On medical abortion
August 10, 2018

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Professor Bogdan Chazan MD, PhD

Historically, the introduction of medical abortion has been justified with claims that, compared with early surgical abortion, it is simpler, cheaper, easier to access, safer, more convenient for rural women, can be administered at home and avoids hospitalisation, causes less psychological distress and is preferred by women. In addition, the Chief Executive of the Society of Obstetricians and Gynaecologists of Canada, has opined that the introduction of medical abortion should not result in more mothers opting for abortion. The current Canadian abortion rate of 100,000 per year is expected to remain stable.

However, an examination of the literature paints a different picture. Compared with early surgical abortion, medical abortion has been reported to cause severe side effects in 23% of women including nausea, vomiting, diarrhoea, abdominal pain, headaches, dizziness and fever. Medical abortion takes longer (up to 2 weeks instead of 2 days) and is less predictable, causing women to abort anywhere and at any time. More doctor and hospital visits are needed to deal with the side effects and the longer process of abortion. More time off work is therefore needed and women undergoing medical abortion have reported more emotional distress from seeing the foetal tissue they have passed. Furthermore, medical abortion cannot entirely replace surgical abortion. In particular women undergoing medical abortion require ready access to a hospital-based service to deal with complications such as an incomplete or failed abortion, and to control heavy bleeding.

Overall, the death rate from medical abortion is about 10 times that of early surgical abortion. This is due to 3 specific problems seen with medical abortion: catastrophic vaginal bleeding, severe overwhelming infection (e.g. with Clostridium sordelli) and the mis-diagnosis of ectopic pregnancy. Serious complications from medical abortion are seen more often in women under the age of 18 years

Medical abortion has the added complication that some women who, having commenced mifepristone (RU486), change their mind and withdraw from treatment. If not managed appropriately with progesterone support, there is a 23% chance of birth defects including sirenomelia (fusion of the lower limbs).

Originally published in full at: http://matercare.org/news-publications/official-statements/statement-on-medical-abortion/