It Is Time to Change the Standard of Medication Abortion

Abstract

Before prescribing medication abortion, clinicians have been compelled to perform a pelvic examination or ultrasonography for gestational dating to adhere to the requirements of the US Food and Drug Administration (FDA) Risk Evaluation and Mitigation System (REMS) program for dispensing mifepristone. These examinations require an in-person clinic visit, which can be logistically burdensome and limit access to care. In this issue of JAMA Internal Medicine, Upadhyay et al¹ provide evidence that medication abortion using mifepristone and misoprostol is safe and effective for pregnancy termination without requiring an in-person clinical evaluation. These data should reassure clinicians and FDA evaluators that allowing history-based screening in lieu of in-person examinations is appropriate and evidence based. Identify all potential conflicts of interest that might be relevant to your comment. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Err on the side of full disclosure. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response. Not all submitted comments are published. Please see our commenting policy for details.