On September 28, 2000, 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. In the decade since, use of early medication abortion has expanded substantially, with growing numbers of providers offering the service, and its approval has given many women a choice between medication or a surgical procedure when seeking an early abortion.
Both the number of medication abortions and the number of providers offering them increased dramatically between 2000 and 2007, 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% of all eligible abortions (those performed prior to nine weeks’ gestation) that year. Preliminary figures suggest use of mifepristone has continued to grow 10–15% annually since 2007.
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.
Prior to FDA approval, medication abortion was described as having the potential to change the nature of abortion provision in the United States. Abortion was expected to become more broadly available, particularly in rural areas without a surgical abortion provider. However, Guttmacher research published last year found that while use of mifepristone has become widespread—and has contributed to the shift toward earlier abortions—it has not substantially improved women’s geographic access to abortion services. Most medication abortions are provided at or near facilities that already offered surgical abortions.
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