Editing Abortion (section)

===Medical===
{{Main|Medical abortion}}
{{Distinguish|text= [[emergency contraception]]}}
{{Image frame|width=300|innerstyle=font-size:88%;|link=:File:Abortionmethods.png|caption=[[Gestational age (obstetrics)|Gestational age]] may determine which abortion methods are practiced.|content={{#invoke:Block diagram|main|width=300|height=190|<border-color #cccccc><border-width 0px 0px 0px 1px><left 30><right 30>&nbsp;<vcentertext><left 70><right 70>&nbsp;<border-width 0px><top 0><bottom 12><left 0><right 100><background-color #ffbcd8>Practice of Induced Abortion Methods<background-color #bdc9df><top 19><bottom 29><left 7.5><right 20>[[manual vacuum aspiration|MVA]]<left 40><right 65>[[dilation and evacuation|D&E]]<top 38><bottom 48><left 15><right 30>[[electric vacuum aspiration|EVA]]<left 50><right 75>[[Hysterotomy abortion|Hyst.]]<left 15><right 37.5><top 56><bottom 66>[[Dilation and curettage|D&C]]<left 50><right 75>[[Intact dilation and extraction|Intact D&X]]<left 7.5><right 30><top 74><bottom 84>[[Mifepristone|Mifepr.]]<left 40><right 75>Induced Miscarr.<left 0><right 30><background-color #b7e690><top 90><bottom 100>[[First trimester|0–12&nbsp;wks]]<left 30><right 70><background-color #dfe988>[[Second trimester|12–28&nbsp;weeks]]<left 70><right 100><background-color #e9c788>[[Third trimester|28–40&nbsp;wks]]}}}}
Medical abortions are those induced by [[abortifacient]] pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of [[prostaglandin]] [[prostaglandin analogue|analogs]] in the 1970s and the [[antiprogestin|antiprogestogen]] [[mifepristone]] (also known as RU-486) in the 1980s.<ref name=Kapp2013/><ref name=":0" /><ref name="Creinin 2009">{{cite book|vauthors=Creinin MD, Gemzell-Danielsson K |year=2009| chapter=Medical abortion in early pregnancy|veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |title=Management of unintended and abnormal pregnancy: comprehensive abortion care| location=Oxford|publisher=Wiley-Blackwell|pages=111–134| isbn=978-1-4051-7696-5}}</ref><ref name="Kapp 2009">{{cite book| vauthors=Kapp N, von Hertzen H |year=2009| chapter=Medical methods to induce abortion in the second trimester| veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |title=Management of unintended and abnormal pregnancy: comprehensive abortion care| location=Oxford|publisher=Wiley-Blackwell| pages=178–192| isbn=978-1-4051-7696-5}}</ref>

The most common early first trimester medical abortion regimens use mifepristone in combination with [[misoprostol]] (or sometimes another prostaglandin analog, [[gemeprost]]) up to 10 weeks (70 days) gestational age,<ref name=":2"/><ref name=":1">{{cite web |author=Center for Drug Evaluation and Research |title=Mifeprex (mifepristone) Information |url=https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information |website=FDA |access-date=2 July 2019 |date=8 February 2019 |archive-date=23 April 2019 |archive-url=https://web.archive.org/web/20190423032409/https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111323.htm |url-status=live }}</ref> [[methotrexate]] in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone.<ref name=":0" /> Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens, and combination regimens are more effective than misoprostol alone, particularly in the second trimester.<ref name="Creinin 2009"/><ref>{{cite journal | vauthors = Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N | title = Medical methods for mid-trimester termination of pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2011 | issue = 1 | pages = CD005216 | date = January 2011 | pmid = 21249669 | pmc = 8557267 | doi = 10.1002/14651858.CD005216.pub2 }}</ref> Medical abortion regimens involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 70 days' gestation.<ref name=":1" /><ref name=":2">{{cite journal | vauthors = Chen MJ, Creinin MD | title = Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review | journal = Obstetrics and Gynecology | volume = 126 | issue = 1 | pages = 12–21 | date = July 2015 | pmid = 26241251 | doi = 10.1097/AOG.0000000000000897 | url = http://www.escholarship.org/uc/item/2pw521h5 | access-date = 30 July 2019 | url-status = live | s2cid = 20800109 | archive-url = https://web.archive.org/web/20200726105924/https://escholarship.org/uc/item/2pw521h5 | archive-date = 26 July 2020 }}</ref>

[[File:Abortion pill.jpg|thumb|right|Shown here is the typical regimen for early medical abortions (200&nbsp;mg [[mifepristone]] and 800&nbsp;μg [[misoprostol]]).]]

In very early abortions, up to 7 weeks [[gestation]], medical abortion using a mifepristone–misoprostol combination regimen is considered to be more effective than surgical abortion ([[vacuum aspiration]]), especially when clinical practice does not include detailed inspection of aspirated tissue.<ref name="WHO FAQs 2006">{{cite book |author=WHO Department of Reproductive Health and Research |url=http://whqlibdoc.who.int/publications/2006/9241594845_eng.pdf |title=Frequently asked clinical questions about medical abortion |publisher=World Health Organization |year=2006 |isbn=92-4-159484-5 |location=Geneva |access-date=22 November 2011 |url-access=subscription |archive-url=https://web.archive.org/web/20111226115043/http://whqlibdoc.who.int/publications/2006/9241594845_eng.pdf |archive-date=26 December 2011 |url-status=dead}}</ref> Early medical abortion regimens using mifepristone, followed 24–48 hours later by [[Buccal administration|buccal]] or vaginal misoprostol are 98% effective up to 9 weeks gestational age; from 9 to 10 weeks efficacy decreases modestly to 94%.<ref name=":2" /><ref name="Fjerstad 2009b">{{cite journal | vauthors = Fjerstad M, Sivin I, Lichtenberg ES, Trussell J, Cleland K, Cullins V | title = Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days | journal = Contraception | volume = 80 | issue = 3 | pages = 282–286 | date = September 2009 | pmid = 19698822 | pmc = 3766037 | doi = 10.1016/j.contraception.2009.03.010 }} The regimen (200&nbsp;mg of mifepristone, followed 24–48 hours later by 800 mcg of ''vaginal'' misoprostol) ''previously'' used by [[Planned Parenthood]] clinics in the United States from 2001 to March 2006 was 98.5% effective through 63 days gestation—with an ongoing pregnancy rate of about 0.5%, and an additional 1% of women having uterine evacuation for various reasons, including problematic bleeding, persistent gestational sac, clinician judgment or a woman's request. The regimen (200&nbsp;mg of mifepristone, followed 24–48 hours later by 800 mcg of ''[[wikt:buccal|buccal]]'' misoprostol) ''currently'' used by Planned Parenthood clinics in the United States since April 2006 is 98% effective through 59 days gestation.</ref> If medical abortion fails, surgical abortion must be used to complete the procedure.<ref>{{cite book| vauthors=Holmquist S, Gilliam M |year=2008| chapter=Induced abortion| veditors=Gibbs RS, Karlan BY, Haney AF, Nygaard I |title=Danforth's obstetrics and gynecology| edition=10th| location=Philadelphia|publisher=Lippincott Williams & Wilkins| pages=586–603| isbn=978-0-7817-6937-2}}</ref>

Early medical abortions account for the majority of abortions before 9 weeks gestation in [[Abortion in Great Britain|Britain]],<ref>{{Cite report |title=Abortion statistics, England and Wales: 2022 |url=https://www.gov.uk/government/statistics/abortion-statistics-for-england-and-wales-2022 |publisher= [[Office for Health Improvement and Disparities]] |date=2023| access-date=2024-07-23 |language=en|section = Table 5: Legal abortions: gestation weeks by purchaser and method of abortion, residents of England and Wales, numbers, percentages, 2022 |section-url = https://assets.publishing.service.gov.uk/media/664dcb9d4f29e1d07fadcc7b/Abortion-statistics-2022-data-tables.ods}}</ref> [[Abortion in France|France]],<ref>{{cite web| vauthors=Vilain A, Mouquet MC |date=22 June 2011 |title=Voluntary terminations of pregnancies in 2008 and 2009 |location=Paris |publisher=DREES, Ministry of Health, France |url=http://www.sante.gouv.fr/IMG/pdf/er765.pdf |access-date=22 November 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110926235733/http://www.sante.gouv.fr/IMG/pdf/er765.pdf |archive-date=26 September 2011 }}</ref> [[Abortion in Switzerland|Switzerland]],<ref>{{cite web| date=5 July 2011|title=Abortions in Switzerland 2010| location=Neuchâtel| publisher=Office of Federal Statistics, Switzerland| url=http://www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html|access-date=22 November 2011| url-status=dead| archive-url=https://web.archive.org/web/20111003203103/http://www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html|archive-date=3 October 2011}}</ref> [[Abortion in the United States|United States]],<ref>{{cite report | vauthors = Jones RK, Witwer E, Jerman J |title=Abortion Incidence and Service Availability in the United States, 2017 |year=2019 |publisher=Guttmacher Institute |doi=10.1363/2019.30760 |doi-access=free |pmc=5487028 }}</ref> and the [[Nordic countries]].<ref>{{cite web| vauthors=Gissler M, Heino A|date=21 February 2011| title=Induced abortions in the Nordic countries 2009| location=Helsinki| publisher=National Institute for Health and Welfare, Finland| url=http://www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf| access-date=22 November 2011| url-status=dead|archive-url=https://web.archive.org/web/20120118094034/http://www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf|archive-date=18 January 2012}}</ref>

Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second trimester abortions in [[Abortion in Canada|Canada]], most of Europe, [[Abortion in China|China]] and [[Abortion in India|India]],<ref name="Kapp 2009"/> in contrast to the United States where 96% of second trimester abortions are performed surgically by [[dilation and evacuation]].<ref name=":3">{{cite book|title=Management of unintended and abnormal pregnancy: comprehensive abortion care| vauthors=Meckstroth K, Paul M|publisher=Wiley-Blackwell| year=2009|isbn=978-1-4051-7696-5|veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD| location=Oxford|pages=135–156|chapter=First-trimester aspiration abortion}}</ref>

A 2020 [[Cochrane review|Cochrane Systematic Review]] concluded that providing women with medications to take home to complete the second stage of the procedure for an early medical abortion results in an effective abortion.<ref name=":4">{{cite journal | vauthors = Gambir K, Kim C, Necastro KA, Ganatra B, Ngo TD | title = Self-administered versus provider-administered medical abortion | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD013181 | date = March 2020 | issue = 3 | pmid = 32150279 | pmc = 7062143 | doi = 10.1002/14651858.CD013181.pub2 }}</ref> Further research is required to determine if self-administered medical abortion is as safe as provider-administered medical abortion, where a health care professional is present to help manage the medical abortion.<ref name=":4" /> Safely permitting women to self-administer abortion medication has the potential to improve access to abortion.<ref name=":4" /> The review also noted a research gap concerning methods to support women who take medication at home for a self-administered abortion.<ref name=":4" />