1. Compared to in-office administration, at-home administration of mifepristone was similarly successful for use in medical abortions.
2. Both physicians and patients were highly satisfied with the experience.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Decades of research and clinical experience demonstrated that medical abortions with mifepristone and misoprostol are safe and effective. Mifepristone administration no longer necessitates an office visit now that it is available in pill form, which allows more flexibility and privacy for women going through the emotionally difficult experience of pregnancy loss. Despite this, mifepristone remains highly regulated in the U.S. and on-label use is restricted to in-office administration. Studies conducted around the world demonstrate that home-administration of mifepristone is similarly effective to in-office administration and that many women prefer home-administration if given the choice. In this study, researchers examined the successful and acceptability of at-home administration of mifepristone for early medical abortions at Planned Parenthood centers around the United States.
At-home mifepristone administered medical abortions were equally successful to in-office administration and both physicians and patients were highly satisfied with the experience. One theoretical opposition to allowing women to administer mifepristone at home is that they will delay taking the medication. However, in this study 83 percent of home-users took the medication at the scheduled time and 0% took it after the recommended 63-day gestational age limit. Strengths of the study included a nationally representative and diverse population and low loss to follow-up (~15%) in both study groups. A notable limitations include selection bias and the possibility that complications from at-home administration may have gone unreported. Future studies randomizing participants to at-home or in-office administration with follow-up assessments would better characterize the pros and cons these modes of administration.
Click to read the study in Contraception
Relevant Reading: Acceptability of at home use of mifepristone for medical abortion
In-Depth [prospective cohort]: Researchers recruited 400 women with pregnancies up to 63 days gestation seeking medical abortion from six Planned Parenthood centers around the United States. Participants were given the choice of taking mifepristone in the office (n = 272, 68%) or at home (n = 128, 32%). Outcomes assessed at 1-2 week follow-up visits included reasons for location choice, time/date of mifepristone administration, number of missed workdays, satisfaction and abortion success.
Success rates were high and did not differ between the home-users and clinic-users (96% and 97% respectively). Of home-use participants, 82% took the mifepristone at the scheduled time and none took it after 63 days gestational age. The primary reason reported for choosing home-use was scheduling flexibility (69%). Home-users were more likely to report making the same at-home administration choice again (p = 0.002), and 96% would recommend home use to a friend.
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