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

In Europe, however, there have not been problems related to follow-up visits. Estimates from regular practice (as opposed to clinical trials) in Europe show that the proportion of women not making follow-up visits after medical abortion ranges from 10% in France to 20% in Scotland. (51) Notably, in France, the proportion of follow-up visits women miss for surgical abortion is larger than that for medical abortion, (52) probably because the importance of return visits is stressed more strongly for medical abortion patients.

WOMEN'S CHOICE OF MEDICAL ABORTION

A woman's decision to choose medical abortion depends, in part, on the options available to her. For women in Great Britain and, to a lesser extent, in France, the choice of the type of early abortion is often between medical abortion and vacuum aspiration under general anesthesia. Women who do not want to be unconscious during the procedure or do not want to risk undergoing general anesthesia may see medical abortion as a more desirable alternative. In Sweden, women often can choose between medical abortion and vacuum aspiration with either local or general anesthesia.

In European countries, cost plays a small role in women's choice of abortion method. National health insurance or national health systems cover all or most of the cost of abortion services in Sweden and France, regardless of whether the provider is a public or private facility or physician. In Sweden, the cost to the patient for either medical or surgical abortion is no more than US $30. (53) In France, most women pay 20% of the charge for medical and surgical abortions, and health insurance covers the rest. Because of the cost of the drugs and staff time involved, the charge for medical abortion is slightly higher than that for surgical abortion, and it usually is not enough to compensate for the relatively greater staff time and drug costs required for medical abortion. Providers receive only slightly higher reimbursement for medical than for surgical abortion. However, the out-of-pocket price difference of approximately $10 usually is not enough to limit women's choice. Women who access abortion services from private providers must pay the full charge and apply for reimbursement through health insurance, which they usually receive within a month.

Health insurance coverage varies more in Great Britain than in the other countries. In 2000, NHS paid for 98% of all abortions in Scotland, but for 75% of all abortions in England and Wales. (54) In Great Britain, services are free at NHS facilities and, for some clients, at nonprofit clinics under contract with NHS. Regional health authorities are responsible for allocating health service funds, and in some areas of England and Wales, abortion services have low priority. Long waiting lists at some NHS hospitals lead many women in England and Wales to turn to non-NHS facilities for abortion services. Though many procedures in non-NHS facilities are paid for by the state health system, approximately 50% of women obtaining abortions at these facilities (and 25% of all women obtaining abortions) pay for the services themselves because NHS-funded services are unavailable or inconvenient. (55) For these women, price may affect the choice of method. BPAS clinics charge approximately $378 for medical or surgical abortion, while clinics run by Marie Stopes charge $499 for medical abortion and $463 for surgical abortion.