US women shift abor­tion pref­er­ences


Amer­i­can women are end­ing preg­nan­cies with med­i­ca­tion al­most as of­ten as with surgery, mark­ing a turn­ing point for abor­tion in the United States, data re­viewed by Reuters shows.

The water­shed comes amid an over­all de­cline in abor­tion, a choice that re­mains po­lit­i­cally charged in the United States, spark­ing a fiery ex­change in the fi­nal de­bate be­tween pres­i­den­tial nom­i­nees Hil­lary Clin­ton and Donald Trump.

When the two med­i­ca­tions used to in­duce abor­tion won US ap­proval 16 years ago, the method was ex­pected to quickly over­take the sur­gi­cal op­tion, as it has in much of Europe. But US abor­tion op­po­nents per­suaded law­mak­ers in many states to put re­stric­tions on their use.

Although many lim­i­ta­tions re­main, in­no­va­tive dis­pens­ing ef­forts in some states, re­stricted ac­cess to sur­gi­cal abor­tions in oth­ers and greater aware­ness boosted med­i­ca­tion abor­tions to 43 per­cent of preg­nancy ter­mi­na­tions at Planned Par­ent­hood clin­ics, the na­tion’s sin­gle largest provider, in 2014, up from 35 per­cent in 2010, ac­cord­ing to pre­vi­ously un­re­ported fig­ures from the non­profit.

The na­tional rate is likely even higher now be­cause of new fed­eral pre­scrib­ing guide­lines that took ef­fect in March. In three states most im­pacted by that change — Ohio, Texas and North Dakota — de­mand for med­i­ca­tion abor­tions tripled in the last sev­eral months to as much as 30 per­cent of all pro­ce­dures in some clin­ics, ac­cord­ing to data gath­ered by Reuters from clin­ics, state health de­part­ments and Planned Par­ent­hood af­fil­i­ates.

Among states with few or no re­stric­tions, med­i­ca­tion abor­tions com­prise a greater share, up to 55 per­cent in Michi­gan and 64 per­cent in Iowa.

Denise Hill, an Ohio mother who works full time and is pur­su­ing a col­lege de­gree, is part of the shift.

Hill, 26, be­came ex­tremely ill with her third preg­nancy, side­lined by low blood pres­sure that made it chal­leng­ing to care for her son and daugh­ter. In July, eight weeks in, she said she made the dif­fi­cult de­ci­sion to have a med­i­ca­tion abor­tion. She called the op­tion that was not avail­able in her state four months ear­lier “a bless­ing”.

The new pre­scrib­ing guide­lines were sought by pri­vate­ly­held Danco Lab­o­ra­to­ries, the sole maker of the pills for the US mar­ket. Spokes­woman Abby Long said sales have since surged to the ex­tent that med­i­ca­tion abor­tion now is “a sec­ond op­tion and fairly equal” to the sur­gi­cal pro­ce­dure.

“We have been grow­ing steadily year over year, and def­i­nitely the growth is larger this year,” Long said.

Women who ask for the med­i­ca­tion pre­fer it be­cause they can end a preg­nancy at home, with a part­ner, in a man­ner more like a mis­car­riage, said Tammi Krom­e­naker, di­rec­tor of the Red River Women’s Clinic in Fargo.

Med­i­ca­tion abor­tion in­volves two drugs, taken over a day or two. The first, mifepri­s­tone, blocks the preg­nancy sus­tain­ing hor­mone pro­ges­terone. The sec­ond, miso­pros­tol, in­duces uter­ine con­trac­tions. Stud­ies have shown med­i­cal abor­tions are ef­fec­tive up to 95 per­cent of the time.

Ap­proved in France in 1988, the abor­tion pill was sup­posed to be a game changer, a con­ve­nient and pri­vate way to end preg­nancy. In West­ern Europe, med­i­ca­tion abor­tion is more com­mon, ac­count­ing for 91 per­cent of preg­nancy ter­mi­na­tions in Fin­land, the high­est rate, fol­lowed by Scot­land at 80 per­cent, ac­cord­ing to the Guttmacher In­sti­tute, a non­profit re­search or­ga­ni­za­tion that sup­ports abor­tion rights.

In the United States, pro­po­nents had hoped the med­i­ca­tion would al­low women to avoid the clin­ics that had long been tar­gets of protests and some­times vi­o­lence.

But Planned Par­ent­hood and other clin­ics re­main key venues for the med­i­ca­tion op­tion. Of the more than 2.75 mil­lion US women who have used abor­tion pills since they were ap­proved in 2000, at least 1 mil­lion got them at Planned Par­ent­hood.

Many pri­vate physi­cians have avoided pre­scrib­ing the pills, in part out of con­cern that it would ex­pose their prac­tices to the type of protests clin­ics ex­pe­ri­enced, say doc­tors, abor­tion providers and health­care or­ga­ni­za­tions.

At the same time, the over­all US abor­tion rate has dropped to a low of 16.9 ter­mi­na­tions per 1,000 women aged 15-44 in 2011, down from 19.4 per 1,000 in 2008, ac­cord­ing to fed­eral data.

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