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PLoS One. 2017 Oct 12;12(10):e0186487. doi: 10.1371/journal.pone.0186487. eCollection 2017.

First trimester medication abortion practice in the United States and Canada.

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Dept. of Epidemiology & Biostatistics, CUNY School of Public Health, New York, New York, United States of America.
Dept. of Obstetrics & Gynecology, Baystate Medical Center, Springfield, Massachusetts, United States of America.
Dept. of Obstetrics & Gynecology, Boston University/Boston Medical Center, Boston, Massachusetts, United States of America.
University of British Columbia, Vancouver, British Columbia, Canada.
Institut National de Santé Publique du Québec, Québec, Canada.
Family Planning Medical Associates Medical Group, Chicago, Illinois, United States of America.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.


We conducted a cross-sectional survey of abortion facilities from professional networks in the United States (US, 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 of fielding, mifepristone was not approved in Canada. 383 (54.5%) US and 78 (83.0%) Canadian facilities participated. In the US, 95.3% offered first trimester medication abortion compared to 25.6% in Canada. While 100% of providers were physicians in Canada, just under half (49.4%) were advanced practice clinicians in the US, which was more common in Eastern and Western states. All Canadian providers used misoprostol; 85.3% with methotrexate. 91.4% of US providers used 200 mg of mifepristone and 800 mcg of misoprostol, with 96.7% 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% of US providers routinely prescribed antibiotics compared to 26.2% in Canada. Nonsteroidal anti-inflammatory drugs were the most commonly reported analgesic, with regional variation in opioid narcotic prescription. In conclusion, medication abortion practice follows evidence-based guidelines in the US 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. Research is needed on optimal antibiotic and analgesic use.

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