This project is a randomized clinical trial comparing ulipristal acetate (UPA) 30 mg followed by misoprostol with mifepristone 200mg followed by misoprostol for telemedicine medication abortion in pregnancies less than 77 days’ duration. Using a hybrid effectiveness–implementation framework, which bridges clinical research and real-world practice by evaluating both whether an intervention works and how it is experienced and delivered, the trial assesses three aims: preliminary clinical effectiveness and safety, the patient-centered abortion experience, and operational feasibility within an existing telemedicine service.

In addition to preliminary clinical effectiveness and safety outcomes, patient experience is a central focus. Although mifepristone-based medication abortion can be delivered effectively and acceptably, nothing is known about the person-centered experience of a UPA-based regimen. We will assess this using surveys adapted from the validated Abortion Care Quality Tool, which measures person-centered domains such as autonomy, communication, respect, and dignity, complemented by semi-structured interviews exploring what matters most to participants. The study also examines what it takes to deliver this regimen in practice. Using established implementation outcomes (Proctor framework), we will evaluate the feasibility, fidelity, and acceptability of integrating UPA into existing telemedicine abortion workflows, drawing on workflow metrics and brief interviews with clinical staff.

This research aims to generate preliminary or feasibility data regarding alternative progesterone receptor modulators for medication abortion and inform future larger-scale comparative studies focused on reproductive healthcare innovation and patient-centered care delivery.