In China, induced abortion can be provided legally as a supplementary measure when contraception fails. Mifepristonewas first introduced in China in 1986, was approved in 1988 and domestic production was registered in 1992. It has been used for early pregnancy termination on a mass scale, nationwide as a non-invasive alternative to surgical abortion.

Despite the vast Chinese experience with this method of abortion, very little is known internationally about the regimens employed there, the approaches established to distribute and ensure safe use of mifepristone, or the experiences of Chinese women with this method.

The first medical abortion study conducted in China in 1986 on 204 women used 600 mg RU-486 alone for pregnancy termination with <42 days of amenorrhoea with a complete abortion rate of 65.2% and an ongoing pregnancy rate of 31% (National Collaborative Group on RU-486 use, 1990). Insubsequent trials between 1988-1990, RU-486 600 mg was combined with PGF 2a for pregnancy termination of < 49 days with a success rate of nearly 86%. Subsequently, several other studies have been done on medical abortion in China (Table 3.4.1).

Since the articulation of family planning as a National Policy in China more than 20 years ago, a multi-level family planning and abortion service network has gradually been established across the country to pursue the agenda of curbing population growth. China’s State Family Planning Commission (SFPC) heads this network, which extends its services from the highest level at the province through the municipality/prefecture, country, town/township and village/neighbourhood levels to the lowest level of family planning centre/public health stations. In addition to providing services, this network also facilitates research on family planning and abortion in China.

A well-established reporting system for data on family planning and abortion exists at the top three levels of network: province, prefecture/municipality and country. Statistics collected from hospitals at each of these levels are reported on a monthly basis to the Ministry of Health or the SFPC.

Between 1986 and early 1993, a collaborative group, initially called the National Collaborating Group on RU-486 use, and later the National Collaborating Group on Extended Mifepristone Multi-centre Clinical Trials, was formed to develop guidelines for assessment criteria, and follow-up procedures. In April 1993, the group comprised SFPC, MOH and SDA, produced draft guidelines and in September 1995, the SFPC established two certification measures in an effort to facilitate quality assurance in medical abortion provision: permission for using mifepristone to terminate early pregnancy and certificate of training for family planning providers. The first certificate regulates medical facilities in which medical abortion is performed, while the second pertains to providers of medical abortion. Senior officers and providers provide the training.

Only clinics that have emergency facilities and are equipped to perform vacuum aspiration can be certified under the first measure, while physicians who undergo a mifepristone training course and pass an examination can obtain the second. Experts are involved in conducting clinical trials, formulating technical guidelines, providing training, disseminating information via symposia and publication in journals, and supervising to check the quality of medical abortion.

Three pharmaceutical companies manufacture Mifepristone in China and distribute it to the medical facilities. They also provide training to healthcare providers and help in information dissemination via symposia and media outlets.

Medical abortion is a well-accepted alternative for termination of early pregnancy, more common in urban than rural areas and more in middle sized than in largesized facilities. Despite a well-developed reporting system, the number of medical and surgical abortions performed annually in China is not officially available (nearly 10 million per year, out of which one third are medical).

To conclude, Chinese experience in providing this non-invasive alternative to surgical abortion will certainly benefit women in both developed and developing countries.