Thanks to Medication Abortion, An Increasing Share of Abortions Take Place By or Before Nine Weeks


September 28th, 2010 marks the ten-year anniversary of the date on which the U.S. Food and Drug Administration (FDA) approved the use of the abortion drug mifepristone (in combination with a second drug, misoprostol) as an alternative to surgical abortion for terminating early pregnancies.  This method is not related to emergency contraception, which like all contraceptive methods prevents a pregnancy from occuring in the first place.

The Guttmacher Institute notes that in the decade since, use of early medication abortion has expanded substantially, with growing numbers of providers offering the service, and a growing number of women choosing medication abortion over surgical abortion for early termination of pregnancy.

Nearly half of pregnancies among American women are unintended, and 40 percent of all unintended pregnancies are terminated by abortion. Twenty-two percent of all (intended and unintended) pregnancies (excluding miscarriages) end in abortion.

The earlier in an unintended pregnancy an abortion occurs, the safer and less costly it is. Medication abortion is only appropriate for unintended and untenable pregnancies up to nine weeks.  Availability of medication abortion has meant that an increasing share of abortions are early, and an increasing share of early abortions are done before six weeks or before nine weeks.

According to Guttmacher, the number of providers offering them increased dramatically between 2000 and 2007, and the number of medication abortions specifically increased even as the total number of abortions performed in the United States declined. In 2007, 158,000 medication abortions were performed using mifepristone, accounting for an estimated 21 percent of all eligible abortions (those performed prior to nine weeks’ gestation) that year. A Guttmacher Update states:

Although the introduction of mifepristone did not increase the overall incidence of abortion, it does appear to have contributed to a change in the timing of women’s abortions. A larger proportion of abortions take place at earlier gestations than they did before the drug was introduced. The Centers for Disease Control and Prevention report that although the proportion of women obtaining abortions in the first trimester has remained stable, the proportion of abortions obtained at nine weeks’ gestation or earlier has increased, as has the proportion obtained within six weeks’ gestation.

Use of mifepristone appears to have continued growing between 10 and 15 percent annually since 2007. 

Yet the full potential of mifepristone to ensure access to all women in need of abortion has yet to be reached.  “While many in the reproductive health field believed approval of mifepristone would expand access to abortion services, particularly in rural areas, that has not happened to any significant extent,” said Dr. Lawrence B. Finer of Guttmacher.

“Instead, almost a decade later, we find that women in areas that already had access to abortion now have the choice between a medication or a surgical abortion. But for most women who were not easily able to access an abortion provider before mifepristone became available, services remain difficult to obtain.”

Still researchers note that mifepristone has become an integral part of abortion service provision in the United States, and suggest that this percentage may continue to increase, pointing data indicating continued growth in the United States and to the widespread use of the method in France and England, where 80 percent and 43 percent of eligible abortions, respectively, are performed using mifepristone.

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  • saltyc

    But which method s safer and more effective?

    That’s my question, it would seem to me that something done with drugs that affect your whole body enough to induce an abortion, would be more taxing to the organism than a simple vacuum aspiration, and also less effective.

    That and  the fact that medical abortion can be abused, that is, taken outside of the context of a health care provider, can cause a lot more complications and unintended effects, does not make me glad that more women are using that rather than early surgical abortion.

    I think the reason more women are opting for the medical abortion is because of the abortion stigma and anti-choice policies which make it harder to obtain the surgical procedure.

    But I am not a health care provider or researcher, so I’m just asking, which one is, outside of the political issues and access, safer and more effective?

  • jodi-jacobson

    Thanks for raising this question, SaltyC.  Below are data and findings from several expert sources.  To summarize, early abortion is an extremely safe procedure whether it is carried out through medication abortion or a vacuum aspiration.  Both carry fewer risks to the woman than a full-term pregnancy, though from my vantage point the comparison is not a great one since someone carrying to term presumably has a chosen, intended and wanted pregnancy, so the risks involved are relative to their own desires to bear a child and certainly acceptable from that point of view and the risks of abortion relative to the untenable nature of an unintended pregnancy.

     

    The bottom line is that medication abortion, which must take place by nine weeks, is extremely safe.  Surgical abortion is also extremely safe.  From what i see, there is little real difference in regard to complications and safety.  Yes, medication abortion is more private which is not necessarily a bad thing, the imposed stigma of surgical abortion aside. It also can be initiated earlier in a pregnancy, which is obviously also a good thing. Both types of abortion need to be done under the care of a doctor. 

     

    One study found that even with the need for follow up (and hence additional time and money investment involved) medication abortion can be an effective method for women in low-income populations.  

     

    The study, conducted by researchers at the University of Colorado Medical School hypothesized that health care providers:

    may be reluctant to offer medication abortion to low-income, non-English-speaking populations. Concerns include lack of patient interest, incorrect use of misoprostol at home, missing mandatory follow-up visits and inappropriate use of emergency services. We describe the appeal, acceptability, safety and follow-up rates of medication abortion in a low-income Latina population in New York City.

    They found, however, that in a population that was predominantly Spanish-speaking, unmarried, poor and publicly insured, 96 percent took the misoprostol at home correctly, 90 percent returned as scheduled without reminders and 2 percent were lost to follow-up. Ninety-six percent described the experience as positive or neutral and 94 percent would recommend medication abortion to a friend. Three serious adverse events occurred and women accessed emergency services appropriately.

     

    They concluded that “Medication abortion can be a very appealing, safe and effective option in low-income, non-English-speaking populations.”

     

    On general safety:

     

    From the Association of Reproductive Health Professionals:

    Millions of women around the world have used medical abortion safely.3

    Among the estimated 850,000 US women who have used mifepristone for early abortion, seven deaths have occurred – six from rare infections associated with childbirth and abortion and one from a ruptured ectopic pregnancy.

    Six infection-related deaths have been reported to the US Food and Drug Administration; the death rate is comparable to that of surgical abortion and miscarriage and lower than the death rate from a delivery. It is not known whether using Mifeprex® and misoprostol caused these deaths.15

     

    From the National Abortion Federation:

    Serious complications arising from aspiration abortions provided before 13 weeks are quite unusual. About 88% of the women who obtain abortions are less than 13 weeks pregnant.4 Of these women, 97% report no complications; 2.5% have minor complications that can be handled at the medical office or abortion facility; and less than 0.5% have more serious complications that require some additional surgical procedure and/or hospitalization.5

    Early medical abortions are limited to the first 9 weeks of pregnancy. Medical abortions have an excellent safety profile, with serious complications occurring in less than 0.5% of cases.6 Over the last five years, six women in North America have died as a result of toxic shock secondary to a rare bacterial infection of the uterus following medical abortion with mifepristone and misoprostol. This type of fatal infection has also been observed to occur following miscarriage, childbirth and surgical abortion, as well as other contexts unrelated to pregnancy. The Centers for Disease Control and Prevention’s (CDC) continuing investigations have found no causal link between the medications and these incidents of infection. Although the Food and Drug Administration (FDA) has issued an updated advisory for warning signs of infection following medical abortion, it has recommended that there be no changes in the current standards for provision of medical abortion.7,8

    Complication rates are somewhat higher for surgical abortions provided between 13 and 24 weeks than for the first-trimester procedures. General anesthesia, which is sometimes used in surgical abortion procedures of any gestation, carries its own risks.

    In addition to the length of the pregnancy, significant factors that can affect the possibility of complications include:

    • the kind of anesthesia used;
    • the woman’s overall health;
    • the abortion method used; and
    • the skill and training of the provider.

     

    The Food and Drug Administration has several fact sheets on uses of Mifepristone and conditions for use.  Here is one.

     

    Great questions.  I hope this information helps answer them at least as a start.

     

    Best wishes, Jodi

  • saltyc

    thanks.