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Jan. 17, 00 -- Nearly nine in 10 U.S. counties lack an abortion provider. Thats only one of several factors that limit Americans access to abortion, according to a new report.
The study comes from the Alan Guttmacher Institute, a not-for-profit sexual and reproductive health research group. Although the now-independent AGI once was a division of Planned Parenthood Federation of America, anti-abortion groups generally accept its data as accurate.
AGI researchers Stanley K. Henshaw, PhD, and Lawrence B. Finer, PhD, note that the U.S. abortion rate continues to drop. This decline pretty much matches the decline in the number of abortion providers.
Its difficult to say which causes which, Finer tells WebMD. One thing that could be behind the decline is fewer unintended pregnancies. Emergency contraception -- thats the morning-after pill -- appears to have played a role in the abortion-rate decline. In the year 000, women using emergency contraception averted up to 51,000 abortions.
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Randall K. OBannon, PhD, director of education and research for the National Right to Life Committee, has a different take on the numbers.
They talk about increased contraceptive use, but over the last 10-15 years a strong abstinence movement began in the U.S., OBannon told WebMD in an October 00 interview. Even among women who become pregnant, a smaller percentage of those are aborting their babies. That is not impacted by abstinence or contraception. Women now have a better sense of what the unborn child is like. We have been involved in an educational campaign about telling what is going on in the womb.
Finer notes that though the abortion rate -- the number of abortions per 100,000 women -- has declined, the proportion of U.S. pregnancies that end in abortion remains the same one in five. This is linked to another statistic half of all U.S. pregnancies are unintended.
Yet women who want abortions face significant obstacles. Those identified in the AGI study include
Providers limit the gestational ages at which they will perform abortions. However, the new report finds that both early and late abortions are increasing.
The cost of abortion is going up -- and most U.S. women pay directly for abortion care.
8% of women must travel more than 100 miles to get an abortion. About 16% travel 50-100 miles.
Though extreme harassment of abortion seekers has declined, 80% of large abortion clinics face picketing. Up to 8% face more extreme harassment. Though 15% of clinics reported bomb threats in 000, thats fewer than the 48% that received such threats in 185.
One other factor is changing the abortion landscape so-called medical abortion. This nonsurgical abortion uses an abortion drug -- usually Mifeprex, formerly known as RU-486. The AGI finds that 6% of pregnancy terminations are now drug induced.
Though no surgery is involved, such abortions often cost more. Thats because more counseling is needed to make sure the drugs are used in the right way. And it takes two office visits one to prescribe the drugs and another to make sure the pregnancy is terminated.
We expect that the 6% number will probably increase, Finer says. But medical abortion will not replace surgical abortion. Each method has advantages and disadvantages. Surgical abortion is quicker. But if a woman doesnt want a surgical procedure and wants a more private procedure, she may opt for medical abortion.
Aug. , 000 -- The impact of an abortion on a womans mental health has been questioned for years. Some studies have suggested that many women suffer depression, regret and even a form of post-traumatic stress disorder called post-abortion syndrome.
But a study out this month finds that 80% of women were not depressed after having an abortion. In fact, the rate of depression in the postabortion group was equal to the rate of depression in the general population. As for post-traumatic stress symptoms, the rate was 1% in the postabortion group compared with an estimated 11% in women of the same age in the general population.
The studys authors say the results agree with previous studies -- including one by former Surgeon General C. Everett Koop, MD -- showing that severe mental distress following an abortion is rare.
Most women were satisfied with their decision, believed they had benefited more than had been harmed by their abortion, and would have the abortion again, writes study author Brenda Major, PhD. These findings refute claims that women typically regret an abortion. Major is a professor of psychology at the University of California in Santa Barbara.
For the study, published in the August issue of Archives of General Psychiatry, Major and colleagues interviewed 88 women undergoing abortion. The interviews were conducted prior to abortion, immediately after the procedure, and, for 44 women, again two years later.
Nearly 70% of women reported being satisfied with the decision, and 7% reported more benefit than harm. Of those who reported depression or regret after the abortion, most were depressed or had emotional problems prior to becoming pregnant.
Experts express little surprise at the findings and say this study is more proof that for the majority of women, abortion has few aftereffects.
In an editorial accompanying the study, Nancy Adler, PhD, says that rather than contributing to mental stress, the studies suggest a significant decrease in mental distress and an increase in positive emotions and self-esteem.
Adler, director of health psychology at the University of California in San Francisco, also points out that it is important to look closer at studies that have found psychological harm after abortion to evaluate whether distress really was the result of the abortion, or of other events.
Experiencing an unwanted pregnancy is itself distressing, as may be the events associated with it. For example, a womans partner may respond to the pregnancy by leaving her. The abortion then occurs in the context of loss and abandonment, yet depression or distress following the abortion would be attributed to the procedure, Adler writes. Facing hostile protesters and intimidation in seeking an abortion also may be factors that heighten risk for psychological problems postabortion in some women, she says.
Most women fare very well emotionally, agrees David Grimes, MD. Its important to understand that abortion is not a problem, its a solution. The problem is the unintended pregnancy. When that is behind them they oftentimes will feel much better. But it is well documented that relief is the overwhelming response of most women.
Psychological counseling is routine at most facilities that perform abortions.
Its mainly a discussion about the risk, benefits and alternatives and then a discussion of contraceptive options after the procedure, Grimes tells WebMD. Grimes is vice president of biomedical affairs at Family Health International, a nonprofit group in Research Triangle Park, N.C., that helps women and men obtain access to family planning services and methods.
Both Adler and Grimes say the findings highlight the need to identify and provide extra support and counseling to women who may be experiencing depression or other problems prior to an abortion and may be at risk for problems afterwards.
Oct. 6, 000 -- In the days following the approval last week of the abortion pill, RU-486, many already are pondering the possible impact of an option other than the usual one, surgical abortion. Indeed, women who wish to end a pregnancy now have another choice, but how likely is it that they will be able to find a doctor willing to offer it to them?
In the first of three scheduled presidential debates this week, Texas Gov. George W. Bush said he feared the decision to approve RU-486 -- which will be sold as Mifeprex -- would lead to more abortions. But most experts predict doctors already performing surgical abortions will make up the large majority who will soon use the pill method, also known as a medical abortion.
Medical abortion is much more difficult to provide [than surgical abortion], says Mitchell Creinin, MD, who has been performing medical abortions for more than seven years in research studies. Unlike surgical abortion, which requires only one visit, a medical abortion requires three. It also requires a lot of counseling, sometimes at an additional visit, because of the lengthy explanation about the procedure and its alternatives.
For those reasons and other burdens placed on doctors, Creinin, an associate professor and director of family planning at the University of Pittsburgh, tells WebMD, you are not going to see as many women in the U.S. seeking out this alternative as you have perhaps in other countries. Women in the U.S. are more interested in something that is going to be done and over with.
The National Abortion Federation (NAF) is doing much of the training of doctors that will be needed for them to use Mifeprex. Vicki Saporta, executive director of NAF, tells WebMD that 1,800 health care providers have been trained in the use of what they are terming the early option pill. Saporta confirms that while some doctors not currently providing abortion have gone through the training, most have been physicians who are already providing abortions. Currently, the vast majority of all abortions are performed in abortion clinics as opposed to private doctors offices.
In addition to the extra training that is needed, another reason fewer individual ob-gyns or womens health care providers may be interested in learning about or offering pill-induced abortions is that many state laws have strict criteria that anyone providing abortions must follow. These include registering as an abortion provider or being licensed as one and making sure their offices comply with often bizarre regulations that stipulate everything from the size of the hallways to the flow of air through the office.
Many states also have strict laws about how the fetal tissue resulting from the abortion can be disposed of, and whether it must be examined. Some pill-induced abortions will occur after the woman leaves the doctors office or clinic, and in some states, women who dont bring the remains of the abortion to their doctor put the doctor at risk for prosecution. Abortion clinics know these things, but experts say individual doctors probably have no clue about the obstacle course of medical and legal issues they will have to negotiate to offer abortion via a pill.
Another thing doctors may not welcome or be ready for is becoming a target for anti-abortion protesters. Some groups already are threatening to publicize the names of doctors willing to perform medical abortions and picket their offices.
Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers, says his group has heard from plenty of interested people, but says the phone isnt exactly ringing off the hook, with doctors saying they definitely want to provide pill-induced abortions in their office.
Its a good option, Fitzsimmons says. But its not the revolution that some people have predicted.
Sept. 8, 000 -- The road toward FDA approval for the abortion pill RU-486, or mifepristone, has spanned two decades and been cluttered with at-times bitter, contentious battles between those against abortion rights and pro-choice advocates. But as of Thursday, medical abortion with RU-486 is now an option for American women.
To date, more than half a million women in Europe have undergone medical abortions with RU-486, as have thousands of women in the U.S. as part of clinical trials.
A combination of complex business and political issues contributed to the long time it has taken to bring this product to the market, says Sandra Waldman, spokesperson for the Population Council, a nonprofit group marketing the drug in the U.S.
I think RU-486 offers more options to women, but it wont solve all of our abortion access problems, says Tina Hoff, director of Public Health Information and Communication at the Henry J. Kaiser Family Foundation in Menlo Park, Calif. There are still issues to overcome including whether or not insurance will cover the cost of abortion with RU-486, whether RU-486 can be administered by non-physician providers, and how doctors will accommodate the [time] that it takes to expel the fetus, she tells WebMD.
To illustrate the long, embattled road toward approval, WebMD has put together a time line of the milestones and roadblocks in the fight to approve RU-486, both here and abroad
180 -- Researchers at Roussel-Uclaf, a French pharmaceutical company, develop mifepristone (RU-486).
18 -- The FDA issues a testing permit to the Population Council, a nonprofit group, to conduct trials of mifepristone as an early abortion method.
188 -- RU-486 is approved in France, but distribution is halted in response to protests. The French Minister of Health intervenes and orders the company to return the drug to the market. Anti-abortion rights groups then threaten to boycott Hoechst A.G. (Rousell-Uclafs parent company).
18 -- In response to pressure from the Bush Administration and others, the FDA bans the importation of RU-486 for personal use. Hoechst says it wont market or distribute the drug outside of France to appease groups against abortion rights.
10 -- Leading scientists testify before Congress that the FDA import ban has hindered research on the broad medical benefits of RU-486, including treatment for some cancers, HIV, and uterine tumors, and for inducing labor.
July 1 -- An American woman named Leona Benten issues the first direct challenge to the FDA import ban when U.S. Customs seizes the drug from her as she returns from Europe. However the U.S. Supreme Court refuses to hear her case or order the FDA to overturn the ban.
Jan. 1 -- President Clinton asks the FDA to re-examine its import ban.
Sept. 1 -- The Institute of Medicine suggests that an expedited new drug application be submitted to the FDA for the use of RU-486 as a method of early abortion.
14-15 -- Roussel-Uclaf gives the Population Council the U.S. patent rights for RU-486. Clinical trials involving ,100 women begin.
March 16 -- The Population Council submits a drug application to the FDA for RU-486 as an early abortion method.
July 16 -- An advisory arm of the FDA recommends approval of RU-486 as a safe and effective early nonsurgical method of abortion.
Sept. 16 -- The FDA issues an approvable letter for RU-486 for early abortion, when used with misoprostol, a drug that causes uterine contractions to expel the embryo. The letter states that the two-drug combination is safe and effective when used under close medical supervision but notes that additional information is needed on the manufacturing process and labeling before a final decision is made.
Feb. 17 -- A major roadblock The European manufacturer responsible for producing RU-486 in the U.S. cancels its contract with the Population Council -- delaying the drugs introduction in the U.S. indefinitely.
April 17 -- A study in The New England Journal of Medicine shows that RU-486, when used in combination with a type of drug called a prostaglandin (misoprostol), medically terminates % of pregnancies when taken within 4 days of conception.
June 18 -- An amendment to a bill is passed that bans the FDA from using funds to test, develop, or approve any abortion drug.
Sept. 18 -- The Clinton administration opposes the amendment.
Oct. 18 -- The ban is deleted from the bill.
Feb. 000 -- The FDA postpones approval of RU-486 until certain questions about the manufacturing and distribution of the drug are answered.
Sept. 8, 000 -- RU-486 is approved by FDA as a method of early medical abortion.
Feb. 6, 001 (Washington) -- Some Republican lawmakers are once again mounting an effort to restrict the use of the highly controversial abortion pill RU-486.
U.S. Rep. David Vitter, (R-La.), and U.S. Sen. Tim Hutchinson, (R-Ark.), on Tuesday introduced legislation that would require physicians prescribing the drug to have previous experience performing surgical abortions. The bill, similar to one introduced by Hutchinson last year, also would require prescribing physicians to receive special training, be able to read an ultrasound, and be able to admit patients to a nearby hospital.
This bill seeks to ensure that the health of women who take this drug will not be jeopardized due to the improper administration of the drug by an inadequately trained health professional, said Hutchinson at a press conference. I have no doubt that if women were asked whether their doctor should be required to be able to read an ultrasound, handle complications, and get them admitted to the hospital in case of emergency, they would not hesitate to demand those levels of competence.
This legislation is about protecting womens health, Vitter said. Last fall, the Clinton-Gore FDA caved into political pressure from the abortion lobby and hurriedly approved the abortion drug without crucial health protections for those who use it. Our legislation corrects that mistake.
Last September, the FDA approved RU-486, also called mifepristone and sold under the name Mifeprex, under a set of rules most often used for the fast-track approval of drugs to treat life-threatening diseases, such as AIDS. The FDA also proposed, but then abandoned, the set of restrictions outlined in the legislation proposed Tuesday.
But pro-choice forces say the bill is a thinly disguised effort to chip away at womens right to choose.
Claims that this legislation is motivated by a concern for womens health are at best disingenuous, and at worst, dishonest, said Vicki Saporta, executive director of the National Abortion Federation, following the Republican press conference.
Although the FDA considered similar restrictions, the agency subsequently rejected them because they were medically unnecessary and inconsistent with the way medicine is practiced in the U.S., Saporta noted. In addition, she pointed out, the FDA did not abandon all of the proposed restrictions. Doctors prescribing the drug are still required to be able to complete a surgical abortion or at least have access to another qualified surgeon.
Joining the National Abortion Federation in protesting the legislation were several other members of Congress, as well as the National Abortion Rights Action League (NARAL) and Planned Parenthood of America.
But despite warning that this legislation is a serious threat and a signal of the current administrations intention to eventually outlaw abortions, opponents of the legislation predicted that it has little chance of passing the Senate, even if passed by the House, where antiabortion forces enjoy their strongest support.
A lot of members, who might otherwise vote for such things as a ban on partial-birth abortions, have clear trouble with telling the FDA what to do, explained Rep. Rosa DeLauro, (D-Conn.).
And some members of Congress would be deterred from voting for the proposed bill because the drug also is being tested and used for the treatment of breast cancer, brain tumors, and other illnesses, she said.
Since becoming available in November, about 100 abortion clinics have begun offering Mifeprex to patients, according to the National Abortion Federation, which represents approximately 400 clinics nationwide. The drug also is approved in 17 other countries and has been used by more than half a million women in Europe and millions of women in China.
Patients in the U.S. can get Mifeprex only from doctors that have signed an agreement to follow the guidelines set by the FDA. Besides requiring doctors to at least have access to an abortion specialist, those guidelines also require regular checkups to ensure that the treatment worked and that the women who took it did not suffer from excessive bleeding, a complication that occurs in about 1% of patients.
FDA officials say these guidelines were based upon science alone. FDA officials also say the drug was approved under the fast-track process because the use of this mechanism gave the agency the ability to control how the drug is prescribed.
But even the potential defeat of this proposed legislation is unlikely to end the debate surrounding Mifeprexs approval. Besides challenging the drugs safety, opponents of the drug also have raised questions regarding Cytotec, a drug that must be combined with Mifeprex to complete the abortion.
The legislation introduced last year aimed to restrict the use of Mifeprex to specialists, such as ob-gyns, who could perform surgical abortions and treat other complications. The measure failed to pass due in large part to the argument that restricting its use to those specialists would be tantamount to its withdrawal and would discriminate against women in rural areas with limited access to specialists.
But supporters and opponents of Mifeprex agree that its widespread availability would make abortion more accessible and more private because women could then end their pregnancies at home rather than travel to an abortion clinic.
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