The Guttmacher Institute released new research that shows the abortion pill (mifepristone, still known by some folks as RU-486) hasn't broadened abortion access in the United States. One of the reasons that feminists worked so hard to get the FDA to approve mifepristone is that they hoped it would be a way for your average OB/GYN to discreetly provide abortions. That it would, in essence, make it impossible for anti-choicers to protest women who were seeking abortions, because they would have to protest outside every clinic and doctor's office. However, Guttmacher found,
Most mifepristone abortions were performed at or near facilities thatalso provided surgical abortion. Only five mifepristone-only providersof 10 or more abortions were located farther than 50 miles from anysurgical provider of 400 or more abortions.
There are a lot of reasons for this. As I wrote last year,
The requirements for being a provider of medical abortion and a provider of surgical abortion are actually very, very similar. Insurance premiums still go up when doctors decide to start providing medical abortion. Also, those doctors still have to get proper training in how to perform a surgical abortion, in case the drugs don't work. When I researched this issue awhile ago, for a story about how mifepristone has affected abortion politics, most people I talked to said the number of ob/gyns and other doctors who became providers of medical abortion (but not other methods) were very small. (Mostly for the insurance and training reasons named above, but also because of the stigma attached. Word gets around in small towns, even if you are only dispensing pills.)
The Guttmacher study won't come as a surprise to those working in the field. In 2006, I interviewed Beth Jordan, the medical director of the Association of Reproductive Health Professionals, who described the incredibly high barriers to providing the abortion pill -- basically, doctors need to perform an ultrasound to determine a woman is, in fact, pregnant and need to have the ability to perform a surgical abortion in case the pills do not work. So there is a training barrier. "If we're seeing trends that the drug is not being picked up," Jordan told me, "there are some real on the ground tactical obstacles."
And despite feminists' wishes, the pill did not reduce the stigma and threats that come with being an abortion provider -- especially in more conservative parts of the country. Karen Kubby, with the Emma Goldman Clinic in Iowa City, Iowa, told me, "It was scary for many people to think of being an abortion provider, even quietly and for your own cadre of clients. Especially because of the harassment."
Increasing numbers of women who seek abortions are choosing mifepristone (a development I have mixed feelings about). But much to the dismay of feminists and women's health advocates who thought the abortion pill would change the landscape of abortion politics, the pill is no silver bullet.
--Ann Friedman
