This is ideology not evidence.

“…misoprostol, can be safely and effectively used on its own.” That’s what MSI Reproductive Choices is telling the public about a medical abortion treatment known to fail once in every five cases. This statement follows a similar one by Dr Grossman, a leading abortion researcher and advocate in the U.S., “What do people need to know about miso-only medication abortion? It’s a little less effective than taking mifepristone together with misoprostol.”

A little less effective?

In his tweet, Grossman says: “What do people need to know about miso-only medication abortion? It’s a little less effective than taking mifepristone together with misoprostol. In a 2019 systematic review, 78% had a complete abortion with miso-only, compared to about 95% with mife.”

The research he links to has just been republished in the journal Contraception (published February 25, 2023) and is being promoted to abortion providers in the U.S. with a misoprostol-only protocol for guidance if use of mifepristone is blocked.

The researchers state: “A systematic review published in 2019 summarized 38 studies of the effectiveness and safety of a large variety of misoprostol-only regimens for medication abortion in the first trimester. Of the 12,829 patients who provided outcome data, 78% aborted completely without a procedure or unplanned additional medications, a substantially lower proportion than the approximately 95% expected after the use of mifepristone and misoprostol at ≤10 weeks of gestation.

So, a medical treatment failure rate of 22% is effective if you read MSI Reproductive Choices, a little less effective according to Grossman, or if we read the evidence presented in this research substantially [less effective].

A miso-only medical abortion treatment is about four times less effective than the mife/miso combination.

Sharp stick ideology.

In their introduction, these researchers say: “In settings where mifepristone is not available, and especially outside the U.S., clinicians and people who self-manage abortion have been using misoprostol-only for decades.”

That’s right; across the globe, abortion organisations promote and provide misoprostol for both facility-based and self-managed medical abortions, especially in countries where abortion is restricted by law. In these places it might not be possible to register, import, and distribute mifepristone because it has only one indication, induced abortion. However, misoprostol can also be used to treat/prevent postpartum haemorrhage (PPH), and that indication can be used for its registration. Once the miso has been imported and distributed in-country, abortion providers use it off-label to induce abortion.

These providers know that miso-only abortion has a very common failure rate (20%+) and that up to one in five women will suffer complications from an incomplete abortion but they remain set on a global strategy to replace ‘unsafe’ abortion with ‘safe’ abortion, even if self-managed miso-only abortion is itself problematic.

Evidence does not outweigh their ideology,
after all, they believe any medical abortion
‘is better than a sharp stick…’

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