Can women use medical abortion without medical supervision?

Medical abortion offers a new option to women seeking to terminate their pregnancies. In particular, the mifepristone-misoprostol regimen consists of simple pills, and is potentially suitable for self-administration. Yet access to and administration of this method of abortion remains tightly controlled. Is this strict control medically necessary? This paper identifies the seven steps women would need to accomplish in order to use mifepristone-misoprostol for abortion without medical supervision: 1) recognise they are pregnant 2) estimate the duration of pregnancy to be sufficiently short 3) select mifepristone-misoprostol as the appropriate regimen; 4) adhere to the correct protocol; 5) manage adverse reactions and seek care for those that warrant medical attention; 6) possibly notice and cope with expulsion of the embryo; and 7) recognise a complete abortion. Data from a large clinical trial of mifepristone-misoprostol medical abortion offer indirect evidence that women maybe able to complete these steps successfully. If so, it is possible that women could use the method safely and effectively with less medical supervision than is currently required in the standard protocols.