Simplifying medication abortion
Medication abortion has the potential to dramatically improve access to safe pregnancy termination services in low-resource settings because it can be provided by clinicians with limited technical expertise—or even by the woman herself. Yet this potential has not yet been realized, largely because of complicated protocols that require multiple clinic visits and expensive technology such as ultrasound.
In Mexico we evaluated a semi-quantitative urine pregnancy test and compared its accuracy to serum hCG measurements and found the test to be quite accurate. With further refinement, the test shows promise as a way to screen for ongoing pregnancy after medication abortion and might eliminate the need for routine ultrasound after the procedure.
In South Africa we analyzed data from a study of more than 600 abortion clients and compared clinician estimates of gestational age to ultrasound estimates. The average difference was two days, which is clinically insignificant, and a small proportion of women, 10%, would have been identified as eligible based on a clinical exam, but were not eligible by ultrasound—the majority of these women could still safely use medication abortion. Using a clinical exam to determine eligibility for medication abortion could greatly expand access to the method in South Africa.