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Many Rural Women Lack Access to Abortions

From the WebMD Archives

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 pregnancy."

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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 write prescriptions.

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 drugs.

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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.

Of those who did not offer abortions, nearly 70% of the physicians in ob/gyn and family medicine practices listed community opposition as a reason, and 65% listed personal moral objections.

Of the 459 respondents who said they would not prescribe abortion drugs, 45% cited moral objections and 20% cited inadequate training, information, or support. But a fourth of the rural physicians indicated they would consider providing medical, rather than surgical, abortions.

"I think it's wonderful that someone has had the courage and responsiveness to examine this issue, in preparation for a time when RU-486 may become more widely available," Roger Rochat, MD, visiting professor in the department of epidemiology at Emory University's Rollins School of Public Health in Atlanta, tells WebMD.

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"But also, she's examining the generic problem of abortion services. I'm amazed that so many people think that abortion and family planning are widely available in the U.S., and yet it's very clear that people have difficulty getting access to both of them -- and with abortion, even more so," says Rochat, who was not involved in the study.

As with midwives who perform deliveries, nurse practitioners or physician assistants should be allowed to prescribe abortion medications only if there is professional medical support, Rochat says. "There's going to be that rare event ... where you need physician backup."

Vital Information:

  • A study in Washington state has found that few rural health care providers are providing abortions, with many citing community opposition and personal moral objection.
  • But many providers indicated they might be willing to offer the abortion pill, known as RU-486, if it is approved by the FDA.
  • Among nurse practitioner and physician assistants, who are allowed to prescribe medications in some states, there was also a clear interest in providing the abortion pill to patients.
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