Original research articleCan mifepristone medication abortion be successfully integrated into medical practices that do not offer surgical abortion?
Introduction
Freestanding abortion clinics provide the overwhelming majority of medication and surgical abortions in the United States [1]. Mifepristone was approved by the Federal Drug Administration (FDA) in 2000 for medication abortion of pregnancies up to 49 days estimated gestational age (EGA). Evidence-based regimens soon expanded eligibility to 63 days EGA [2] and offered home administration of misoprostol [3]. Proponents of improved access to abortion services hoped that the availability of a medication regimen could expand access to abortion care by facilitating the provision of early abortion care by physicians who did not have the technical skills or desire to offer uterine aspiration for abortion in their offices. As 87% of counties in the United States lack an abortion provider [4], the introduction of medication abortion into primary care could increase access to early abortion. Women could receive abortion care from the personal physician with whom they have an established relationship. The option of home administration of misoprostol provides privacy in a familiar, comfortable environment and is associated with a high level of patient satisfaction [5].
The feasibility of providing medication abortion in medical offices that do not offer surgical abortion services has not been determined. Studies have demonstrated high satisfaction rates with both medication and uterine aspiration abortion [6], [7]. Approximately 60% of women present for abortion care before 9 weeks gestational age when they are eligible for mifepristone [8], although fewer than 15% of eligible women have a medication abortion [9]. If most women choose uterine aspiration, then initial evaluation in offices that offer uterine aspiration abortion may be preferable. Medication abortion at Planned Parenthood clinics nationally increased from an average of 9% of early abortions in 2001 to 24% in 2004 [10].
Medication abortion was introduced into three University of New Mexico (UNM) Family Medicine and Obstetrics/Gynecology residency clinics in 2002. These clinics did not offer uterine aspiration abortion [11]. We integrated abortion services into our residency clinics to improve resident and medical student training and to mainstream abortion care with the aim of modeling incorporation of abortion services into residents' future practices. Residents received additional training in surgical abortion and medication abortion at freestanding abortion clinics in Albuquerque as well as the medication abortion training at the University residency clinics. Abortion training is part of the required residency rotations at UNM, although residents can “opt out” for religious or philosophical reasons. The primary purpose of this study was to determine the proportion of women presenting for pregnancy options counseling who were eligible for and chose medication abortion in a clinic setting that only offered medication abortion. A secondary goal was to assess the feasibility of offering medication abortion in our university residency clinic setting.
Section snippets
Methods
A retrospective chart review was performed of all women referred to the University of New Mexico Family Medicine and Obstetrics/Gynecology clinics for pregnancy options counseling from July 2002 to September 2005. The University of New Mexico Human Research Review Committee approved the study.
Prior to the introduction of medication abortion in July 2002, UNM patients requesting abortion care were referred to outside facilities. Women were generally informed prior to the appointment that we
Results
During the study period, 220 women presented for options counseling (Fig. 1). Age distribution, parity and gestational age at the time of the clinic visit are presented in Table 1. Of the 220 women, 204 (93%) were eligible for medication abortion based on EGA of ≤63 days. One hundred seventy-three (85%) of the 204 eligible women and 176 (80%) of all 220 women who received counseling chose medication abortion. Three women underwent medication abortion beyond 63 days EGA; two at 64 days and one
Discussion
The major finding of the study was that the majority of patients presenting to our clinics for options counseling were eligible for and chose medication abortion for pregnancy termination. Uterine aspiration was easily accessible at several freestanding clinics within 5 miles of the UNM clinics and could usually be arranged for the same or next day as the options counseling appointment at UNM. UNM Family Medicine and obstetrician/gynecologist resident physicians train at each of these
Acknowledgment
The authors thank Betty Skipper PhD for statistical analysis and consultation. There was no external funding support for this work.
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