Oct. 6, 2000 -- In the days following the approval last week of the abortion pill, RU-486, many already are pondering the possible impact of an option other than the usual one, surgical abortion. Indeed, women who wish to end a pregnancy now have another choice, but how likely is it that they will be able to find a doctor willing to offer it to them?
In the first of three scheduled presidential debates this week, Texas Gov. George W. Bush said he feared the decision to approve RU-486 -- which will be sold as Mifeprex -- would lead to more abortions. But most experts predict doctors already performing surgical abortions will make up the large majority who will soon use the pill method, also known as a medical abortion.
"Medical abortion is much more difficult to provide [than surgical abortion]," says Mitchell Creinin, MD, who has been performing medical abortions for more than seven years in research studies. Unlike surgical abortion, which requires only one visit, a medical abortion requires three. It also requires a lot of counseling, sometimes at an additional visit, because of the lengthy explanation about the procedure and its alternatives.
For those reasons and other burdens placed on doctors, Creinin, an associate professor and director of family planning at the University of Pittsburgh, tells WebMD, "you are not going to see as many women in the U.S. seeking out this alternative as you have perhaps in other countries. Women in the U.S. are more interested in something that is going to be done and over with."
The National Abortion Federation (NAF) is doing much of the training of doctors that will be needed for them to use Mifeprex. Vicki Saporta, executive director of NAF, tells WebMD that 1,800 health care providers have been trained in the use of what they are terming "the early option pill." Saporta confirms that while some doctors not currently providing abortion have gone through the training, most have been physicians who are already providing abortions. Currently, the vast majority of all abortions are performed in abortion clinics as opposed to private doctors' offices.
In addition to the extra training that is needed, another reason fewer individual ob-gyns or women's health care providers may be interested in learning about or offering pill-induced abortions is that many state laws have strict criteria that anyone providing abortions must follow. These include registering as an abortion provider or being licensed as one and making sure their offices comply with often bizarre regulations that stipulate everything from the size of the hallways to the flow of air through the office.
Many states also have strict laws about how the fetal tissue resulting from the abortion can be disposed of, and whether it must be examined. Some pill-induced abortions will occur after the woman leaves the doctor's office or clinic, and in some states, women who don't bring the remains of the abortion to their doctor put the doctor at risk for prosecution. Abortion clinics know these things, but experts say individual doctors probably have no clue about the obstacle course of medical and legal issues they will have to negotiate to offer abortion via a pill.
Another thing doctors may not welcome or be ready for is becoming a target for anti-abortion protesters. Some groups already are threatening to publicize the names of doctors willing to perform medical abortions and picket their offices.
Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers, says his group has heard from plenty of interested people, but says "the phone isn't exactly ringing off the hook," with doctors saying they definitely want to provide pill-induced abortions in their office.
"It's a good option," Fitzsimmons says. "But it's not the revolution that some people have predicted."