Exploring the Journey of Mifepristone in Canada and Australia

Abstract

Mifepristone, also known by its drug development name RU486, is an anti-progestin that is part of the gold standard regimen of medication abortion. This medication is taken orally to induce an abortion through 70 days after the first day of the pregnant person’s last menstrual period. When mifepristone is used in conjunction with misoprostol, a prostaglandin analog that induces uterine contractions and causes cervical softening, the regimen results in a complete abortion about 98% of the time. France first registered mifepristone for use as an early abortifacient in 1988. Mifepristone has subsequently been introduced in more than 60 countries and used by over 40 million women worldwide. The promise of mifepristone to expand access to abortion care stems from the fact that it can be safely provided by a variety of clinicians, including family doctors and nurse practitioners, in a wider variety of settings than instrumentation abortion procedures. In addition, the regimen is safe, effective, cost-effective, and highly acceptable to patients. Canada and Australia are two countries that have recently made mifepristone available after drawn-out drug approval processes. In Canada, mifepristone was registered in 2015 and became available in 2017; in Australia, mifepristone was approved for commercial import in 2012. This thesis uses qualitative methods to explore how the introduction of mifepristone has impacted the service delivery landscape of abortion care in Canada and Australia, with a specific focus on patient experiences. In addition, this thesis examines how different regulatory settings and barriers condition access to abortion care and aims to generate policy-relevant insights for improving access to medication abortion.