Reactions to medical abortion among providers of surgical abortion: An early snapshot

Medical abortion has the potential to expand US women's access to pregnancy termination, especially in areas that lack surgical providers. Exploratory interviews conducted in 1996 with 25 long-term providers of surgical abortion offered a "snapshot" of an early moment in the adoption of medical abortion techniques in the US. 20 of these providers already had experience with methotrexate and/or mifepristone. Overall, the interviews suggested that innovation in the area of abortifacient agents is likely to proceed slowly and cautiously, despite their high degrees of efficacy and safety. Although providers were committed to providing women a full range of abortion alternatives, they indicated that medical abortion demands substantial modifications in office routines. For example, counseling medical abortion patients requires twice the time as talking to a surgical abortion patient. The need for ultrasound to size very early pregnancies and ensure the abortion has been completed restricts provision to physicians with access to this technology. The requirement of ultrasound and multiple office visits makes medical abortion more costly than the surgical approach. Continued expansion in the ranks of medical abortion providers is dependent upon factors such as the ultimate status of mifepristone in terms of US Food and Drug Administration approval and appropriate manufacturing and distribution arrangements, clarification of whether misoprostol insertion must be performed in a physician's office, the willingness of managed care insurance plans to cover this alternative, and the response of US anti-abortion organizations.