Misoprostol-only medication abortion: A sample protocol

Mifepristone for medication abortion is widely used in the United States. It can be provided entirely remotely by telemedicine and mail, which is critical for people who face barriers to in-person care.

However, in the aftermath of the Supreme Court decision ending the constitutional right to abortion, mifepristone is under threat. It’s urgent to understand options for medication abortion without mifepristone.

A group including ANSIRH researchers Daniel Grossman and Ushma Upadhyay published a new sample protocol for abortion using only misoprostol, with guidelines for clinicians and a sample education sheet to share with patients.

In places where mifepristone isn’t available, especially outside the United States, clinicians and people who manage their own abortions have been using misoprostol-only for decades. The World Health Organization and other international and national professional guidelines endorse this option.

After more than 22 years on the market and clinical use for more than 3 decades around the world, the safety and effectiveness of mifepristone have been clearly established. The authors note that “from a medical perspective, to prohibit the use of this drug for abortion care is senseless.” However, even if mifepristone is legally available, it may not be accessible to some patients due to cost, telehealth regulations, distribution restrictions, health issues or personal reasons. Offering medication abortion with misoprostol only is a safe, effective, patient-centered approach to enable continued access to this essential health service.