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 The watershed comes amid an overall decline in abortion, a choice
that remains politically charged in the United States, sparking a
fiery exchange in the final debate between presidential nominees
Hillary Clinton and Donald Trump.
When the two medications used to induce abortion won U.S. approval
16 years ago, the method was expected to quickly overtake the
surgical option, as it has in much of Europe. But U.S. abortion
opponents persuaded lawmakers in many states to put restrictions on
their use.
Although many limitations remain, innovative dispensing efforts in
some states, restricted access to surgical abortions in others and
greater awareness boosted medication abortions to 43 percent of
pregnancy terminations at Planned Parenthood clinics, the nation's
single largest provider, in 2014, up from 35 percent in 2010,
according to previously unreported figures from the nonprofit.
The national rate is likely even higher now because of new federal
prescribing guidelines that took effect in March. In three states
most impacted by that change - Ohio, Texas and North Dakota - demand
for medication abortions tripled in the last several months to as
much as 30 percent of all procedures in some clinics, according to
data gathered by Reuters from clinics, state health departments and
Planned Parenthood affiliates.
Among states with few or no restrictions, medication abortions
comprise a greater share, up to 55 percent in Michigan and 64
percent in Iowa.
Denise Hill, an Ohio mother who works full time and is pursuing a
college degree, is part of the shift.
Hill, 26, became extremely ill with her third pregnancy, sidelined
by low blood pressure that made it challenging to care for her son
and daughter. In July, eight weeks in, she said she made the
difficult decision to have a medication abortion. She called the
option that was not available in her state four months earlier "a
blessing."
The new prescribing guidelines were sought by privately-held Danco
Laboratories, the sole maker of the pills for the U.S. market.
Spokeswoman Abby Long said sales have since surged to the extent
that medication abortion now is "a second option and fairly equal"
to the surgical procedure.
"We have been growing steadily year over year, and definitely the
growth is larger this year," Long said.
Women who ask for the medication prefer it because they can end a
pregnancy at home, with a partner, in a manner more like a
miscarriage, said Tammi Kromenaker, director of the Red River
Women's Clinic in Fargo, North Dakota.
GAME CHANGER
Medication abortion involves two drugs, taken over a day or two. The
first, mifepristone, blocks the pregnancy sustaining hormone
progesterone. The second, misoprostol, induces uterine contractions.
Studies have shown medical abortions are effective up to 95 percent
of the time.
Approved in France in 1988, the abortion pill was supposed to be a
game changer, a convenient and private way to end pregnancy. In
Western Europe, medication abortion is more common, accounting for
91 percent of pregnancy terminations in Finland, the highest rate,
followed by Scotland at 80 percent, according to the Guttmacher
Institute, a nonprofit research organization that supports abortion
rights.
In the United States, proponents had hoped the medication would
allow women to avoid the clinics that had long been targets of
protests and sometimes violence.
But Planned Parenthood and other clinics remain key venues for the
medication option. Of the more than 2.75 million U.S. women who have
used abortion pills since they were approved in 2000, at least 1
million got them at Planned Parenthood.
Many private physicians have avoided prescribing the pills, in part
out of concern that it would expose their practices to the type of
protests clinics experienced, say doctors, abortion providers and
healthcare organizations.
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At the same time, the overall U.S. abortion rate has dropped to a
low of 16.9 terminations per 1,000 women aged 15-44 in 2011, down
from 19.4 per 1,000 in 2008, according to federal data. The decline
has been driven in part by wider use of birth control, including
long lasting IUDs.
In March, the U.S. Food and Drug Administration changed its
prescribing guidelines for medication abortion. The agency now
allows the pills to be prescribed as far as 10 weeks into pregnancy,
up from seven. It cut the number of required medical visits and
allowed trained professionals other than physicians, including nurse
practitioners, to dispense the pills. It also changed dosing
guidelines.
The changes were supported by years of prescribing data and reflect
practices already common in most states where doctors are free to
prescribe as they deem best.
Ohio, Texas and North Dakota took the unusual step of requiring
physicians to strictly adhere to the original guidelines. Many
abortion providers were reluctant to prescribe the pills under the
older guidelines, which no longer reflected current medical
knowledge, said Vicki Saporta, President and CEO of the National
Abortion Federation.
Randall K. O'Bannon, a director at the anti-abortion National Right
to Life organization, criticized the new guidelines but said his
organization had no plans to fight them.
"What they did was make it more profitable," O'Bannon said. "It will
increase the pool of potential customers."
Planned Parenthood said both types of abortion typically cost from
$300 to $1,000, including tests and examinations. The group charges
a sliding fee based on a patient's ability to pay, regardless of
which type of abortion they choose.
VARIED ACCESS
Despite a landmark U.S. Supreme Court ruling that abortion is a
woman's right, access varies widely by state. Some states maintain
restrictions on both surgical and medication abortions; others have
worked to increase access.
In rural Iowa, where clinics are few and far between, Planned
Parenthood is using video conferencing, known as telemedicine, to
expand access.
The way it works is, a woman is examined in her community by a
trained medical professional, who checks vital signs and blood
pressure and performs an ultrasound. The information is sent to an
off-site doctor, who talks with the woman via video conference and
authorizes the medications.
Since the telemedicine program began in Iowa in 2008, medication
abortions increased to 64 percent of all pregnancy terminations, the
highest U.S. rate.
In New York, Hawaii, Washington and Oregon, a private research
institute, Gynuity Health Projects, works with clinics to send
abortion pills by mail to pre-screened women.
"Medication abortion is definitely the next frontier," said Gloria
Totten, president of the Public Leadership Institute, a nonprofit
that advises advocates.
And in Maryland and Atlanta, the nonprofit organization Carafem
opened centers in the last 18 months that offer birth control and
medication, but not surgical, abortions. It promotes its services
with ads that read: "Abortion. Yeah, we do that."
(Reporting By Jilian Mincer; Editing by Michele Gershberg and Lisa
Girion)
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