Posted on 09/25/2002 3:39:38 PM PDT by Tumbleweed_Connection
Two years after the abortion pill was introduced in the United States, abortion providers say that only a small percentage of women seeking abortions are using it and few doctors outside of abortion clinics are offering it.
The distributor for Mifeprex, the abortion-inducing pill once known as RU-486, said yesterday that more than 100,000 women in America had used the drug since it went on sale in November 2000. In that time, however, about 2.6 million women in America had abortions, and about half of them had abortions within seven weeks of pregnancy, the time when Mifeprex could be used.
Advocates for abortion rights, who had fought for years for the drug's introduction, had predicted that Mifeprex would change the politics and the practice of abortion in this country. But medical abortions, with pills, are more time-consuming and expensive than surgical abortions, doctors say, and women often say they are not interested when they hear what is involved — three office visits over two weeks, two separate drugs, sometimes long-lasting bleeding and cramping, compared with a surgical procedure that is over quickly.
Some providers charge at least $100 more for a medical abortion than a surgical one, explaining that each Mifeprex pill costs $100. Many use a lower dose, giving one pill instead of the three that the company recommends, but say the extra cost of the pill-induced abortion is still a burden for some patients.
In addition, many doctors in private practice worry about malpractice insurance if they offer the drug. Some may be put off by requirements that they provide backup surgical abortions if the pills fail. The drug's distributor, Danco Laboratories of New York, said most of the women who used Mifeprex got it at abortion clinics — just 17 percent of the sales were to doctors' private practices.
But Dr. Carole Joffe, a visiting professor in the department of obstetrics and gynecology at the University of California at San Francisco, said that if the experience in Europe was any guide, it takes time for medical abortions to take hold.
A recent report from the Alan Guttmacher Institute said that more than half of the early abortions in France, Scotland and Sweden were now done with pills rather than surgery but that it took a decade for medical abortions to reach such levels. The report cited barriers including bureaucratic inertia, limited financing for abortions, providers unfamiliar with the method and bad timing — many women arrived too late for a medical abortion, which is an option only early in pregnancy.
Heather O'Neill, a spokeswoman for Danco, said the sales trends in the United States were encouraging, with sales in the first eight months of this year up 38 percent over the same time last year (the company would not release actual sales figures). "It's just two years and it is growing substantially," Ms. O'Neill said of the drug's use.
Dr. Vanessa Cullen, vice president for medical affairs at Planned Parenthood Federation of America, said it was too soon to decide the fate of the abortion pill. "It takes time for these things to occur," she said.
Vicki Saporta, the president of the National Abortion Federation, which represents about half of the nation's abortion clinics, said her group always thought that the abortion pill would have a slow start and that gradually its use would increase. That is what is happening, she said. "This has actually progressed faster than some new technologies," Ms. Saporta said.
Others said the pill had been a disappointment.
"It's not the social revolution that people predicted," said Ron Fitzsimmons, the executive director of the National Coalition of Abortion Providers, which represents about 150 independent abortion clinics. "There were all these predictions that doctors would come out of the woodwork and offer it. We haven't seen it. We haven't seen people who do not do surgical abortions offer it. There were predictions that this would get the protesters away from the clinics. It hasn't panned out that way."
A pill-induced abortion, doctors explained, is not a simple procedure. First, the woman is counseled, receives a medical guide and takes three tablets of Mifeprex, which blocks a hormone necessary to maintain a pregnancy. She returns two days later for a second drug, misoprostol, to expel the fetal tissue.
The side effects include abdominal pain, bleeding and often nausea that usually lasts for 9 to 16 days. The third visit, 12 days later, is to be sure the abortion is complete.
Dr. William West, who practices at an abortion clinic in Dallas, said most women who arrived asking for the pill changed their minds when they heard what was involved. "Most say, `Heck, I don't want to go through all that,' " he said. "They say, `Let's get it over with today,' " and choose a surgical abortion. Fewer than 1 percent of his patients end up taking the pill, he said.
Dr. William Ramos, the director of a Las Vegas abortion clinic, said he offered Mifeprex and even advertised in the Yellow Pages that he had it. But he does not try to steer women toward the pill because he thinks surgery is better. A medical abortion with drugs, he said, "is more involved, it is a longer procedure, it is more expensive and, I think, it is more uncomfortable."
He added, "If I were a woman and in need of an abortion, I would go for the three-minute surgery rather than the two- week medical abortion."
So far, he said, his clinic has done 207 medical abortions since the pill became available and about 8,000 surgical procedures.
Abortion providers said they know of no doctors in private practice who are offering the pill. One of the few who does, Dr. Linda Prine, a family practice doctor in New York, said doctors worried about malpractice coverage and reimbursement by health insurers. "Even physicians who want to use it are facing obstacles," she said.
Another reason doctors in private practice hesitate, Dr. Ramos said, is the requirements that must be met. Doctors must be able to be sure that a pregnant women does not have an ectopic pregnancy, in which the fetus is lodged in a fallopian tube rather than the uterus, and they must be trained to use Mifeprex. They need to have backup surgical services available in case the medical abortion fails. Such requirements, Dr. Ramos said, limit the drug's appeal to doctors in private practice. "To my knowledge, no private doctors in the area are offering it," he said.
Renee Chelian, the director of Northland Family Planning, a Detroit abortion clinic, said no private doctors in her area offered the pill either, as far as she knew. "It's too much trouble," she said, and it is easy for women to get Mifeprex from the many abortion clinics in Detroit. "There are so many clinics that it's, Why bother?" Ms. Chelian said.
Ms. Chelian said she had provided Mifeprex to about 75 women, which is less than 1 percent of the women having abortions at her clinic. They tend to be women who had bad experiences in the past with surgical abortions, Ms. Chelian said. Those women, however, report that they preferred the medical abortions. "I frankly have been very surprised," Ms. Chelian said.
Dr. Prine said she advertised that she offered the pill and that many who received it from her were not her patients — they sought her out. So far, she said, she has provided medical abortions to 240 women, but added that many women still were unaware that they had any choice other than surgery to end a pregnancy.
"I think that women don't know enough about it yet," Dr. Prine said. "They don't know to ask for it."
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