortions within 5 months of the start of mifepristone distribution. Almost all (99%) reported using mifepristone/misoprostol regimens, with most offering one or more evidence-based alternative regimens (83%); a few (4%) used the FDA-approved regimen.

Conclusion

After FDA approval of mifepristone, NAF member facilities rapidly adopted evidence-based mifepristone/misoprostol regimens.     

Abortion education in the medical curriculum: a survey of student attitudes

BACKGROUND: The purpose of this study was to evaluate student attitudes toward the inclusion of abortion education in the preclinical and clinical medical school curriculum. STUDY DESIGN: All students completing the OB-GYN rotation from May 2004 through January 2005 (n=118) were asked to complete a 21-item survey. Survey questions focused on students' attitudes about the appropriateness of abortion education, reasons for participation or nonparticipation in the abortion care experiences in the clinical curricula and the value of abortion education. RESULTS: One hundred students completed the survey for a response rate of 85%. Nearly all respondents indicated that abortion education was appropriate in the preclinical and clinical curricula (96%). Fifty-three percent of students participated in a clinical abortion care experience. The majority of these students rated it as valuable (84%) and would recommend it to a friend (73%). Most students who planned a career in Family Medicine and OB-GYN preferred the integration of abortion training into the residency curriculum (74%). CONCLUSIONS: Abortion education is acceptable and valued by medical students and should be integrated into the curricula of all medical schools.     

Mifepristone-misoprostol abortion: a trial in rural and urban Maharashtra,India

As several important policy questions remain regarding the use of medical abortion in developing countries, we investigated the safety, efficacy, and acceptability of mifepristone-misoprostol abortion in the outpatient family planning departments of two urban hospitals and one rural hospital in India. Nine-hundred women (with gestations of < or =63 days in the urban sites and < or =56 days in the rural site) received 600 mg mifepristone followed 48 h later by 400 microg oral misoprostol in the clinic. Four point four percent or fewer urban women and 1.0% rural women were lost to follow-up. Perfect and typical-use failure rates were low at all sites. While rural women reported fewer side effects at all sites, the vast majority of women were satisfied with their medical abortions. Medical abortion can be offered safely, effectively, and acceptably in the outpatient family planning departments of urban and rural hospitals in India.     

Future abortion provision among US graduating obstetrics and gynecology residents, 2004

Background

This study was conducted to identify characteristics associated with US obstetric and gynecology graduating residents' intention to provide pregnancy termination services in their clinical practice.

Study Design

In this cross-sectional study, we surveyed all 1148 fourth-year residents in obstetrics and gynecology graduating from US training programs in 2004.

Results

Of 494 respondents, 187 (39%) planned to perform elective abortions after residency. In multivariable analysis controlling for various factors, the following were independently associated with plans to perform pregnancy termination in the future: pre-residency intentions to provide pregnancy termination [odds ratio (OR), 10; 95% confidence interval (CI), 5.3–18.9; p<.001], performing more than 50 first-trimester abortions during residency (OR, 5.1; 95% CI, 1.3–19.6; p=.02) and plans to enter academic practice (OR, 2.5; 95% CI 1.1–6.2; p=.04).

Conclusions

Intentions before residency to provide pregnancy termination services was the strongest predictor of future abortion provision.     

Medical students' attitudes toward patient-centred care: a longitudinal survey

PURPOSE: Patient-centredness should be at the heart of medical education. This longitudinal study aimed to assess possible attitude changes towards patient-centredness in a medical students' cohort as they progressed through the clinical curriculum. It also investigated the possible impact of socio-demographic factors on students' attitudes. METHODS: The same student cohort was tested on 2 occasions: during their initial exposure to clinical curricula (year 4) and after 2 years, at the end of the clerkship (year 6). Students completed a questionnaire including demographics and the 18-item Patient-Practitioner Orientation Scale (PPOS). PPOS differentiates between patient-centred versus doctor-centred or disease-centred orientation, measuring attitudes along 2 dimensions: 'sharing' and 'caring'. RESULTS: A total of 483 fully completed questionnaires was returned (response rate 83%). The cohort's attitudes were significantly more doctor-centred at the end of their studies compared to the beginning of their clinical curricula (P < 0.001). However, regarding the caring part of their relationship with patients, they maintained a satisfactory level of patient-centredness. Concerning sharing information, female students were significantly more patient-centred at year 4, with their mean score decreasing at the end of their clerkship. Furthermore, among only female students, having a looser relationship with religion was associated with more patient-centred attitudes. CONCLUSIONS: Increased authoritarianism in graduating students' attitudes emphasises clearly the need for future research and redesigning communication curricula. Furthermore, the influence of gender and relationship with religion on attitudes towards the doctor-patient relationship should be explored further, in order to eliminate disparities in the provision of patient-centred medical care.     

Medical abortion in the late first trimester: a systematic review

Objective

To describe the efficacy, safety, and acceptability of medical abortion in the late first trimester.

Experience of clandestine use of medical abortion among university students in Chile: a qualitative study

Objectives

To explore the ways in which medical abortion pills are obtained and used by university students in Chile in a clandestine context.

Medical versus surgical abortion: a survey of knowledge and attitudes among abortion clinic patients.

A survey of 405 abortion clinic patients identified confusion regarding the purpose of RU 486 and lack of commitment to required follow-up visits, suggesting a need for widespread educational efforts.     

Medical Students for Choice's Reproductive Health Externships: impact on medical students' knowledge, attitudes and intention to provide abortions

BACKGROUND: The number of abortion providers in the United States has declined dramatically in the past 15 years, threatening women's already limited access to abortion services. Improving medical students' training in abortion could help abate this public health crisis. STUDY DESIGN: From 2004 to 2006, we surveyed students before and after their participation in Medical Students for Choice's Reproductive Health Externship (RHE) program to assess their knowledge about abortion and unintended pregnancy, attitudes about performing abortions, intentions to provide abortions in the future and (in 2006) counseling patients. RESULTS: Following participation in an RHE, 15% more students answered at least 75% of questions about unintended pregnancy and abortion correctly (p=.006) than prior to participation. RHE participants were more supportive of abortion provision (p<.001) and more inclined to provide abortions in the future (p=.008). In 2006, the RHE participants were twice as likely to feel comfortable counseling patients about abortion (p<.001). CONCLUSIONS: Early clinical experiences with abortion and family planning can impact medical students' knowledge, attitudes, intentions to provide abortions and ability to counsel patients, potentially improving women's access to comprehensive reproductive health care in the future.     

Differences in efficacy, differences in providers: results from a hazard analysis of medical abortion

Sample sizes of even the largest medical abortion trials are generally not adequate to provide an understanding of how well the regimen works for subgroups of women, particularly when controlling for factors known to influence efficacy, such as gestational age. By pooling data from four previously published studies of medical abortion and using hazard analyses, we can undertake such an investigation. We find that women with lower gestational ages, women younger than 23 years of age, women with more than 12 years of education and women with no previous induced abortion experience were more likely to experience a successful medical abortion. After taking into account demographic factors, we find that significant differences in efficacy persist across study sites, indicating that differences in providers' tendency to intervene by performing vacuum aspiration vary across medical abortion providers.     

Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases of early medical abortion treated with reduced doses of mifepristone and vaginal gemeprost

The antiprogesterone mifepristone in combination with a suitable prostaglandin provides an effective method for induction of abortion in early pregnancy up to 63 days of gestation. The combination of 600 mg mifepristone followed by 1 mg of gemeprost vaginal pessary 48 h later is one of the standard regimens in practice, which is registered in several countries in Europe. In 1995, we reduced the doses for both mifepristone and gemeprost to 200 mg and 0.5 mg respectively, as this was shown to decrease significantly the incidence of side effects whilst maintaining a high efficacy. In this article, we report our experience with this regimen in routine clinical practice by analysing 3161 consecutive medical abortions retrospectively. Twelve case notes (0.4%) were not available, and for 310 (9.8%) women, the outcome was not known with certainty as they did not return for their follow up visit. Of the remaining 2839 women, 2732 (96.2%) had a complete abortion following their treatment. One-hundred-two (3.6%) women required an evacuation of the uterus: for incomplete abortion in 63 (2.2%) and ongoing pregnancy in 39 (1.4%). Three women had to undergo surgery for ectopic pregnancies. The surgical intervention rate was significantly higher at gestation of >49 days compared to ≤49 days (5.7% vs. 2.6%, p = 0.002) and at >56 days than among those at ≤56 days (6.7% vs. 3.1%; p <0.001). However, for incomplete abortion a significant increase was only seen at gestation >49 days compared to ≤49 days (3% vs. 1.6%, p = 0.017). The incidence of ongoing pregnancies increased significantly only after 56 days of gestation compared to ≤56 days (3.8% vs. 0.9%; p <0.001). Parity was related to the outcome with parous women having significantly more incomplete/ongoing abortions compared to nulliparous women (5.4% vs. 2.0%; p <0.001), although parous women did present earlier in pregnancy for termination than nulliparous women (p = 0.01). The incidence of complications was low: 165 (5.8%) women were given antibiotics for presumed genital infection and severe haemorrhage occurred in 11 (0.4%) women, of whom only two required blood transfusion. In summary, the recommended regimen with the reduced doses of mifepristone and gemeprost is highly effective, meeting the anticipated efficacy with a complete abortion rate of >95%. We have concluded from the data that gestation and parity are strong predictors for clinicians to anticipate the probability of a successful medical termination of pregnancy.     

Knowledge and attitudes about the differences between emergency contraception and medical abortion among middle-class women and men of reproductive age in Mexico City

Two reproductive technologies—emergency contraception and medical abortion—have the potential to reduce unintended pregnancy significantly in Latin America. Lack of knowledge and negative attitudes about the methods may limit their impact, however. Results from focus group discussions with middle-class men and women of reproductive age residing in Mexico City indicate that knowledge about emergency contraception and medical abortion is low. After being informed about both methods, participants supported emergency contraception but tied their support for medical abortion to its legal status. Participants remained concerned about the methods’ efficacy, mechanism of action, and potential to encourage sexual risk-taking. While almost all desired greater dissemination of information about and access to both methods in Mexico, participants cited religious and cultural concerns, as well as barriers in communication with providers and within families, as significant challenges. Participants hoped, however, that both emergency contraception and medical abortion might play important roles in preventing unwanted pregnancy and abortion-related morbidity and mortality in Mexico in the future.     

石河子大学医学生食品安全知识、态度及行为调查

目的对石河子大学医学院大学生食品安全知识、态度及行为情况进行调查,并分析其影响因素,为大学生食品安全健康教育提供依据。方法随机抽取医学院6个专业925名大学生进行食品安全知识、态度及行为问卷调查。结果医学生食品安全知识平均得分（5.77±1.87）分,不同年级学生得分不全相同,高年级组得分高于低年级组,差异有统计学意义（χ^2=14.588,P=0.006）;女生得分（5.88±1.74）高于男生（5.57±2.07）,差异有统计学意义（Z=-2.576,P=0.007）;汉族得分（5.95±1.82）高于少数民族（5.04±1.90）,差异有统计学意义（Z=-5.603,P=0.000）;学过食品相关课程的学生得分（5.99±1.88）高于未学过的学生（5.64±1.85）,差异有统计学意义（Z=-2.764,P=0.006）;电视、网络是医学生获取食品安全信息和知识的主要途径。结论高校应加强对大学生的食品安全教育,使他们获得更多的食品安全知识,改变不良的行为习惯。     

Expanding medical abortion in Tunisia: women's experiences from a multi-site expansion study

From November 2000 to July 2001, 321 consenting women were enrolled at four sites across the country in an effort to demonstrate that mifepristone medical abortion could safely be used by providers throughout Tunisia. Women who met the study's inclusion criteria were given 200 mg oral mifepristone and offered the choice of taking 400 μg oral misoprostol 2 days later either at home or at the clinic. At follow-up, women were examined to determine completed abortion status and surveyed to gauge their satisfaction with the method. Ninety-six percent of women had a successful abortion using this method. Women expressed a strong preference for home use of misoprostol, indicating that it is more confidential (34%), easier (28%) and requires fewer clinic visits (28%). The high rate of success, demonstrated safety and acceptability of the method in new facilities and with new providers suggests that medical abortion can be safely expanded to new settings with reasonable levels of training and supervision.     

International medical school faculty development: the results of a needs assessment survey among medical educators in China

To explore the need for faculty development among Chinese medical educators. Leaders at each medical school in China were asked to complete a 123-item survey to identify interest in various topics and barriers and perceived benefits of participating in faculty development programs. Interest levels were high for all topics. Experience with Hospital Management and Research positively correlated with interest in learning more (p < 0.001). Ninety-two percent believe that international experiences are very or extremely important to medical educators’ career advancement. Chinese medical education faculty members have a strong interest in faculty development programs.     

"You can't do that 'round here": a case study of the introduction of medical abortion care at a University Medical Center

Mifepristone medical abortion was introduced in 2002 into the University of New Mexico Medical Center clinic system through a joint effort of the departments of Family Medicine and Obstetrics and Gynecology. A stepwise approach to the integration of medical abortion, manual vacuum uterine aspiration, and first trimester obstetric ultrasound was successful in overcoming a series of educational, political, economic and logistical challenges. The integration of medial abortion care into resident training in FM and Ob/Gyn may expand access to reproductive services in primary care settings.     

Mifepristone vaginally in an early medical abortion regimen: a pilot study

OBJECTIVE: This prospective observational pilot study was undertaken to assess the efficacy of mifepristone and misoprostol, both administered vaginally. The ultimate goal is to investigate alternative means of reducing the time interval between the two treatments involved. The efficacy of the early medical abortion regimen utilizing mifepristone and misoprostol is beyond doubt. The regimen usually involves administering misoprostol 36 h following oral administration of mifepristone. The interval between the two treatment components might affect a woman's choice of the medical method. METHODS: Eighteen women undergoing abortion for nonmedical reasons were recruited. RESULTS: Seven women required further intervention to achieve complete abortion. Median induction-to-abortion interval was 7.66 h in the 11 women with complete abortion. CONCLUSION: The complete abortion rate of 61% in this study was lower than that with the standard medical regimen.     

The medical abortion experiences of married and unmarried women in Tunis, Tunisia

CONTEXT: The study explores the social dimensions of abortion in Tunisia and offers evidence supporting the provision of medical abortion to special populations, such as young and unmarried women. METHODS: For this study we recruited 222 women (unmarried: n = 101, married: n = 121) at three clinics in Tunis, Tunisia, from April 1999 to March 2001. All eligible women who consented to participate were administered a simplified regimen of medical abortion consisting of 200 mg oral mifepristone + 400 microg oral misoprostol 2 days later either at home or in the clinic. RESULTS: Our results demonstrate that unmarried women (94.8%) are as likely as married women (94.1%) to have a successful abortion using this regimen. We noted a strong initial preference for home administration of misoprostol among both groups (unmarried: 73.3%, married: 80.2%), which grew even stronger after the procedure. Women indicated that home administration is desirable because transportation to the clinic is expensive (32.7%), home administration is more confidential (26.3%), easier and more convenient (12.8%). Both groups expressed a high degree of satisfaction with the method. CONCLUSIONS: Medical abortion with the option of home administration of misoprostol is safe and feasible for special populations; such as unmarried women in Tunisia.