title: Reaching women where they are: eliminating the initial in-person medical abortion visit.
abstract: The requirement that every woman desiring medical abortion must come in person to a clinical facility to obtain the drugs is a substantial barrier for many women. To eliminate this requirement in the United States, two key components of the standard initial visit would need to be restructured. First, alternatives to ultrasound and pelvic exam would need to be identified for ensuring that gestational age is within the limit for safe and effective treatment. This is probably feasible: for example, data from a large study suggest that in selected patients menstrual history is highly sensitive for this purpose. Second, the Food and Drug Administration would need to remove the medically unwarranted restriction on distribution of mifepristone. These two changes could allow provision of the service by a broader range of providers in nontraditional venues or even by telemedicine. Such options could have profound benefits in reducing cost and expanding access to abortion.
authors.affiliation: Gynuity Health Projects, 15 E 26th Street, Suite 801, New York, NY, 10010, USA. Electronic address: eraymond@gynuity.org.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Raymond
authors.affiliation: Ibis Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, San Francisco, CA, USA. Electronic address: dgrossman@ibisreproductivehealth.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
authors.affiliation: Department of Family Practice, University of British Columbia and Medical Director, Willow Women's Clinic, Vancouver, British Columbia, Canada. Electronic address: ellenwiebe@gmail.com.
authors.forename: Ellen
authors.initials: E
authors.lastname: Wiebe
authors.affiliation: Gynuity Health Projects, 15 E 26th Street, Suite 801, New York, NY, 10010, USA. Electronic address: bwinikoff@gynuity.org.
authors.forename: Beverly
authors.initials: B
authors.lastname: Winikoff
mesh_terms: D000019:Abortifacient Agents / Q000008:administration & dosage* / Q000191:economics; D000028:Abortion, Induced / Q000191:economics / Q000331:legislation & jurisprudence*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015735:Mifepristone / Q000008:administration & dosage / Q000191:economics; D016595:Misoprostol / Q000008:administration & dosage / Q000191:economics; D009819:Office Visits; D011247:Pregnancy; D017216:Telemedicine; D014481:United States; D014486:United States Food and Drug Administration / Q000331:legislation & jurisprudence*; D016387:Women's Health
chemical_list: D000019:Abortifacient Agents; D016595:Misoprostol; D015735:Mifepristone