Many Rural Women Lack Access to Abortions
June 2, 2000 -- As the FDA continues to weigh a final decision
on whether to approve U.S. sales of the French abortion pill RU-486, a study
indicates that women living in rural areas of the country still do not have
easy access to abortions.
Although reproductive health care is widely available in rural
Washington, few providers in rural areas of the state are performing either
surgical abortions or medical abortions (those achieved with the morning-after
pill or drugs), says Sharon A. Dobie, MCP, MD, author of the study published in
the American Journal of Public Health. "The primary reasons are ...
consistent with those cited in other states: community opposition and personal
moral objections," says Dobie, an assistant professor of family medicine at
the University of Washington in Seattle.
"There's a real paucity of providers who do surgical
termination of pregnancy -- traditional abortion," Dobie tells WebMD.
"However, we found a pretty significant willingness among all providers in
learning more about and possibly providing medical termination of
Dobie also found a "clear interest" among nurse
practitioners and physician assistants in providing this type of abortion. In
Washington and several other states, these health care providers are allowed to
Over the last decade, Dobie has kept an eye on reproductive
health care in Washington. "Surprisingly, we found that the scope of
services is quite broad, that many providers are not just family physicians and
ob/gyns but also general surgeons, primary care internists, pediatricians in
addition to nurse practitioners and physician assistants," Dobie tells
WebMD. But "increasingly, obtaining pregnancy terminations in the rural
part of the state has become very difficult. Most women travel to the urban
areas to obtain terminations."
For this current study, Dobie says, she was interested in
talking to the providers rather than just looking at statistical information.
She said she wanted to find out "who is doing what in the realm of
reproductive health care, including contraceptive care, basic primary care,
obstetrics, gynecology, the higher technology -- and then looking at who
provides pregnancy termination."
Her study focused on responses to a questionnaire mailed to
1,135 licensed health care providers -- including physicians, midwives, nurse
practitioners, and physician assistants -- in rural or semi-rural areas. The
questionnaire asked about reproductive health services they provided, whether
they performed abortions, and any reasons for not performing abortions. The
survey also asked whether they would be willing to prescribe oral abortion
Of the 707 providers who responded, only 1.2% reported that
they performed first-trimester abortions. These eight providers (five men and
three women) had been in practice an average of 19 years and devoted most of
their practices to women's reproductive health care. Seven were family
physicians or obstetrician-gynecologists, says Dobie.