New Study Finds Increases in Medical Abortion, but not Access

September 28, 2009

A new study in the journal Obstetrics and Gynecology, conducted by researchers from the Guttmacher Institute, attempts to quantify the availability of medication abortion (non-surgical abortion via the medication mifepristone/Mifeprex) in the United States, and the overlap between medication and surgical abortion providers. The authors explain that it was hoped that the availability of this non-surgical option might increase abortion accessibility “because it could be delivered more privately and without surgical facilities, [and] offered by a wider range of providers, such as private obstetrician-gynecologists and family practitioners.”

The authors used sales data from the U.S. distributor of mifepristone and abortion surveillance data from the CDC and Guttmacher’s own surveys of abortion providers. Using this data, they attempted to calculate the estimated numbers of mifepristone abortions and providers by year, provider type, and physician specialty, the proportion of all abortions and of eligible (i.e., early enough for the medication option) abortions that used mifepristone, and the number of mifepristone-only providers who were more than 50 miles away from a known surgical provider. [The researchers detail this process and their related assumptions in the methods; statistics geeks will want to get a full copy of the paper for that info and their notes on the limitations.]

Among the findings:

  • Not surprisingly, the estimated number of medication abortions increased sharply in the years immediately after the drug became available, from about 55,000 in 2001 (the first full year of availability) to about 158,000 by 2007.
  • Based on existing trends, they estimate that mifepristone would represent 7% of eligible abortions performed in 2000, and about 21% in 2007 (an increase in percentage of all abortions from about 4% in 2001 to 10% in 2007).
  • Provision of medication abortion tends to follow trends for provision of all abortion, with clinics providing the most, followed by physicians and hospitals. More ob/gyns provide the drug than other physicians (such as family practice or internal medicine) by a wide margin.
  • Clinics, which typically provided surgical abortions as well, accounted for 88% of mifepristone abortions, and 96% were in metropolitan areas – “Only 14 mifepristone-only providers were located more than 50 miles away from any surgical provider. Only five mifepristone-only providers of 10 or more abortions were located farther than 50 miles from any surgical provider of 400 or more abortions.” Fewer counties had a mifepristone provider than had any abortion provider generally, and more total abortion providers were estimated than mifepristone providers (meaning that some providers may offer surgical abortion only).

The authors conclude, therefore, that “The large geographic overlap between facilities that provide surgical abortion and those that offer mifepristone means that, in many cases, women are able to choose the type of early abortion procedure they prefer,” but that “mifepristone has not brought a major improvement in the geographic availability of abortion.”

The study did not survey providers as to why they might not offer medication abortion when surgical abortion is offered, why more providers such as family practice physicians don’t seem to provide the drug, or why more providers in areas with few or no surgical providers nearby do not offer the drug as a matter of accessibility. The authors speculate that “One limiting factor may be liability coverage, which has been identified as a barrier to provision of abortion services generally, and mifepristone specifically, in family medicine.” Another unexamined issue is that a small percentage of women (5-8% according to the drug label) using Mifeprex  need a follow-up surgical procedure to complete the abortion or control bleeding; it is not clear what impact this might have on providers who do not provide surgical abortions or in areas where those services are not easily located.

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