Background: Current approaches to pain management are inadequate for both aspiration and medication abortion. Our recent placebo controlled trial found that an easily taught auricular acupuncture protocol led to much lower maximum pain during aspiration abortion compared to usual care (median scores 39.5 versus 71 on a 100-point Visual Analog Scale). The intervention also substantially ...Read more >

Background: There is global consensus that there is benefit to providing Rh immune globulin in the third trimester to prevent immune sensitization and consequent pregnancy complications, however, evidence to guide management of Rh-negative women in the first trimester bleeding is lacking. Our preliminary data indicate that women undergoing abortion in the first trimester are exposed ...Read more >

Background: This project will build upon existing training resources to develop and pilot a free, online, training resource titled “Medication Abortion in Primary Care.” This training will be designed to meet the needs of general Internists, and other primary care providers who may not be comfortable performing intrauterine procedures. By providing clinicians a continuing medical ...Read more >

Background: Access to safe abortion is declining in the US—especially in the Southeast—and Black, Latinx, and/or lower income women experience disproportionate barriers to abortion care and increased risk for unintended pregnancy, HIV/AIDS, and maternal mortality. Medication abortion has the potential to improve access for marginalized and high-risk women. SisterLove, Inc., a community-based reproductive justice organization ...Read more >

Background: Expanding the pool of trained, competent medication abortion providers is necessary to fill gaps in access to safe abortion in the US. The scope of practice for advanced practice clinicians (APCs), including nurse practitioners (NPs), certified nurse midwives (CNMs) and physician assistants (PAs), extends well beyond the skills required to safely manage medication abortion ...Read more >

Background: Medical abortion with mifepristone and misoprostol is highly effective; however, continuing pregnancy can still occur, especially as gestation advances. Even after completing treatment, some women with continuing pregnancies change their mind. Legislators began to focus on women who change their mind after mifepristone administration following a 2012 report of “medical abortion reversal” in which ...Read more >

Background: Women are seeking abortion at increasingly earlier gestations which increases the likelihood that providers will have difficulty visualizing the pregnancy on ultrasound, the current standard of care in most abortion clinics in the US. Women with no gestational sac visualized on ultrasound have a pregnancy of unknown location (PUL). The most serious risk of ...Read more >

Background: New strategies are needed to help people overcome barriers to abortion and achieve greater reproductive autonomy. Demedicalized models for medication abortion care have the potential to greatly expand access to abortion, particularly for those most affected by distance and cost barriers. Methods: The study is a patient-centered, clinically supported, prospective observational study among people ...Read more >

Background: Current regulations restrict access to medication abortion and contribute to the perception that women cannot safely take medication abortion pills (mifepristone and misoprostol) on their own without clinician supervision. However, these drugs meet many of the Food and Drug Administration (FDA) criteria for being available over the counter (OTC). Medication abortion is safe, has ...Read more >

Background: While mifepristone has the potential to expand abortion access in the US through integration into primary care, initial expectations for provision by family physicians have not been realized. Research indicates that physician motivation to provide medication abortion is an important factor in overcoming logistical and organizational barriers to abortion provision. Methods: For this project, ...Read more >