Abor­tion by pre­scrip­tion now ri­vals surgery for US women A turn­ing point for abor­tion in United States

Kuwait Times - - HEALTH & SCIENCE - NEW YORK: Game changer Var­ied ac­cess

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 pri­vately-held 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, North Dakota.

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. The de­cline has been driven in part by wider use of birth con­trol, in­clud­ing long last­ing IUDs. In March, the US Food and Drug Ad­min­is­tra­tion changed its pre­scrib­ing guide­lines for med­i­ca­tion abor­tion. The agency now al­lows the pills to be pre­scribed as far as 10 weeks into preg­nancy, up from seven. It cut the num­ber of re­quired med­i­cal vis­its and al­lowed trained pro­fes­sion­als other than physi­cians, in­clud­ing nurse prac­ti­tion­ers, to dis­pense the pills. It also changed dos­ing guide­lines.

The changes were sup­ported by years of pre­scrib­ing data and re­flect prac­tices al­ready com­mon in most states where doc­tors are free to pre­scribe as they deem best. Ohio, Texas and North Dakota took the un­usual step of re­quir­ing physi­cians to strictly ad­here to the orig­i­nal guide­lines. Many abor­tion providers were re­luc­tant to pre­scribe the pills un­der the older guide­lines, which no longer re­flected cur­rent med­i­cal knowl­edge, said Vicki Sa­porta, Pres­i­dent and CEO of the Na­tional Abor­tion Fed­er­a­tion.

Ran­dall K O’Ban­non, a di­rec­tor at the anti-abor­tion Na­tional Right to Life or­ga­ni­za­tion, crit­i­cized the new guide­lines but said his or­ga­ni­za­tion had no plans to fight them. “What they did was make it more prof­itable,” O’Ban­non said. “It will in­crease the pool of po­ten­tial cus­tomers.” Planned Par­ent­hood said both types of abor­tion typ­i­cally cost from $300 to $1,000, in­clud­ing tests and ex­am­i­na­tions. The group charges a slid­ing fee based on a pa­tient’s abil­ity to pay, re­gard­less of which type of abor­tion they choose.

De­spite a land­mark US Supreme Court rul­ing that abor­tion is a wo­man’s right, ac­cess varies widely by state. Some states main­tain re­stric­tions on both sur­gi­cal and med­i­ca­tion abor­tions; oth­ers have worked to in­crease ac­cess. In ru­ral Iowa, where clin­ics are few and far be­tween, Planned Par­ent­hood is us­ing video con­fer­enc­ing, known as telemedicine, to ex­pand ac­cess. The way it works is, a wo­man is ex­am­ined in her com­mu­nity by a trained med­i­cal pro­fes­sional, who checks vi­tal signs and blood pres­sure and per­forms an ul­tra­sound. The in­for­ma­tion is sent to an off­site doc­tor, who talks with the wo­man via video con­fer­ence and au­tho­rizes the medications. Since the telemedicine pro­gram be­gan in Iowa in 2008, med­i­ca­tion abor­tions in­creased to 64 per­cent of all preg­nancy ter­mi­na­tions, the high­est US rate.

In New York, Hawaii, Wash­ing­ton and Ore­gon, a pri­vate re­search in­sti­tute, Gy­nu­ity Health Pro­jects, works with clin­ics to send abor­tion pills by mail to pre­screened women. “Med­i­ca­tion abor­tion is def­i­nitely the next fron­tier,” said Glo­ria Tot­ten, pres­i­dent of the Pub­lic Lead­er­ship In­sti­tute, a non­profit that ad­vises ad­vo­cates. And in Mary­land and At­lanta, the non­profit or­ga­ni­za­tion Carafem opened cen­ters in the last 18 months that of­fer birth con­trol and med­i­ca­tion, but not sur­gi­cal, abor­tions. It pro­motes its ser­vices with ads that read: “Abor­tion. Yeah, we do that.” —Reuters

COLORADO: Don­ald Trump sup­porter Mary Ce­leste Madrid stands by her car, in Pue­blo, Colo. A long­time Demo­crat and Obama voter who changed her reg­is­tra­tion to Repub­li­can last year over the GOP’s sup­port for gun rights and op­po­si­tion to abor­tion, Madrid says she’s also had to en­dure fam­ily bat­tles over her sup­port for Trump. —AP

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