Prior to FDA approval in 2000, mifepristone for medication abortion was described as having the potential to change the nature of abortion provision in the United States. There was an expectation that abortion would become more easily accessible, particularly in rural areas without a surgical abortion provider. But new research published in the September 2009 issue of Obstetrics & Gynecology suggests that, although use of mifepristone has become widespread and has contributed to the shift toward earlier abortions, its use has not improved women’s geographic access to abortion services.

“Effect of Mifepristone on Abortion Access in the United States,” by Lawrence B. Finer and Junhow Wei of the Guttmacher Institute, found that both the number of medication abortions and the number of providers offering mifepristone increased dramatically between 2000 and 2007, even as the total number of abortions performed in the United States declined steadily over this period. In 2007, 902 providers performed 158,000 mifepristone abortions, which represented an estimated 21% of eligible abortions performed that year. However, the authors also found that most medication abortions were performed at or near facilities that also provided surgical abortions.

“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. Finer. “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.”

Mifepristone has become an integral part of abortion service provision in the United States, accounting for about one-fifth of very early abortions. The authors suggest that this percentage may continue to increase, pointing to preliminary 2008 figures indicating continued growth and to the widespread use of the method in France and England, where 80% and 43% of eligible abortions, respectively, are performed using mifepristone.