Exclusive: Abortion by prescription now rivals surgery for U.S. women
By Jilian Mincer
NEW YORK, Oct 31 (Reuters) – American women are ending
pregnancies with medication almost as often as with surgery,
marking a turning point for abortion in the United States, data
reviewed by Reuters shows.
pregnancies with medication almost as often as with surgery,
marking a turning point for abortion in the United States, data
reviewed by Reuters shows.
The watershed comes amid an overall decline in abortion, a
choice that remains politically charged in the United States,
sparking a fiery exchange in the final debate between
presidential nominees Hillary Clinton and Donald Trump.
choice that remains politically charged in the United States,
sparking a fiery exchange in the final debate between
presidential nominees Hillary Clinton and Donald Trump.
When the two medications used to induce abortion won U.S.
approval 16 years ago, the method was expected to quickly
overtake the surgical option, as it has in much of Europe. But
U.S. abortion opponents persuaded lawmakers in many states to
put restrictions on their use.
approval 16 years ago, the method was expected to quickly
overtake the surgical option, as it has in much of Europe. But
U.S. abortion opponents persuaded lawmakers in many states to
put restrictions on their use.
Although many limitations remain, innovative dispensing
efforts in some states, restricted access to surgical abortions
in others and greater awareness boosted medication abortions to
43 percent of pregnancy terminations at Planned Parenthood
clinics, the nation’s single largest provider, in 2014, up from
35 percent in 2010, according to previously unreported figures
from the nonprofit.
efforts in some states, restricted access to surgical abortions
in others and greater awareness boosted medication abortions to
43 percent of pregnancy terminations at Planned Parenthood
clinics, the nation’s single largest provider, in 2014, up from
35 percent in 2010, according to previously unreported figures
from the nonprofit.
The national rate is likely even higher now because of new
federal prescribing guidelines that took effect in March. In
three states most impacted by that change – Ohio, Texas and
North Dakota – demand for medication abortions tripled in the
last several months to as much as 30 percent of all procedures
in some clinics, according to data gathered by Reuters from
clinics, state health departments and Planned Parenthood
affiliates.
federal prescribing guidelines that took effect in March. In
three states most impacted by that change – Ohio, Texas and
North Dakota – demand for medication abortions tripled in the
last several months to as much as 30 percent of all procedures
in some clinics, according to data gathered by Reuters from
clinics, state health departments and Planned Parenthood
affiliates.
Among states with few or no restrictions, medication
abortions comprise a greater share, up to 55 percent in Michigan
and 64 percent in Iowa.
abortions comprise a greater share, up to 55 percent in Michigan
and 64 percent in Iowa.
Denise Hill, an Ohio mother who works full time and is
pursuing a college degree, is part of the shift.
pursuing a college degree, is part of the shift.
Hill, 26, became extremely ill with her third pregnancy,
sidelined by low blood pressure that made it challenging to care
for her son and daughter. In July, eight weeks in, she said she
made the difficult decision to have a medication abortion. She
called the option that was not available in her state four
months earlier “a blessing.”
sidelined by low blood pressure that made it challenging to care
for her son and daughter. In July, eight weeks in, she said she
made the difficult decision to have a medication abortion. She
called the option that was not available in her state four
months earlier “a blessing.”
The new prescribing guidelines were sought by privately-held
Danco Laboratories, the sole maker of the pills for the U.S.
market. Spokeswoman Abby Long said sales have since surged to
the extent that medication abortion now is “a second option and
fairly equal” to the surgical procedure.
Danco Laboratories, the sole maker of the pills for the U.S.
market. Spokeswoman Abby Long said sales have since surged to
the extent that medication abortion now is “a second option and
fairly equal” to the surgical procedure.
“We have been growing steadily year over year, and
definitely the growth is larger this year,” Long said.
definitely the growth is larger this year,” Long said.
Women who ask for the medication prefer it because they can
end a pregnancy at home, with a partner, in a manner more like a
miscarriage, said Tammi Kromenaker, director of the Red River
Women’s Clinic in Fargo, North Dakota.
end a pregnancy at home, with a partner, in a manner more like a
miscarriage, said Tammi Kromenaker, director of the Red River
Women’s Clinic in Fargo, North Dakota.
GAME CHANGER
Medication abortion involves two drugs, taken over a day or
two. The first, mifepristone, blocks the pregnancy sustaining
hormone progesterone. The second, misoprostol, induces uterine
contractions. Studies have shown medical abortions are effective
up to 95 percent of the time.
two. The first, mifepristone, blocks the pregnancy sustaining
hormone progesterone. The second, misoprostol, induces uterine
contractions. Studies have shown medical abortions are effective
up to 95 percent of the time.
Approved in France in 1988, the abortion pill was supposed
to be a game changer, a convenient and private way to end
pregnancy. In Western Europe, medication abortion is more
common, accounting for 91 percent of pregnancy terminations in
Finland, the highest rate, followed by Scotland at 80 percent,
according to the Guttmacher Institute, a nonprofit research
organization that supports abortion rights.
to be a game changer, a convenient and private way to end
pregnancy. In Western Europe, medication abortion is more
common, accounting for 91 percent of pregnancy terminations in
Finland, the highest rate, followed by Scotland at 80 percent,
according to the Guttmacher Institute, a nonprofit research
organization that supports abortion rights.
In the United States, proponents had hoped the medication
would allow women to avoid the clinics that had long been
targets of protests and sometimes violence.
would allow women to avoid the clinics that had long been
targets of protests and sometimes violence.
But Planned Parenthood and other clinics remain key venues
for the medication option. Of the more than 2.75 million U.S.
women who have used abortion pills since they were approved in
2000, at least 1 million got them at Planned Parenthood.
for the medication option. Of the more than 2.75 million U.S.
women who have used abortion pills since they were approved in
2000, at least 1 million got them at Planned Parenthood.
Many private physicians have avoided prescribing the pills,
in part out of concern that it would expose their practices to
the type of protests clinics experienced, say doctors, abortion
providers and healthcare organizations.
in part out of concern that it would expose their practices to
the type of protests clinics experienced, say doctors, abortion
providers and healthcare organizations.
At the same time, the overall U.S. abortion rate has dropped
to a low of 16.9 terminations per 1,000 women aged 15-44 in
2011, down from 19.4 per 1,000 in 2008, according to federal
data. The decline has been driven in part by wider use of birth
control, including long lasting IUDs.
to a low of 16.9 terminations per 1,000 women aged 15-44 in
2011, down from 19.4 per 1,000 in 2008, according to federal
data. The decline has been driven in part by wider use of birth
control, including long lasting IUDs.
In March, the U.S. Food and Drug Administration changed its
prescribing guidelines for medication abortion. The agency now
allows the pills to be prescribed as far as 10 weeks into
pregnancy, up from seven. It cut the number of required medical
visits and allowed trained professionals other than physicians,
including nurse practitioners, to dispense the pills. It also
changed dosing guidelines.
prescribing guidelines for medication abortion. The agency now
allows the pills to be prescribed as far as 10 weeks into
pregnancy, up from seven. It cut the number of required medical
visits and allowed trained professionals other than physicians,
including nurse practitioners, to dispense the pills. It also
changed dosing guidelines.
The changes were supported by years of prescribing data and
reflect practices already common in most states where doctors
are free to prescribe as they deem best.
reflect practices already common in most states where doctors
are free to prescribe as they deem best.
Ohio, Texas and North Dakota took the unusual step of
requiring physicians to strictly adhere to the original
guidelines. Many abortion providers were reluctant to prescribe
the pills under the older guidelines, which no longer reflected
current medical knowledge, said Vicki Saporta, President and CEO
of the National Abortion Federation.
requiring physicians to strictly adhere to the original
guidelines. Many abortion providers were reluctant to prescribe
the pills under the older guidelines, which no longer reflected
current medical knowledge, said Vicki Saporta, President and CEO
of the National Abortion Federation.
Randall K. O’Bannon, a director at the anti-abortion
National Right to Life organization, criticized the new
guidelines but said his organization had no plans to fight them.
National Right to Life organization, criticized the new
guidelines but said his organization had no plans to fight them.
“What they did was make it more profitable,” O’Bannon said.
“It will increase the pool of potential customers.”
“It will increase the pool of potential customers.”
Planned Parenthood said both types of abortion typically
cost from $300 to $1,000, including tests and examinations. The
group charges a sliding fee based on a patient’s ability to pay,
regardless of which type of abortion they choose.
cost from $300 to $1,000, including tests and examinations. The
group charges a sliding fee based on a patient’s ability to pay,
regardless of which type of abortion they choose.
VARIED ACCESS
Despite a landmark U.S. Supreme Court ruling that abortion
is a woman’s right, access varies widely by state. Some states
maintain restrictions on both surgical and medication abortions;
others have worked to increase access.
is a woman’s right, access varies widely by state. Some states
maintain restrictions on both surgical and medication abortions;
others have worked to increase access.
In rural Iowa, where clinics are few and far between,
Planned Parenthood is using video conferencing, known as
telemedicine, to expand access.
Planned Parenthood is using video conferencing, known as
telemedicine, to expand access.
The way it works is, a woman is examined in her community by
a trained medical professional, who checks vital signs and blood
pressure and performs an ultrasound. The information is sent to
an off-site doctor, who talks with the woman via video
conference and authorizes the medications.
a trained medical professional, who checks vital signs and blood
pressure and performs an ultrasound. The information is sent to
an off-site doctor, who talks with the woman via video
conference and authorizes the medications.
Since the telemedicine program began in Iowa in 2008,
medication abortions increased to 64 percent of all pregnancy
terminations, the highest U.S. rate.
medication abortions increased to 64 percent of all pregnancy
terminations, the highest U.S. rate.
In New York, Hawaii, Washington and Oregon, a private
research institute, Gynuity Health Projects, works with clinics
to send abortion pills by mail to pre-screened women.
research institute, Gynuity Health Projects, works with clinics
to send abortion pills by mail to pre-screened women.
“Medication abortion is definitely the next frontier,” said
Gloria Totten, president of the Public Leadership Institute, a
nonprofit that advises advocates.
Gloria Totten, president of the Public Leadership Institute, a
nonprofit that advises advocates.
And in Maryland and Atlanta, the nonprofit organization
Carafem opened centers in the last 18 months that offer birth
control and medication, but not surgical, abortions. It promotes
its services with ads that read: “Abortion. Yeah, we do that.”
Carafem opened centers in the last 18 months that offer birth
control and medication, but not surgical, abortions. It promotes
its services with ads that read: “Abortion. Yeah, we do that.”
(Reporting By Jilian Mincer; Editing by Michele Gershberg and
Lisa Girion)
Lisa Girion)
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