Original research articleMedical abortion practices: a survey of National Abortion Federation members in the United States
Introduction
Abortion is one of the most common medical procedures obtained by women in the United States (US) [1], with most occurring in the first trimester. Vacuum aspiration abortion has been the method of choice for first-trimester pregnancy termination since the 1960s [2]. In September 2000, the US Food and Drug Administration (FDA) approved mifepristone, an antiprogestin, for use with misoprostol (a prostaglandin) in early medical abortion, providing a nonsurgical alternative to women seeking pregnancy termination [1], [2]. Since the approval of mifepristone in France and China in 1988, 37 additional countries around the world have approved this alternative abortion method [3]. Studies by the Guttmacher Institute suggest that integration of mifepristone regimens into first-trimester abortion practice took a decade or longer to occur in several European countries [4], [5]. Mifepristone is not available in Canada, where evidence-based use of methotrexate is still the most common method of medical abortion.
Understanding how US facilities incorporated mifepristone medical abortion into existing services has important implications, given the potential for medical abortion to improve access to abortion procedures. Few data exist on medical abortion provision in the US shortly after legalization of mifepristone. We therefore surveyed member facilities of the National Abortion Federation (NAF), the professional and educational organization of abortion providers in North America, on medical abortion practice in 2001.
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Materials and methods
The methods of the study have been described previously [6]. Briefly, we mailed self-administered questionnaires about abortion practice, including medical abortion practice, to all active member facilities of NAF in 2002. A similar survey on first-trimester surgical abortion practices had been conducted in 1997 [7]; questions about medical abortion practice were added to the new survey. The total population of recipients consisted of 364 facilities in the US, Canada and Australia. Of those who
Results
Eighty-three percent (208/218) of the facilities offering medical abortion reported actually providing medical abortions in 2001. These facilities provided an estimated total of 28,400 medical abortions in 2001.
Discussion
US NAF member facilities rapidly adopted mifepristone with misoprostol regimens after mifepristone was approved by the FDA in September 2000. Eighty-seven percent of facilities offered medical abortion in 2001, all but two of which offered mifepristone with misoprostol regimens. This finding suggests that alternatives to surgical aspiration abortion and to previously used medical abortion regimens with methotrexate were welcomed. At the same time, use of methotrexate regimens among NAF
Acknowledgments
We would like to acknowledge Vicki Saporta and Beth Kruse of the National Abortion Federation, Lynne Randall of Planned Parenthood Federation of America, Richard Hausknecht, Susan Dudley, Larry Finer and Stanley Henshaw. We are grateful to all of the participating NAF member facilities, their staff and providers for taking the time to complete these surveys. Financial support was provided by an anonymous foundation.
References (23)
- et al.
Second trimester surgical abortion practices: a survey of National Abortion Federation members
Contraception
(2008) - et al.
First trimester surgical abortion practices: a survey of National Abortion Federation members
Contraception
(2001) - et al.
Abortion with mifepristone and misoprostol: regimens, efficacy, acceptability and future directions
Am J Obstet Gynecol
(2000) - et al.
Methotrexate and misoprostol for early abortion
Contraception
(1993) Medical abortion regimens: historical context and overview
Am J Obstet Gynecol
(2000)- et al.
Can mifepristone medical abortion be simplified? A review of the evidence and questions for future research
Contraception
(2007) - et al.
Clinicians' perception of sonogram indication for mifepristone abortion up to 63 days
Contraception
(2002) - et al.
Clinical utility of urine pregnancy assays to determine medical abortion outcome is limited
Contraception
(2007) - et al.
Medical abortion outcomes after a second dose of misoprostol for persistent gestational sac
Contraception
(2008) - et al.
Abortion in the United States: incidence and access to services, 2005
Perspect Sex Reprod Health
(2008)
Medical methods for first trimester abortion
Cochrane Database Syst Rev
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