Although legalized a decade or more ago in several European countries, medical abortion (mifepristone, or RU-486) has only recently been integrated as a method of abortion, according to "Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden," by Rachel K. Jones and Stanley K. Henshaw. The report, published in the May/June 2002 issue of Perspectives on Sexual and Reproductive Health, finds that many factors impede the initial acceptance of medical abortion, but once accepted, use of mifepristone has gradually increased and continues to do so.
In France, Scotland and Sweden, more than half of eligible early abortions are performed using mifepristone--56% in France, 61% in Scotland and 51% in Sweden. In each country, since mifepristone was introduced, women have started obtaining abortions earlier in pregnancy. Further, although the proportion of early abortions involving mifepristone has increased steadily each year since its introduction, there is no evidence that the availability of mifepristone has resulted in more women in these countries having abortions.
Many factors impeded the initial acceptance of mifepristone in Europe, and may delay its acceptance in the United States:
• It takes time to adopt regulations and protocols appropriate to the new technology.
• Limited funding for abortion services and bureaucratic inertia may discourage abortion providers from adopting new techniques.
• Because medical abortions are restricted to the first few weeks of pregnancy, delays in accessing services reduce the number of women eligible for the method.
• Providers' lack of experience with the method may result in a medical culture that does not encourage providers to offer the option, or to inform patients of its availability.
Different countries have adopted varying protocols with regards to dosage and gestational limits, indicating that the protocols can be flexible in order to improve the method's availability and accessibility. Most European women are required to administer the second drug at a medial facility, and although this restriction is being reconsidered, at present it is one way that European protocols are less flexible than the one used by most providers in the United States. Under all protocols, a medical abortion can be initiated as soon as a pregnancy is confirmed, allowing women to have an abortion earlier than surgical abortions are provided in some settings.
The Food and Drug Administration approved mifepristone for use in medical abortion in the United States in September, 2000. If the European experience is any indication, it could take a decade or longer for mifepristone to be fully recognized and integrated in this country. Indeed, many of the obstacles that impeded medical abortion's acceptance in Europe--particularly cost barriers and delays caused by mandatory waiting periods--are equally, if not more, evident in the United States. However, the European experience suggests that these obstacles can be overcome and that as a result, women will be able to access abortion services more easily and earlier in pregnancy.
Also in the May/June 2002 issue of Perspectives on Sexual and Reproductive Health:
• "Friendships and Early Relationships: Links to Sexual Initiation Among American Adolescents Born to Young Mothers," by Elizabeth C. Cooksey et al.
• "Employment and the Sexual and Reproductive Behavior of Female Adolescents," by Lauren M. Rich and Sun-Bin Kim
• "Contraceptive Method Switching in the United States," by William R. Grady et al.
• Research Note: "Predictors of Contraceptive Discontinuation in a Sexually Transmitted Disease Clinic Population," by Karen C. Ramstrom et al. and
• Viewpoint: "How Can Pharmacies Improve Access to Emergency Contraception," by Jane E. Boggess
COMING SOON:
• October: new data on the characteristics of women having abortions in the United States
• December: new data on U.S. abortion patients' contraceptive use
• January: new data on trends and barriers to abortion in the United States