Wednesday, October 31, 2001

Cost deters those who would use abortion pill, doctors say
By Ruth Padawer
Knight-Ridder Tribune

HACKENSACK, N.J. — When the federal government approved the abortion pill one year ago, the drug’s supporters predicted it would revolutionize the way women ended their pregnancies — and temper the intensity of the public debate.

But a new national survey finds that only 6 percent of gynecologists and 1 percent of family practice physicians use mifepristone, known commonly as RU-486.

“People thought all these doctors were going to come out of the woodwork to offer the pill,” said Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers, which represents 160 clinics. “It hasn’t happened.”

One New Jersey abortion provider said only 5 percent of his patients who are eligible for the method opt for it.

Forty percent of surveyed doctors said they “personally oppose” the use of the drug.

Of the remainder, half said their decision not to offer it was based on concerns about protests or violence. The survey of 790 doctors was conducted by the Kaiser Family Foundation, a non-profit healthcare research group.

Prior to Food and Drug Administration approval of mifepristone on Sept. 28, 2000, 44 percent of gynecologists and 31 percent of family practice physicians told Kaiser they would be at least “somewhat likely” to prescribe the abortion pills if they became available.

They were drawn to the drug’s advantages: the fact that it didn’t require anesthesia or surgery, it offered privacy, and it mimicked a natural miscarriage, prompting bleeding over the course of nine to 16 days.

In addition, mifepristone allows a woman to end her pregnancy right after discovering it, instead of having to wait until her sixth week for surgical abortion.

Abortion rights supporters hoped that the enthusiasm for the drug would swell the ranks of abortion providers at a time when the number nationwide was plummeting.

But the more familiar doctors became with the drug’s financial, procedural and political hurdles, the less enamored of it they were.

Even among the 27 percent of gynecologists nationwide who already offer surgical abortion, many who had expected to use mifepristone have since backed away from it. In large part, that’s because few anticipated the drug’s manufacturer would charge as much as it does for the three-pill regimen: $270.

“The medication cost alone is so high, and when you add the physician fee and the cost of ultrasound, the price was prohibitive,” said one New Jersey abortion provider who had planned to offer it. “Once we presented it to our patients, they all said no.”

The protocol for patients using mifepristone requires them to visit their doctor three times in two weeks. In the 5 percent to 8 percent of cases when it doesn’t work, a surgical abortion is necessary.

Another New Jersey gynecologist has offered the 600-milligram regimen of mifepristone for the past eight months — at double the price of an early surgical abortion, which averages about $300. Patients favor it for many reasons, though few end up using it.

“They want to avoid anesthesia, and they want to have the abortion in the confines of their own home,” he said. “Lots of other women want that method, too, but they can’t afford it.”

Many clinics around the country have slashed the price of a mifepristone abortion by using a 200-milligram dosage instead of the 600-milligram approved by the FDA.

But many physicians are uncomfortable deviating from FDA protocol, because the agency has threatened to deny the drug to any doctors who fail to follow the stringent rules it set last September.

For their part, antiabortion activists are delighted with the drug’s lackluster showing.
“Pro-lifers haven’t had to change their practice in the last year,” said John Tomicki, head of the League of American Families in Ringwood, N.J. “Those who feel it is their calling to be at clinics, offering alternatives, are still at those clinics. We’re not aware of any new places to go to protest.”