Exploring the journey of mifepristone in Canada and Australia
Bibliographic record
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. Mifépristone, ou RU486, est une antagoniste des récepteurs à la progestérone et elle est comprise dans le régime pour l’interruption volontaire de la grossesse (IVG) médicale. Ce médicament se prend oralement afin d’induire une IVG jusqu’au 70e jour depuis les dernières règles. Lorsque la mifépristone est prise en combinaison avec le misoprostol, une prostaglandine synthétique qui provoque des contractions et la maturation du col de l’utérus, ce régime a un taux de succès de 98%. La France a enregistré la mifépristone comme médicament abortif en 1988. Depuis ce temps, la mifépristone a été introduite dans plus de 60 pays, et utilisée par plus de 40 millions de femmes globalement. La mifépristone peut avoir un impact considérable sur l’accessibilité de l’IVG puisqu’elle peut être distribuée par plusieurs cliniciens, incluant les médecins de familles et les infirmières praticiennes, avec une plus grande capacité que les IVG instrumentales. De plus, ce régime est sécuritaire, efficace, a un bon rapport coût-efficacité, et très bien supporté par les patients. Le Canada et l’Australie sont deux pays qui ont récemment autorisé la distribution de la mifépristone, suivant un délai considérable du processus d’approbation. Au Canada, la mifépristone a été enregistré en 2015, et rendue disponible en 2017; en Australie, mifépristone a été approuvée pour l’importation commerciale en 2012. Cette thèse emploie des méthodes de recherche qualitatives afin d’explorer comment l’introduction de la mifépristone a eu un impact sur la prestation de services de l’IVG au Canada et en Australie, avec un accent sur les expériences des patientes. De plus, cette thèse examine comment les différentes régulations et obstacles conditionnent l’accès aux IVG et vise à générer des connaissances sur les politiques pour améliorer l’accès à l’IVG médicale.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.039 | 0.018 |
| Scholarly communication | 0.008 | 0.004 |
| Open science | 0.003 | 0.008 |
| Research integrity | 0.003 | 0.007 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".