NRL News
Page 23
September 2009
Volume 36
Issue 9

Guttmacher Study: Doctors Reluctant to
Add RU486 Abortions to Services
By Randall K. O'Bannon, Ph.D.

When the U.S. government approved RU486 for sale in September 2000, many of the abortifacient’s supporters hoped it would revolutionize the abortion industry. By that they meant that it would expand abortion “access” throughout the country, bring in a whole new generation of abortionists, and help make abortion a more socially accepted part of the medical profession.

Today, nearly a decade after approval, a study by the Guttmacher Institute says that while many abortion clinics are offering the drug and many women are using it, abortion is generally available where it was before, and few doctors are adding chemical abortions to their practices. Guttmacher was formerly affiliated with Planned Parenthood and is still pro-abortion, but its analyses carry much weight.

The study, “Effect of Mifepristone on Abortion Access in the United States” by Guttmacher researchers Lawrence B. Finer and Junhow Wei, appeared in the September 2009 edition of the medical journal Obstetrics & Gynecology. It utilized abortion numbers from Guttmacher’s 2005 survey of abortion clinics along with sales data from Danco, the U.S. distributor of RU486. (“Mifepristone” is the commercial name for RU486.)

Coming from within the abortion establishment, it does not attempt to address the concerns of pro-lifers, such as the impact of RU486 on abortion numbers overall (see sidebar). But it does give a good read on what the industry’s plans were for the abortion pill and how well they think they have achieved those aims.

According to Finer and Wei, the abortion industry pinned high hopes on RU486. Approval brought “expectations that abortion would become more widely accessible and that women would make use of an option that was perceived to be more private, more agreeable to some women, and, because it could be delivered more privately and without surgical facilities, offered by a wider range of providers, such as private obstetrician-gynecologists and family practitioners.”

As might be expected, use did take off when it obtained governmental approval.

Guttmacher’s numbers indicate that about 5,000 abortions were performed with RU486 after the drug went on the market in late 2000, jumping to 55,000 in 2001, the first full year of use. The number aborting with RU486 reached 140,000 in 2004 and then gradually increased to an estimated 158,000 in 2007.

Today, the authors say, RU486 is used in about 14% of all abortions. Looked at another way, 21% of all abortions performed at nine weeks gestation or earlier used RU486.

The number of “providers” prescribing the abortions pills increased correspondingly. Utilizing sales figures from Danco, the U.S. distributor of the drug, Guttmacher’s researchers say that some 208 “providers” purchased RU486 pills in the first two months they became available in 2000, a figure which jumped to 700 in the following year. The number was 887 by 2005, but then dropped to 886 in 2006 before rising to 902 in 2007.

Despite the hopes of the abortion industry that this would bring a lot of private physicians to the ranks of abortionists, about 88% of these chemical abortions are still done in abortion clinics. Most abortions (79%) were performed by those with an Ob-Gyn specialty, though about 11% were performed by family practitioners.

Most of those offering RU486 are clinics also offering surgical abortions, thus likely locations where abortions were being done before the chemical method’s approval. Guttmacher identified 1,787 abortion “providers” in the U.S. in its 2005 survey, with 887, or just under half, offering RU486.

There were 111 sites offering only the RU486 chemical abortions but not surgical abortions. Those might be expected to be the new abortion locations—areas of market expansion. However, the study indicates that few of these were in areas where someone was not already doing surgical abortions. Just 14 were located in some zip code at least 50 miles from a surgical abortion facility.

The authors say that “Our results suggest that mifepristone has not brought a major improvement in the geographic availability of abortion,” adding, “most mifepristone provision occurs among existing surgical abortion providers and the majority of providers who offer only mifepristone are located near surgical providers.”

Finer and Wei speculate that the reason that RU486 use has not taken off more than it has may be the use of the prostaglandin, misoprostol, by itself to induce abortions rather than as the second half of the two-drug RU 486 technique. (Usually, RU486 shuts down the baby’s life support system, starving the child, with the prostaglandin being given days later to stimulate uterine contractions to expel the dead child.)

While misoprostol is much cheaper than RU486, it is not considered to be as “effective” as the combination.

Finer and Wei also wonder whether the low number of family practice physicians taking on the abortion pill has to do with issues of liability coverage, which they say “has been identified as a barrier to provision of abortion services, and mifepristone specifically, in family medicine.”

The authors seem blind to the possibility that most doctors reject RU486 because they don’t want to be associated with abortion, seeing it as inconsistent with their job as healers. They also fail to mention that some doctors may have been discouraged from offering the drug due to the publicity of several deaths associated with use of RU486 (see the NRL factsheet on “Deaths Associated with RU486” at www.nrlc.org/Factsheets/FS15_pilldanger.pdf).

There are RU486 abortionists in nearly every state, with South Dakota being the one exception. The biggest numbers are in the larger states—New York (183), California (155), and Florida (55)—though there are substantial numbers in states that might not be expected, for their size or population, to have so many, e.g., Connecticut (24), Maryland (25), New Jersey (38), North Carolina (19), and Oregon (15).

Finer and Wei suggest that demand for RU486 may rise in the future, noting how usage in other countries gradually increased. France, they note, went from 40% of “eligible abortions” (those abortions at nine weeks or less) in the early 1990s to more than 80% in 2002. In England and Wales, usage in 2007 was 43% after being just 18% five years earlier.

Obvious in all this is the abortion industry’s hope that repackaging their product would enable them to expand sales. Something they failed to consider was that the product, not the packaging, was the problem. Surgical or chemical, abortion still takes a human life, and, thankfully, a lot of doctors still find that distasteful.

Has RU486 Meant More Abortions?

Overall, abortions have declined since RU486 was approved in 2000, dropping from 1,312,990 in that year to 1,206,200 in 2005, the last year for which we have national data. But would there have been a bigger drop without RU486? Difficult to say.

According to Guttmacher, there were 1,819 abortionists in the U.S. in 2000. That number dropped to 1,787 in 2005, a decline of 2%. But Guttmacher says that the decline in abortionists would have been 8% if not for the new doctors adding RU486 to their practices.

How many aborting women would have kept their babies were it not for these new abortionists hocking their wares? No one knows, but there are certainly numbers of women who, skittish about surgery, succumbed to the sales pitch of safe, easy chemical abortions.

If numbers from the study are accurate, growth in the number of RU486 abortions slowed in 2004 and 2005 when news of several deaths associated with the drug surfaced in the media. Though questions about the RU486’s safety (for mothers) still remain, the abortion industry has modified its delivery method and worked hard to rehabilitate the abortifacient’s image. (See “PPFA Claims New RU486 Protocol Helps Avoid Deadly Infections,” page 22.)

Time will tell whether they have been successful and whether the number of both chemical abortions and abortions overall will surge again.