{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:49:57Z","timestamp":1762508997154,"version":"build-2065373602"},"reference-count":31,"publisher":"Guttmacher Institute","issue":"3","license":[{"start":{"date-parts":[[2023,7,2]],"date-time":"2023-07-02T00:00:00Z","timestamp":1688256000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Perspect Sexual Reproductive"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>Early pregnancy loss (EPL) affects 1 million patients in the United States (US) annually, but integration of mifepristone into EPL care may be complicated by regulatory barriers, practice\u2010related factors, and abortion stigma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted qualitative, semi\u2010structured interviews among obstetrician\u2010gynecologists in independent practice in Massachusetts, US on mifepristone use for EPL. We recruited participants via professional networks and purposively sampled for mifepristone use, practice type, time in practice, and geographic location within Massachusetts until we reached thematic saturation. We analyzed interviews using inductive and deductive coding under a thematic analysis framework to identify facilitators of and barriers to mifepristone use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We interviewed 19 obstetrician\u2010gynecologists; 12 had used mifepristone for EPL and 7 had not. Participants were in private practice (<jats:italic>n<\/jats:italic>\u2009=\u200912), academic practice (<jats:italic>n<\/jats:italic>\u2009=\u20096), or worked at a federally qualified health center (<jats:italic>n<\/jats:italic>\u2009=\u20091). Seven had fellowship training, including four in complex family planning. The most common facilitators of mifepristone use for EPL were access to the expertise or protocols of local\u2010regional experts, leadership from a \u201cchampion,\u201d prior experience with abortion care, and hospital capacity constraints during the COVID\u201019 pandemic. The most common barriers were related to the Mifepristone Risk Evaluation and Mitigation Strategy (REMS) Program imposed by the US Food and Drug Administration (FDA). Additionally, mifepristone's affiliation with abortion was a barrier to its use in EPL for some obstetrician\u2010gynecologists.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The FDA Mifepristone REMS Program presents substantial barriers to obstetrician\u2010gynecologists incorporating mifepristone into their EPL care.<\/jats:p><\/jats:sec>","DOI":"10.1363\/psrh.12237","type":"journal-article","created":{"date-parts":[[2023,7,3]],"date-time":"2023-07-03T04:56:30Z","timestamp":1688360190000},"page":"210-217","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Mifepristone use for early pregnancy loss: A qualitative study of barriers and facilitators among OB\/GYNS in Massachusetts, USA"],"prefix":"10.1363","volume":"55","author":[{"given":"Sara","family":"Neill","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Gynecology, &amp; Reproductive Biology Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mugdha","family":"Mokashi","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alisa","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, &amp; Reproductive Biology Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"ASPIRE Center for Sexual and Reproductive Health Planned Parenthood League of Massachusetts  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Fortin","sequence":"additional","affiliation":[{"name":"ASPIRE Center for Sexual and Reproductive Health Planned Parenthood League of Massachusetts  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Janiak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, &amp; Reproductive Biology Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"ASPIRE Center for Sexual and Reproductive Health Planned Parenthood League of Massachusetts  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"259","published-online":{"date-parts":[[2023,7,2]]},"reference":[{"issue":"7","key":"e_1_2_6_2_1","first-page":"1","article-title":"Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990\u20102008","volume":"60","author":"Ventura SJ","year":"2012","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002899"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31788-8"},{"issue":"8","key":"e_1_2_6_5_1","first-page":"473","article-title":"Mifepristone and misoprostol for early pregnancy loss and medication abortion","volume":"103","author":"Macnaughton H","year":"2021","journal-title":"Am Fam Physician"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1715726"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13224-017-0992-5"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2020.100233"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2021.04.022"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2021.04.028"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1712939"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.conx.2020.100049"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12747"},{"key":"e_1_2_6_14_1","unstructured":"Danco Laboratories U.S. Food and Drug Administration. Initial REMS Approval: NDA 20\u2010687.2011."},{"key":"e_1_2_6_15_1","unstructured":"Risk Evaluation and Mitigation Strategy (REMS) Single Shared System for Mifepristone 200mg."},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa2109779"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2021.04.002"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsb1612526"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2021.04.017"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.2307\/j.ctv17vf79f"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2017.11.004"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003110"},{"issue":"9","key":"e_1_2_6_23_1","first-page":"1408","article-title":"Are we there yet? 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