Beverly Winikoff, MD, MPH, Gynuity Health Projects, 15 East 26th Street, Suite 1609, New York, NY 10010, 212-228-1230, bwinikoff@gynuity.org

The process of registration of mifepristone in the US was incredibly prolonged due to the insertion of political issues into a normal drug registration process. This intrusion initially affected the French company that had invented the drug and later became more important among actors within the US itself. The complications that arose form this very unusual situation meant that a non-profit organization had to shepherd the introduction of the drug with the aid of the advocacy community. This alliance allowed much more access of women's health experts and advocates to the decision-making aspects of drug introduction. At the same time, the prolonged discussion about the drug led medical innovators to begin to experiment with new approaches to service delivery even before drug registration. These innovation in services had been completely absent from the service delivery environment in the three European countries that were already providing the method. The legal framework of both drug use and abortion service delivery in the U.S. created a third axis of particularity that helps to explain the unique (and ultimately much more woman-friendly) service delivery models that have evolved in this country.

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