Effect of Mifepristone on Abortion Access in the United States

Finer, Lawrence B. PhD; Wei, Junhow

doi: 10.1097/AOG.0b013e3181b2a74d
Original Research

OBJECTIVE: To examine the pattern of mifepristone uptake in the United States and whether the introduction of this drug has facilitated access to abortion services.

METHODS: Using data from a national census of abortion providers and from the U.S. distributor of mifepristone, we assessed the number and proportion of abortions performed using mifepristone, the distribution of mifepristone providers by provider type and medical specialty, and the geographic distribution of mifepristone and surgical providers.

RESULTS: The number of mifepristone providers increased from 208 in the last 2 months of 2000 to 700 in 2001, the first full year of availability, and to 902 in 2007. Some 158,000 mifepristone abortions were performed in 2007, representing an estimated 14% of all abortions and 21% of eligible early abortions. Physicians represented 51% of mifepristone providers but accounted for just 11% of abortions; most were obstetrician-gynecologists. The proportion of abortions in each state performed using mifepristone ranged from 0% to 80%. Most mifepristone abortions were performed at or near facilities that also provided surgical abortion. 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.

CONCLUSION: Mifepristone has become an integral part of abortion provision in the United States and likely has contributed to a trend toward very early abortions. However, expectations that approval of mifepristone would result in a wider range of providers offering abortion have not yet been met, and mifepristone has not brought a major improvement in the geographic availability of abortion.

LEVEL OF EVIDENCE: III

Mifepristone has become an integral part of U.S. abortion provision, but has not brought a major improvement in the geographic availability of abortion.

From the Guttmacher Institute, New York, New York.

Supported by the Robert Sterling Clark Foundation and the Educational Foundation of America.

Preliminary results of this study were presented at the 2007 annual meeting of the American Public Health Association, November 7, 2007, Washington, DC, and at the 2008 annual meeting of the National Abortion Federation, April 7, 2008, Minneapolis, Minnesota.

Corresponding author: Lawrence B. Finer, PhD, Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038; e-mail: lfiner@guttmacher.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 The American College of Obstetricians and Gynecologists