For the most recent and up to date information on medical abortion, please see the Center's 2005 Briefing Paper on the subject.

Factsheets (PDF) in Polish: Part A | Part B | Part C | Part D

New technologies in the field of reproductive health

Medical abortion is officially available in almost all Western European countries, though it has yet to be legalized in Poland. Restrictive Polish abortion laws have negatively influenced health care providers’ attitudes about medical abortion and helped prevent the availability of the method. Women in Poland have thus not been able to benefit from medical advancements that have made abortion safer and more convenient for women around the world. The curettage, which is still widely used in Poland, was long ago replaced by the vacuum method, a procedure much less invasive and more comfortable for women. Introduction of a medical method of pregnancy termination would give women in Poland yet another choice.

In addressing women’s health issues, international standards and social justice principles require that governments make women’s welfare their top priority. This means that the latest medical achievements and progress in a particular field of medicine should be used in providing health care. As a product of modern medical research and progress, medical abortion should be made available in Poland for the benefit of women’s health. Poland’s restrictive abortion law should not be used to justify the unavailability of this method, since abortion is still legal in some cases.

Medical abortion is also used in countries where it has not been legalized. Information from the Federation for Women and Family Planning (Federacji na rzecz Kobiet i Planowania Rodziny) shows that this is also true in Poland. Lack of proper training of physicians and mid-level medical personnel, combined with a lack of reliable information on this method, may jeopardize the health of women using medical abortion improperly.

The aim of this paper is to provide missing information and dispel myths surrounding medical abortion. Women and health care providers in Poland have the right to information about this method.

Recommendations:

Since abortion is legal in Poland in limited circumstances, the Polish system of health care should respect women's right to benefit from medical achievements and progress in abortion and ensure their right to have access to all safe methods of pregnancy termination, including medical abortion. The Polish government is obligated to protect these fundamental human rights pursuant to international conventions.

The Federation for Women and Family Planning and the Center for Reproductive Rights thus make the following recommendations:

Polish health care authorities should take active steps to make all World Health Organization-approved methods of pregnancy termination available in Poland, including medical abortion and the vacuum method. To this end, health care authorities should:

• 1) Approve registration of mifepristone, an antiprogestin that acts to weaken the attachment of the fertilized egg to the uterus, in Poland;
• 2) Adequately train health care personnel in both medical abortion and the vacuum method of pregnancy termination; and
• 3) Provide women with appropriate post-abortion care, including but not limited to access to all information and methods of family planning, including emergency contraception.

What is medical abortion?

Medical abortion is an early, safe and effective non-invasive alternative to surgical abortion that involves the use of two medicines to end a pregnancy. The most common regimen calls for an oral dose of mifepristone followed 36 to 48 hours later by an oral or intravaginal dose of a prostaglandin analog—either misoprostol or gemeprost—that causes contractions of the uterus, helping to expel the fertilized egg. ¹ This regimen, which can be initiated as soon as pregnancy is confirmed,² is approximately 95% effective for abortion up to 49 days’ gestation,³ but has been approved for up to 63 days’ gestation in some countries.⁴ Mifepristone, first approved for medical abortion in France in 1988, is also commonly known by its original French name, RU-486.⁵

Medical abortion should not be confused with emergency contraception (EC). While the function of medical abortion is to terminate a pregnancy, that of EC is to prevent a pregnancy.⁶ EC includes emergency contraceptive pills (ECPs), the first dose of which may be taken up to 72 hours after unprotected intercourse, with a second dose taken 12 hours later, and the copper-T intrauterine device (IUD), which may be inserted up to five days after unprotected intercourse. These methods may prevent pregnancy by delaying or inhibiting ovulation, inhibiting fertilization, or inhibiting implantation of a fertilized egg. ⁷

Why is medical abortion important?

Making medical abortion available and accessible is a matter of promoting and protecting women’s rights to life, health and reproductive autonomy, and to benefit from scientific progress. Every year, nearly 80,000 women die and thousands more suffer permanent disabilities as a result of unsafe abortion.⁸ The availability of medical abortion can improve women’s access to safe abortion services and thus help reduce abortion-related mortality and morbidity. As a safe method of pregnancy termination with the potential to reduce maternal health risks for thousands of women, medical abortion is an important component of reproductive health care to which all women are entitled.

Women are further entitled to have access to medical abortion as their right to benefit from scientific progress. ⁹ Medical abortion is the result of decades of medical research conducted to develop and perfect a safe and perhaps more acceptable alternative to surgical abortion, with the larger goal of benefiting women’s health and access to health care services. Women are entitled to have access to modern health care options that such medical advancements make possible.

• Accessibility: Some studies suggest that the availability of medical abortion can lead to an increase in the number of health care providers who offer abortion services, thereby improving women’s overall access to safe abortion;¹⁰
  
• Acceptability: For women who wish to avoid a surgical procedure for reasons of health, culture, privacy or convenience , medical abortion provides a more acceptable option of pregnancy termination;
  
• Safety: Many abortion providers will not perform some types of surgical abortion until at least the sixth week of gestation. Because medical abortions can be initiated as soon as pregnancy is confirmed up to the first few weeks of gestation, the availability of medical abortion may allow women to obtain earlier, and thus safer, abortions.¹¹
  

Reasons why women choose medical abortion¹²

• It can be initiated as soon as pregnancy is confirmed;
  
• It requires no invasive procedure or surgery;
  
• It requires no anesthesia;
  
• Side effects other than bleeding tend to be short-lived;
  
• It does not carry risk of reproductive tract injury or infection;
  
• It has the potential for greater privacy;
  
• Some women feel it gives them greater control over their bodies.
  

Experiences with medical abortion in Europe

Mifepristone has been registered for use as medical abortion in most of Europe, including Austria, Belgium, Denmark, Finland, France, Germany, Great Britain, Greece, Luxembourg, the Netherlands, Norway, Spain, Sweden and Switzerland.¹³ While these countries’ positions on the legality of abortion differ—Spain permits abortion only to preserve the woman’s life or physical or mental health while Sweden permits abortion upon request—their legalization of medical abortion reflects a common effort to expand women’s options with regard to pregnancy termination and reasoned consideration of the proven safety and efficacy of the regimen involved.

Studies of women and physicians in France, Great Britain and Sweden, where medical abortion with mifepristone has been legal for more than a decade, ¹⁴ provide ample evidence that the regimen is safe, effective and accepted by women:

• In general, medical abortion with mifepristone has consistently expanded in use since its introduction in each country. ¹⁵ According to recent estimates, more than half of all abortions within approved gestational limits are performed medically in each country—56% in France, 61% in Scotland and 51% in Sweden;¹⁶
  
• Since mifepristone was introduced, women who wish to terminate their pregnancies have started obtaining earlier abortions. The earlier in pregnancy an abortion is performed, the lower the risk of complications.¹⁷ In France, where women may obtain medical abortion up to the seventh week of gestation, the proportion of abortions performed at or before that stage of pregnancy rose from 12% in 1987 to 20% in 1997.¹⁸ In Scotland, where women can obtain medical abortion up to the 10th week of gestation, the proportion of all abortions that occur within the eligible period increased from 51% in 1990 to 67% in 2000.¹⁹ In Sweden, where medical abortion is approved up to nine weeks’ gestation, the proportion of abortions performed before that time increased from 45% in 1991 to 65% in 1999;²⁰
  
• While opponents of choice predicted that the availability of medical abortion would lead more women to terminate their pregnancies, patterns in overall abortion rates suggest that these predictions are false.²¹ In France and England and Wales, abortion rates remained stable from the year before mifepristone was approved to the most recent year for which data are available.²² In Sweden, the abortion rate fell from 21 abortions per 1,000 women the year before mifepristone was approved to 18 per 1,000 in 1999;²³
  
• Research on patients’ evaluations of medical abortions found that the majority of women—often more than 90%—were satisfied with the procedure and would opt for the same method if a future termination were necessary.²⁴ Studies also show that 57-70% of women prefer medical abortion when presented with a choice between medical and surgical abortion.²⁵
  

How is medical abortion regulated?

Medical abortion is generally considered abortion under the laws that govern abortion practice in many countries. The laws and regulations that govern surgical abortion thus often also apply to medical abortion. Medical abortion services are generally regulated through specifications on the categories of medical personnel authorized to prescribe and administer the drugs and/or the type of medical facilities authorized to offer the service. Several countries, pursuant to their general abortion laws, also impose mandatory counseling and waiting periods on women seeking medical abortion.

Although regulations that allow only physicians to prescribe the drugs for medical abortion are the norm among European countries that allow medical abortion, such regulations are often liberally interpreted in practice.²⁶ Qualified mid-level health practitioners, such as nurses and midwives, thus actually administer the drugs in many cases. In Great Britain, for example, nurses may administer the drugs as long as a physician prescribes them.²⁷ Similarly, in Sweden, physicians’ main role is to estimate the duration of pregnancy by ultrasound and to serve as consultants and supervisors; midwives are responsible for counseling women and administering mifepristone and misoprostol.²⁸ Expanding the group of medical personnel allowed to administer the drugs minimizes reliance on and involvement of physicians in medical abortion, thus reducing costs and helping to make medical abortion more available and accessible to women.²⁹

Several countries restrict the type of medical facility authorized to provide medical abortion, limiting the availability of the method to hospitals or clinics attached to hospitals. Austria, Denmark, Netherlands, Slovakia and Sweden have restrictions of this type.³⁰ Regulations in France, Germany and Great Britain, on the other hand, permit licensed private medical facilities to provide medical abortion in addition to public hospitals.³¹ The law on medical abortion in France was further liberalized in July 2001,³² effectively allowing women to self administer the prostaglandin analog of the two-step medical abortion regimen at home, thereby reducing the number of office visits previously necessary for the method, and authorizing private doctors to administer misoprostol outside of hospitals. Although regulations for implementation of the new law have not yet been published, use of medical abortion has increased in the country. Clinical trials in other countries indicate that home administration of the second dose of the regimen is a safe and effective option that may be preferred by and make medical abortion more convenient, accessible and private for many women.³³ In Great Britain, the Department of Health is considering proposals for such an option.³⁴

Pursuant to their general abortion laws, some countries impose mandatory counseling and/or a waiting period before a woman takes her first dose of mifepristone. Because safe and effective medical abortions are limited to the first few weeks of pregnancy, the delays caused by such restrictions can reduce the number of women eligible for the method. In France, for example, women must wait seven days before they can obtain a medical or surgical abortion.³⁵

Countries where medical abortion is legal include:

• All European Union countries except
  • Ireland
    
  • Italy
    
  • Portugal
    
• China
• India
• Israel
• New Zealand
• Norway
• Russia
• South Africa
• Switzerland
• Taiwan
• Tunisia
• Ukraine
• United States

ENDNOTES
1. Mitchell D. Creinin, MD, Medical abortion regimens: Historical context and overview, American Journal of Obstetrics and Gynecology, Vol. 183, No. 2, August 2000, part 2.
2. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, Vol. 34. No. 3, May/June 2002.
3. Mitchell D. Creinin, MD, Medical abortion regimens: Historical context and overview, American Journal of Obstetrics and Gynecology, Vol. 183, No. 2, August 2000, part 2.
4. Mifepristone has been approved for early abortion up to 63 days in Great Britain and Sweden. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, Vol. 34. No. 3, May/June 2002.
5. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, Vol. 34. No. 3, May/June 2002.
6. NARAL Foundation, The Difference Between Emergency Contraception (ECPs) and Early Abortion Options (RU 486), available at (last visited January 29, 2003).
7. Center for Reproductive Rights, Emergency Contraception: Contraception, Not Abortion: An Analysis of Laws and Policy Around the World, April 2002. 8. Center for Reproductive Law and Policy, Reproductive Rights 2000: Moving Forward 37 (2000).
9. International Covenant on Economic, Social and Cultural Rights, article 15; See also Convention on Human Rights and Biomedicine, preamble.
10. In the United States, studies conducted after FDA approval of mifepristone but before the drug was released on the market indicated that the availability of mifepristone as an abortifacient would increase women’s access to abortion services in the U.S., primarily by increasing the number of health care providers who offer abortion services. Bonnie Scott Jones, JD and Simon Heller, JD, Providing Medical Abortion: Legal Issues of Relevance to Providers, note 2, American Medical Women’s Association, Inc., June 2000.
11. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, Vol. 34. No. 3, May/June 2002.
12. Population Council, Fact Sheet, Mifepristone-Misoprostol Medical Abortion.
13. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, Vol. 34. No. 3, May/June 2002.
14. Mifepristone was registered for use as an abortifacient in 1988 in France, 1991 in Great Britain and 1992 in Sweden. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, Vol. 34. No. 3, May/June 2002.
15. Elizabeth Pirruccello Newhall, MD and Beverly Winikoff, MD, MPH, Abortion with mifepristone and misoprostol: Regimens, efficacy, acceptability and future directions, American Journal of Obstetrics and Gynecology 2000, Vol. 183, No. 2, S44-S53.
16. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, note 16, Vol. 34. No. 3, May/June 2002.
17. Royal College of Obstetricians and Gynecologists, The Care of Women Requesting Induced Abortion, March 2000.
18. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, note 23, Vol. 34. No. 3, May/June 2002.
19. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, note 24, Vol. 34. No. 3, May/June 2002.
20. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, note 25, Vol. 34. No. 3, May/June 2002.
21. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, Vol. 34. No. 3, May/June 2002.
22. The abortion rate in France for women aged 15-44 was 13 abortions per 1,000 women in 1987 and 1997, and 16 per 1,000 in 1990 and 2000 in England and Wales. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, note 27, Vol. 34. No. 3, May/June 2002.
23. The abortion rate fell from 21abortions per 1,000 women in 1990 to 18 per 1,000 in 1999. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, note 28, Vol. 34. No. 3, May/June 2002.
24. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, note 57, Vol. 34. No. 3, May/June 2002.
25. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, note 58, Vol. 34. No. 3, May/June 2002.
26. European countries include Albania, Austria, France, Denmark, Great Britain, Latvia, Netherlands, Slovakia and Sweden.
27. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, Vol. 34. No. 3, May/June 2002.
28. Ipas, Deciding Women’s Lives are Worth Saving: Expanding the Role of Midlevel Providers in Safe Abortion Care, Issues in Abortion Care 7, December 2001.
29. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, Vol. 34. No. 3, May/June 2002.
30. Center for Reproductive Rights, Medical Abortion in Europe, presentation at Population Council meeting, Paris, Sept. 30-Oct.1, 2002 (on file with Center for Reproductive Rights).
31. Id.
32. July 4th, 2001 Statute on Abortion ("Voluntary Interruption of Pregnancy") and Contraception.
33. Elizabeth Pirruccello Newhall, MD and Beverly Winikoff, MD, MPH, Abortion with mifepristone and misoprostol: Regimens, efficacy, acceptability and future directions, American Journal of Obstetrics and Gynecology 2000, Vol. 183, No. 2, S44-S53.
34. Medical abortion to be more widely available in the UK, Reproductive Health Matters, Vol. 10, No. 19, May 2002.
35. Rachel K. Jones and Stanley K. Henshaw, Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden, Perspectives on Sexual and Reproductive Health, Vol. 34. No. 3, May/June 2002.