Date of Conferral

2019

Degree

Ph.D.

School

Public Health

Advisor

Peter B. Anderson

Abstract

Unsafe abortions pose serious threats to women's health. Medical abortion provides safer abortion access to many. The lengthy interval between misoprostol and mifepristone creates multiple barriers for women and providers.

A paucity of research exists about medical abortion protocols that allow single day procedures. The efficacy and the safety of 3 medical abortion protocols of varying lengths were explored in this study.

A secondary data set of over 55,000 patients from the United Kingdom was retrospectively analyzed using binomial logistic regression. Efficacy results showed no significant difference between the conventional and the simultaneous protocols; when compared to those, the 6- to 8- hour protocol showed a 79% higher risk (OR = 0.210, 95% CI = 0.178 - 0.246) of failure. Safety of the simultaneous protocol was 48% lesser (OR = 0.524, 95% CI = 0.447 - 0.613) and the safety of the 6- to 8- hour protocol 61% lesser (OR = 0.386, 95% CI = 0.304- 0.489) compared to the conventional protocol. The absolute risk of complications or severe adverse events of all protocols (0.98%, 1.97%, and 2.67%) was very low.

The results suggest the simultaneous protocol is a viable alternative to the conventional protocol up to 10 weeks' gestation. The results could promote the adoption of the simultaneous protocol by health systems, give millions more women access to safe and effective single day medical abortions, reduce the need for skilled clinicians, and reduce cost burdens for both women and for healthcare systems overall. Implementation of these social changes could make abortion safer globally.

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