Elsevier

Contraception

Volume 78, Issue 6, December 2008, Pages 486-491
Contraception

Original research article
Medical abortion practices: a survey of National Abortion Federation members in the United States

https://doi.org/10.1016/j.contraception.2008.07.015Get rights and content

Abstract

Background

Little is known about clinical implementation of medical abortion in the United States following approval of mifepristone as an abortifacient by the Food and Drug Administration (FDA) in 2000. We collected information regarding medical abortion practices of National Abortion Federation (NAF) members for the year 2001.

Methods

Questionnaires were mailed to 337 active US NAF member facilities.

Results

A total of 258 facilities responded (77%); 252 nonhospital facilities were included in the analysis. Most of these facilities (87%) offered medical abortion in 2001, providing an estimated 28,400 medical abortions, approximately 52% of medical abortions in the US that year. Over 75% began offering mifepristone/misoprostol abortions within 5 months of the start of mifepristone distribution. Almost all (99%) reported using mifepristone/misoprostol regimens, with most offering one or more evidence-based alternative regimens (83%); a few (4%) used the FDA-approved regimen.

Conclusion

After FDA approval of mifepristone, NAF member facilities rapidly adopted evidence-based mifepristone/misoprostol regimens.

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.

Section snippets

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.

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