Abstract
Despite its safety record, mifepristone is subject to a highly restrictive set of
regulatory measures through the Risk Evaluation and Mitigation Strategy (REMS) by
the US Food and Drug Administration. We argue that these restrictions both reflect
and perpetuate a cycle of abortion stigma, creating particular barriers to mifepristone
use in primary care settings where communities that historically experience barriers
to care can most easily access reproductive health services. Through qualitative interviews
with Illinois primary care clinicians, we discovered how the REMS heightens institutional
anxiety over implementation of mifepristone use. To address this, we created ExPAND Mifepristone, a learning collaborative targeting institutional anxiety and logistical barriers
to mifepristone use. The learning collaborative model holds high potential to mitigate
institutional barriers to mifepristone use by increasing providers’ self-efficacy
to identify, address, and overcome institutional fears. Until the REMS is fully repealed,
learning collaboratives constitute a promising tool to combat the practical and psychological
barriers to mifepristone use that these restrictions currently pose.
Keywords
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Article info
Publication history
Published online: April 19, 2021
Accepted:
April 4,
2021
Received in revised form:
March 31,
2021
Received:
February 5,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
