Prescribing the abortion pill without restrictions is safe and
effective, study finds
Researchers say Canada's experience offers a roadmap for other countries


Date:
December 8, 2021
Source:
University of British Columbia
Summary:
Abortion remains safe after Canada removed restrictions on the
medical abortion pill mifepristone in November 2017, according to
a new study.

The study used comprehensive government health data to examine
315,000 abortions in Ontario between 2012 and 2020. An analysis
showed no increase in abortion-related health complications
following the removal of restrictions on mifepristone.



FULL STORY ========================================================================== Abortion remains safe after Canada removed restrictions on the medical
abortion pill mifepristone in November 2017.


========================================================================== That's one of the key findings from a UBC-led study published today in
the New England Journal of Medicine.

The study used comprehensive government health data to examine 315,000 abortions in Ontario between 2012 and 2020. An analysis showed no
increase in abortion-related health complications following the removal
of restrictions on mifepristone, which is considered the "gold standard"
drug for medical abortion globally.

"Complications were already very rare, and we found that abortion
continued to be safe and effective when mifepristone was prescribed
without restrictions," said Dr. Laura Schummers (she/her), the study's
lead author and a postdoctoral fellow in UBC's department of family
practice. "This is the strongest evidence yet that it is safe to provide
the abortion pill like most other prescriptions -- meaning any doctor
or nurse practitioner can prescribe, any pharmacist can dispense, and
patients can take the pills if, when and where they choose." Canada was
the first country in the world to remove all supplemental restrictions
on the dispensing and administration of mifepristone.

The previous rules, which went into place when the drug was first approved
in July 2015, included a requirement that physicians observe patients
taking the medication. Additionally, the drug could only be dispensed
to patients by specially trained physicians who registered with the manufacturer, and not by pharmacists.



==========================================================================
Many of the restrictions that Canada removed are still mandated by
countries around the world, including the U.S.

"Our study is a signal to other countries that restrictions are
not necessary to ensure patient safety," says Professor Wendy Norman
(she/her), the study's senior author and professor in UBC's department of family practice. "There is no scientific justification for mifepristone restrictions, which only make it harder for people to access the care
they need. Canada's experience offers a roadmap for other countries on
how to safely improve access to family planning services." The findings revealed that the uptake of medical abortion -- those performed using medication, rather than surgically -- was rapid following the change in
policy. Before mifepristone became available, 2.2 per cent of abortions
were provided using medication. That percentage rose to 31.4 per cent
two years after the drug became available as a normal prescription.

At the same time, the overall abortion rate continued to decline after restrictions were removed, decreasing from 11.9 to 11.3 abortions per
1,000 female residents aged 15-49 years.

"We saw that patients and their health care providers rapidly began
choosing medical abortion, which can sometimes be preferred over surgical methods by offering care closer to home and earlier in pregnancy," said
study co-author Dr. Sheila Dunn (she/her), scientist and family physician
at Women's College Hospital in Toronto. "As other studies have shown,
making abortion more accessible does not increase the number of people
seeking abortion. We found that abortion rates continued to decrease
after mifepristone's availability as a normal prescription." By linking
and analyzing government health data on a secure data platform at ICES,
a not-for-profit research institute in Ontario, the researchers produced
a complete picture of abortion health outcomes that they say provides
the best data available on abortion safety.

"We were able to complete a robust safety profile for the entire
province by linking together health records from all practitioner
visits, hospital visits and outpatient prescriptions," said co-author
Dr. Elizabeth Darling (she/her), assistant dean of midwifery and associate professor at McMaster University, and an ICES scientist. "This paints
the most comprehensive picture of abortion safety to date, capturing any setting where a complication would present. It demonstrates very clearly
that restrictions on the abortion pill are not necessary for safety."
This study was funded by the Canadian Institutes of Health Research and
the Women's Health Research Institute with the support of ICES.

========================================================================== Story Source: Materials provided by University_of_British_Columbia. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Laura Schummers, Elizabeth K. Darling, Sheila Dunn, Kimberlyn
McGrail,
Anastasia Gayowsky, Michael R. Law, Tracey-Lea Laba, Janusz
Kaczorowski, Wendy V. Norman. Abortion Safety and Use with Normally
Prescribed Mifepristone in Canada. New England Journal of Medicine,
2021; DOI: 10.1056/NEJMsa2109779 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/12/211208182541.htm

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