Mifepristone for early medical abortion: experiences in France, Great Britain and Sweden - Special Report

Perspectives on Sexual and Reproductive Health, May-June, 2002 by Rachel K. Jones, Stanley K. Henshaw

Cost Affects Access to Medical Abortion

While cost is often a minor factor in European women's choice between medical and surgical abortion, it is an important issue for many providers and affects their willingness to offer the method. Private physicians in France receive greater compensation for surgical abortion than for medical abortion, relative to the staff time involved, and are less likely to offer the latter. In Scotland and certain areas of England, where early medical abortion costs less to provide than surgical abortion, providers are encouraged to adopt a protocol that emphasizes the use of medical rather than surgical abortion during the first 7-9 weeks of pregnancy. While this increases access to medical abortion, it may do so by reducing access to the surgical option.

Costs to both patients and providers are likely to affect medical abortion services in the United States. Preliminary reports suggest that a majority of NAF members charge more for medical abortion than for surgical. (64) The higher cost is reported to be a product of the expense of the drug and the extra time spent in counseling and follow-up. This may restrict accessibility of medical abortion in the United States, because a majority of women pay out of pocket. (65) Home administration of misoprostol, lower doses of mifepristone, * an increasing role of lower-cost midlevel practitioners and coverage of mifepristone by Medicaid and several large insurance plans suggest that cost may become less of an obstacle in the coming years.

CONCLUSION

The European experience suggests that early medical abortions can be safely performed at later gestations and under simpler protocols than the one approved by the FDA, and that acceptance of mifepristone by both providers and women will continue to increase in the United States for a number of years. Mifepristone has the potential to make it less difficult for women to access abortion services, particularly if large numbers of physicians who do not currently offer surgical abortion start providing medical abortion services. While not all women prefer medical to surgical abortions, providing women the choice between the methods will increase satisfaction levels among women obtaining abortions. Finally, as knowledge of mifepristone abortion increases among women, they may seek abortion at earlier gestations to ensure that they are eligible for the procedure. Hence, the availability of medical abortion may lead to an increase in the proportion of all abortions that are performed at earlier gestations.

Acknowledgments

The authors thank the following people for providing valuable information about medical abortion in Europe: Joeri van den Bergh, Nicolas Brouard, Christian Fiala, Clas Hedberg, Anne Furedi, Kristina Gemzell Danielsson, Mika Gissler, Danielle Hassoun, Katarina Lindahl, Christina Rorbye, John Romo and Kajsa Sundstrom. They also thank Talcott Camp, Charlotte Ellertson, Jenny Higgins, James Trussell and Beverly Winikoff for reading earlier versions of this report and providing comments. The research on which this article is based was supported by a grant from The David and Lucile Packard Foundation.