Three residents pointing to a computer monitor

ExPAND Mifepristone Learning Collaborative

ExPAND Mifeprisone, formally known as Expanding Access to New Directions in Mifepristone Use, is a learning collaborative developed to support evidence-based use of mifepristone for early pregnancy loss (EPL) and/or abortion in primary care settings. Mifepristone is part of a two-drug regimen for medication abortion care that has been shown to improve the treatment of EPL. Yet, research with primary care providers (PCPs) in Illinois revealed that PCPs face numerous barriers in providing this medication for patients, including restrictions imposed by the Risk Evaluation and Mitigation Strategy (REMS) and abortion stigma.

Informed by this research, ExPAND Mifepristone’s Co-Directors, Dr. Debra Stulberg, a family physician, and Elizabeth Janiak, ScD, a public health researcher, developed the program to support primary care clinics in overcoming barriers to evidence-based reproductive healthcare. ExPAND Mifepristone is run by the University of Chicago Department of Family Medicine. The learning collaborative provides expert guidance and technical assistance in the form of specialized resources and tools, hands-on training, in-clinic didactics, and individualized administrative coaching.

The pilot year of ExPAND Mifepristone included two FQHCs who successfully implemented mifepristone for EPL and devised new abortion referral protocols. Future directions include continuing to expand the evidence-based provision of reproductive health services in primary care and analyzing the effectiveness of the learning collaborative in terms of improved patient-centeredness and clinical outcomes.

As ExPAND Mifepristone continues to grow, we hope to cultivate a longstanding network of PCPs and clinical sites equipped with the resources and training needed to expand and protect access to essential reproductive healthcare.

If your clinic is interested in learning more about ExPAND Mifepristone or discussing possible participation in the next cohort, please contact Dr. Debra Stulberg at dstulber@bsd.uchicago.edu 

Rasmussen KN, Janiak E, Cottrill AA, Stulberg DB. Expanding access to medication abortion through pharmacy dispensing of mifepristone: Primary care perspectives from Illinois. Contraception 2021;104(1):98-103. (In eng). DOI: 10.1016/j.contraception.2021.03.022.

Calloway D, Stulberg DB, Janiak E. Mifepristone restrictions and primary care: Breaking the cycle of stigma through a learning collaborative model in the United States. Contraception 2021;104(1):24-28. (In eng). DOI: 10.1016/j.contraception.2021.04.002 

Schreiber CA, Creinin MD, Atrio J, Sonalkar S, Ratcliffe SJ, Barnhart KT. Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss. The New England journal of medicine 2018;378(23). DOI: 10.1056/NEJMoa1715726.

Chu JJ, Devall AJ, Beeson LE. Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): a randomised, double-blind, placebo-controlled trial. The Lancet 2021;396(10253):770-778. DOI: doi:10.1016/S0140-6736(20)31788-8.

Nagendra D, Koelper N, Loza-Avalos SE, Sonalkar S, Chen M, et al. Cost-effectiveness of Mifepristone Pretreatment for the Medical Management of Nonviable Early Pregnancy. JAMA Netw Open. 2020;3(3):e201594.

Amico JR, Cheng TL, Godfrey EM. Providing Abortion Services in the Primary Care Setting. Primary Care: Clinics in Office Practice. 2018;45(4):599-613. DOI:10.1016/j.pop.2018.07.010

Prine L, Shannon C, Gillespie G, et al. Medical Abortion: Outcomes in a Family Medicine Setting. J Am Board Fam Med. 2010;23(4):509-513. DOI:10.3122/jabfm.2010.04.090229

Godfrey EM, Rubin SE, Smith EJ, Khare MM, Gold M. Women's preference for receiving abortion in primary care settings. J Women’s Health. 2010;19(3):547-53.

Logsdon MB, Handler A, Godfrey EM.  Women's preferences for the location of abortion services: a pilot study in two Chicago clinics. Maternal Child Health J. 2012;16(1):212-6.

Our Team

Dr. Debra Stulberg

Dr. Stulberg is the Director of ExPAND Mifepristone. Her research explores racial and socioeconomic disparities in reproductive health in the United States. She has a special interest in understanding the effect of religiously-sponsored health care in reproductive health, medical decision-making, and the doctor-patient relationship. Dr. Stulberg is also Associate Professor and Chair in the Department of Family Medicine, The University of Chicago with secondary appointments at the Department of Obstetrics and Gynecology Section of Family Planning & Contraceptive Research, and the Maclean Center for Clinical Medical Ethics.

Elizabeth Janiak, ScD

Elizabeth Janiak is an interdisciplinary public health researcher and Assistant Professor at Harvard Medical School and the Harvard TH Chan School of Public Health. Her research traces how public and institutional policies perpetuate inequities in access to and quality of sexual and reproductive health care including contraceptive, abortion, and obstetric services. Current projects include several studies of evidence-based mifepristone use for abortion and early pregnancy loss. Dr. Janiak completed her undergraduate and graduate training at Harvard. She is a recipient of the Society of Family Planning's Junior Investigator Award, the preeminent career development grant for abortion researchers in the United States. Her research has been cited by the National Academies of Sciences, Engineering and Medicine, and covered in dozens of media outlets including The Boston Globe, Salon, and National Public Radio.  

 

Dr. Catherine Hennessey

Dr. Catherine Hennessey is a Complex Family Planning Fellow in the Department of Obstetrics and Gynecology at the University of Chicago. Her research interests include increasing access to evidence-based treatments for pregnancy loss and abortion. She completed medical school at Georgetown University School of Medicine and OB/GYN Residency at The George Washington University. 

Ashley McHugh

Ashley McHugh is the RHOADs Research Coordinator. She plays a lead role in managing research operations for the RHOADs research group taking on regulatory compliance, study coordination, grant development and management and serving as a resource for collaborators and research staff. She is passionate about access to reproductive healthcare, maternal/child health and gender equity in the workplace. Ashley is also the Research Coordinator for the Department of Family Medicine, The University of Chicago.

Hannah Shireman Photo

Hannah Shireman, MA

Hannah Shireman is a RHOADs Research Assistant. She assists with all aspects of study activities including regulatory compliance, data collection and analyses and manuscript preparation. Hannah has a Masters of Human Rights with a background in legal advocacy. She is particularly interested in understanding and addressing inequities across systems and public policy. Hannah is also a Research Assistant for the Department of Family Medicine, The University of Chicago.

Hillary Wolff

Hillary Wolff is a Research Assistant in the Department of Family Medicine and a Master in Public Policy candidate at the University of Chicago Harris School of Public Policy. She assists with evaluation development, regulatory compliance, data collection and analyses, manuscript development and programmatic support.

Kayla Rasmussen

Kayla Rasmussen is a Research Assistant for ExPAND Mifepristone. She helped to conduct, analyze, and publish the formative research that led to the development of our learning collaborative. Kayla is graduating from the University of Chicago Pritzker School of Medicine in 2022 and pursuing a career in Family Medicine with hopes to expand access to comprehensive reproductive health services in primary care. 

 

Meera Sakthivel

Meera Sakthivel is a medical student working with ExPAND Mifepristone. She helped to collect and analyze qualitative data in the assessment of our learning collaborative. After graduating from the University of Chicago Pritzker School of Medicine in 2024, she will hopefully pursue a career in Family Medicine.

Collaborators and Consultants

  • Lee Hasselbacher, JD
  • Kristie Monast
  • Julie Chor