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Research project

Novel Abortion Provision Models

Medication abortion is safe and effective and makes up about one in three abortion procedures in the United States. The most effective regimen for medication abortion involves two medications – mifepristone and misoprostol – taken in conjunction to terminate a pregnancy up to 10 weeks gestation. The nature of medication abortion gives it the potential to be accessible outside of the traditional healthcare setting – meaning people could have more control and autonomy over their abortion experience. However, abortion access is restricted in the US, including how medication abortion pills can be dispensed. In addition to state laws that restrict medication abortion, the Food and Drug Administration (FDA) requires that mifepristone be dispensed only at a doctor’s office, clinic, or hospital, and that clinicians who wants to provide medication abortion have to register with the drug’s distributor and stock the medication in their offices. These rules restrict access to mifepristone. A group of experts, including ANSIRH’s Dr. Daniel Grossman, are calling on the FDA to eliminate these burdensome requirements (Read Dr. Grossman’s commentary in the New England Journal of Medicine and the op-ed he wrote for the Los Angeles Times based on that commentary).

ANSIRH researchers are investigating the demand for and feasibility of various novel strategies that hold the potential to make medication abortion more accessible. The Methods of Alternative Provision (MAP) Study is investigating abortion clients’ interest in accessing medication abortion through three of the proposed new models, discussed below.

Pharmacy Dispensing of Medication Abortion

Pharmacists play an important role in the provision of reproductive health care, including prescribing hormonal contraception and emergency contraception in some states. But pharmacists have limited involvement in abortion care, primarily due to the FDA’s dispensing restrictions on mifepristone. There is increasing interest in removing the dispensing restrictions on mifepristone in the United States, which would enable pharmacists to dispense the drug directly to patients with a prescription from their clinician. We are conducting a study, under an Investigational New Drug (IND) application to the FDA, examining the effectiveness and acceptability of pharmacist dispensing of medication abortion.

Over-the-Counter Medication Abortion

Mifepristone and misoprostol meet many of the FDA’s criteria for being available over the counter: they are safe, have no risk of overdose, are not addictive, and people are already using them safely on their own in many parts of the world. We are conducting a series of preliminary studies to investigate the feasibility of an over-the-counter (OTC) medication abortion product. An OTC model would involve the medications being available for pickup without prescription in a drug store or grocery, similar to condoms or pregnancy tests. The pills would come with detailed information and instructions, as well as access to a number of different resources to support people through the process of medication abortion.

Telemedicine

Accessing healthcare remotely from a clinician via phone or teleconference to address a health need is becoming increasingly common across medical specialties. ANSIRH is exploring the potential of telemedicine to improve access to abortion care, specifically in a variety of settings.

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ANSIRH is a program within the UCSF Bixby Center for Global Reproductive Health and is a part of UCSF's Department of Obstetrics, Gynecology & Reproductive Sciences.

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