Guttmacher Study: Doctors Reluctant to
Add RU486 Abortions to Services
Randall K. O'Bannon, Ph.D.
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.
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
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.)
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.
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.”
be expected, use did take off when it obtained governmental
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.
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.
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.
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.
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.
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.
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.”
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.)
misoprostol is much cheaper than RU486, it is not considered to be
as “effective” as the combination.
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
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
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
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
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.
Meant More Abortions?
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.
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.
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.
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.)
tell whether they have been successful and whether the number of
both chemical abortions and abortions overall will surge again.