September 28th, 2010 marks the ten-year anniversary of the date on which the U.S. Food and Drug Administration (FDA) approved the use of the abortion drug mifepristone (in combination with a second drug, misoprostol) as an alternative to surgical abortion for terminating early pregnancies. This method is not related to emergency contraception, which like all contraceptive methods prevents a pregnancy from occuring in the first place.
The Guttmacher Institute notes that in the decade since, use of early medication abortion has expanded substantially, with growing numbers of providers offering the service, and a growing number of women choosing medication abortion over surgical abortion for early termination of pregnancy.
Nearly half of pregnancies among American women are unintended, and 40 percent of all unintended pregnancies are terminated by abortion. Twenty-two percent of all (intended and unintended) pregnancies (excluding miscarriages) end in abortion.
The earlier in an unintended pregnancy an abortion occurs, the safer and less costly it is. Medication abortion is only appropriate for unintended and untenable pregnancies up to nine weeks. Availability of medication abortion has meant that an increasing share of abortions are early, and an increasing share of early abortions are done before six weeks or before nine weeks.
According to Guttmacher, the number of providers offering them increased dramatically between 2000 and 2007, and the number of medication abortions specifically increased even as the total number of abortions performed in the United States declined. In 2007, 158,000 medication abortions were performed using mifepristone, accounting for an estimated 21 percent of all eligible abortions (those performed prior to nine weeks’ gestation) that year. A Guttmacher Update states:
Although the introduction of mifepristone did not increase the overall incidence of abortion, it does appear to have contributed to a change in the timing of women’s abortions. A larger proportion of abortions take place at earlier gestations than they did before the drug was introduced. The Centers for Disease Control and Prevention report that although the proportion of women obtaining abortions in the first trimester has remained stable, the proportion of abortions obtained at nine weeks’ gestation or earlier has increased, as has the proportion obtained within six weeks’ gestation.
Use of mifepristone appears to have continued growing between 10 and 15 percent annually since 2007.
Yet the full potential of mifepristone to ensure access to all women in need of abortion has yet to be reached. “While many in the reproductive health field believed approval of mifepristone would expand access to abortion services, particularly in rural areas, that has not happened to any significant extent,” said Dr. Lawrence B. Finer of Guttmacher.
“Instead, almost a decade later, we find that women in areas that already had access to abortion now have the choice between a medication or a surgical abortion. But for most women who were not easily able to access an abortion provider before mifepristone became available, services remain difficult to obtain.”
Still researchers note that mifepristone has become an integral part of abortion service provision in the United States, and suggest that this percentage may continue to increase, pointing data indicating continued growth in the United States and to the widespread use of the method in France and England, where 80 percent and 43 percent of eligible abortions, respectively, are performed using mifepristone.