Implementing medical abortion with mifepristone and misoprostol in Norway 1998–2013

Abstract

Background: Medical abortion with mifepristone and misoprostol was introduced in Norway in 1998, and since then there has been an almost complete change from predominantly surgical to medical abortions. We aimed to describe the medical abortion implementation process, and to compare characteristics of women obtaining medical and surgical abortion. Methods: Information from all departments of obstetrics and gynaecology in Norway on the time of implementation of medical abortion and abortion procedures in use up to 12 weeks of gestation was assessed by surveys in 2008 and 2012. We also analysed data from the National Abortion Registry comprising 223 692 women requesting abortion up to 12 weeks of gestation during 1998-2013. Results: In 2012, all hospitals offered medical abortion, 84.4% offered medical abortion at 9-12 weeks of gestation and 92.1% offered home administration of misoprostol. The use of medical abortion increased from 5.9% of all abortions in 1998 to 82.1% in 2013. Compared with women having a surgical abortion, women obtaining medical abortion had higher odds for undergoing an abortion at 4-6 weeks (adjusted OR 2.33; 95% confidence interval 2.28-2.38). Waiting time between registered request for an abortion until termination was reduced from 11.3 days in 1998 to 7.3 days in 2013. Conclusions: Norwegian women have gained access to more treatment modalities and simplified protocols for medical abortion. At the same time they obtained abortions at an earlier gestational age and the waiting time has been reduced.

Efficacy of medical abortion prior to 6 gestational weeks: a systematic review

“…A growing proportion of induced abortions in the United States (US) and internationally are medical abortions [4]. Medical abortion at less than 9 weeks of gestation accounted for 31% of all clinic-based abortions in 2014 in the US, as compared with 24% in 2011 [4,5]. Medical abortion represents the majority of induced abortions in some European countries [4,5].…”

“…Medical abortion at less than 9 weeks of gestation accounted for 31% of all clinic-based abortions in 2014 in the US, as compared with 24% in 2011 [4,5]. Medical abortion represents the majority of induced abortions in some European countries [4,5]. Given the few medical requirements for safe provision of medical abortion drugs and that the abortion process is generally managed at a woman's home on her own, medical abortion has expanded women's access to induced abortion globally.…”

What if medical abortion becomes the main or only method of first-trimester abortion? A roundtable of views

“…Manual vacuum aspiration in Norway has been almost completely superseded by medical abortion with mifepristone+misoprostol. This has benefits for women seeking abortion, as they obtain abortion at an earlier gestational age and the waiting time has been reduced [1]. At the same time, practical skills in manual vacuum aspiration for trainees are now much more limited than they used to be; after cesarean section, the next most common gynecological procedure in Norway is abortion.…”

Medikamentell abort hos avtalespesialist

“…I Norge har abortantallet per år vaert relativt stabilt, med 13 977 provoserte aborter i 1998 og 13 169 i 2016, samtidig som det fra 2006 har vaert en betydelig nedgang i provoserte aborter blant yngre kvinner (2). Frem til 1998 ble alle aborter i Norge utført som et kirurgisk inngrep, men i 1998 ble tilbudet om medikamentell abort innført (3). Fra 1998 har det vaert en tilnaermet total omlegging av abortbehandlingen til medikamentell behandling.…”