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Medication abortions: Upswing reported
Findings from a new national report reflect an increase in the use of early medication abortion. The number of such procedures performed in nonhospital facilities rose from 161,000 to 199,000 between 2005 and 2008, and the proportion of all nonhospital abortions that were early medication procedures increased from 14% to 17%.1
Early medication abortion has become an integral part of abortion care; 59% of all known abortion providers now offer this service. That early medication abortion is becoming more widely available is good news, says Rachel Jones, PhD, senior research associate at the Guttmacher Institute in New York City and lead author of the new study.
"U.S. government reports have shown that abortions are increasingly occurring earlier in pregnancy, when the procedure is safest," said Jones in a statement accompanying the new publication. "Increased access to medication abortion is helping to accelerate that trend."
The Food and Drug Administration (FDA) approved mifepristone (Mifeprex, Danco Laboratories, New York City) for use in early medication abortion in 2000. Mifepristone acts as an antiprogesterone to block continued support of the pregnancy. A second drug, misoprostol, is administered following mifepristone to induce expulsion of the products of conception.2
Research of medication abortion has looked at alternative regimens using methotrexate and misoprostol, or a misoprostol-only approach. Neither alternative approach carries FDA approval.
More abortion providers are looking at use of mifepristone. Guttmacher Institute analysts report an increase in the number of mifepristone-induced abortions, from 158,000 in 2007 to 187,000 in 2008. This increase over one year corresponds with recent usage estimates from the drug's manufacturer and might suggest an increased reliance on the procedure, say analysts.1 The median charge for early medication abortions was $490, report analysts. This compares to a $470 median charge for a surgical abortion at 10 weeks gestation.1
To perform the current analysis, Guttmacher researchers classified providers as operating in abortion clinics, other clinics, hospitals, or physicians' offices. In 2008, 1,066 facilities (59%) provided one or more early medication abortions, slightly higher (4%) than in 2005, they report. While the number of nonspecialized clinics that provided early medication abortion services increased by 23%, the numbers of hospitals and physicians' offices declined by 13% and 9% respectively.
Eighty-three percent of abortion clinics and 88% of other clinics performed at least one early medication abortion in 2008, compared to 25% of hospitals and 55% of physicians' offices. The likelihood of providing early medication abortion services increased with caseload; 30% of the smallest providers said they offered such services, compared to 94% of the largest providers. At least 9% of abortion providers said they offer only early medication abortion services. Eleven percent of physicians' offices were in this group, as were 27% of nonspecialized clinics.1
Rate decline stalls
While abortion rates in the United States have steadily declined since 1981, the new report indicates the trend has stalled. In 2008, there were 19.6 abortions per 1,000 women ages 15-44, well below the 1981 peak of 29.3 abortions for every 1,000 women. The 2008 abortion rate showed no change from the 2005 rate of 9.4 abortions; likewise, the total number of abortions in 2008 (1.21 million) essentially was unchanged from 2005, Guttmacher analysts report.1
Sharon Camp, PhD, Guttmacher president and chief executive officer, in a statement accompanying the report, said, "In this time of heightened politicization around abortion, our stalled progress should be an urgent message to policymakers that we need to do more to increase access to contraceptive services to prevent unintended pregnancy, while ensuring access to abortion services for the many women who still need them."
The report also indicated little change in the number of abortion providers; 1,787 providers were represented in the 2005 survey, compared to 1,793 in 2008. Most counties (87%) in the United States have no abortion provider; 35% of women of reproductive age lived in those counties, the 2008 survey shows.
Delaware had the highest abortion rate in 2008 (40 per 1,000 women), partly due to a 37% increase in the number of abortions. Much of the increase was attributed to one provider who acknowledged underreporting abortions in the 2005 survey. New York and New Jersey had the second and third highest abortion rates: 38 and 31 abortions per 1,000 women respectively. The abortion rate in the District of Columbia dropped 45% between 2005 and 2008, from 54 to 30 per 1,000, which made it the fourth highest in the country. High rates were also seen in Maryland, California, Florida, Nevada, and Connecticut (25–29 per 1,000).1
Harassment of abortion providers is on the upswing. The number of large nonhospital providers (those offering 400 abortions or more) reporting antiabortion harassment rose from 82% in 2000 to 89% in 2008. Harassment was particularly common among providers of all sizes in the Midwest and South. Picketing was the most common form of harassment (reported by 55% of providers), followed by picketing combined with blocking patient access to facilities (21%), the report notes.