Sexual and reproductive health

Preventing unsafe abortion

Research

Medical abortion

Improving abortion technologies and expanding the choice of safe and effective methods to the full extent of the law are critical to reducing the incidence of unsafe abortion. Medical abortion offers women an effective alternative to surgical procedures. HRP’s work over the past three decades has contributed significantly to the development and wide acceptance of the current recommended regimen of 200 mg of mifepristone, given orally, followed 36–48 hours later by a prostaglandin – either 0.8 mg of misoprostol or 1 mg of gemeprost – given vaginally.

Results from current clinical studies

  • A randomized, multicentre trial has been carried out to determine whether the dose of mifepristone in the standard regimen could be lowered from 200 mg to 100 mg, and whether the interval between the administration of mifepristone and misoprostol could be shortened from 36–48 hours to 24 hours. A total of 2181 women in 11 countries were included in the study. The combination of the lower dose of mifepristone and the shorter interval was effective in 93% of women with a pregnancy of up to 63 days. There was no difference in efficacy between the two doses of mifepristone or between the two intervals of administration of mifepristone and misoprostol.

  • In the context of a multicentre clinical trial to compare sublingual and vaginal administration of three doses of misoprostol for termination of early pregnancy, women’s perceptions of the positive and negative features of the misoprostol-only regimens were compared with those of women who chose surgical abortion (vacuum aspiration). Of the 3127 women in the trial, 2066 chose a misoprostol-only regimen while 1061 opted for vacuum aspiration. Most of those who chose medical abortion did so because it was thought to be more natural and private, not to interfere with work and to be less painful. The most common reasons for choosing surgery were the speed of the procedure, the fact that the outcome was known earlier, and the need for fewer visits. Over 90% of the women who had a medical abortion reported that they were highly satisfied or satisfied with the procedure, compared with 74% of those who had surgery. Some 74% of those having surgery reported pain as the worst feature of the procedure, while among those having medical abortion, 31% ranked the duration of the procedure and 27% the bleeding as the worst feature.

  • A study is under way to compare two doses of misoprostol – 0.8 mg and 0.4 mg – in the combined mifepristone-misoprostol regimen. The four-armed, randomized, double-blind trial will include over 3000 women in 16 centres, and is expected to be completed by mid-2008.

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Work in the area of prevention of unsafe abortion is done exclusively within the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)

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Frequently asked clinical questions about medical abortion

The July 2006 issue of Contraception was devoted to medical abortion, and included 13 papers presented at the Bellagio Consensus Conference on Medical Abortion, organized by HRP in November 2004.

The Conference also resulted in an evidence-based publication for service providers, Frequently asked clinical questions about medical abortion.
Over 30 000 copies of the English version have already been distributed. It has been translated into French, Russian and Spanish. A Vietnamese version is also planned.