Abortion drug up against misinformation, report says.

Byline: GREG BOLT The Register-Guard

Lack of knowledge and bureaucratic barriers have kept the abortion drug RU-486 from living up to its promise of making medical abortions more easily available to a larger number of women, according to a new report co-authored by a University of Oregon researcher.

The report calls for a national campaign to educate policy-makers and the public on the medical abortion option and increase the number of health care providers who offer the procedure. It also calls for eliminating regulations that have slowed its availability to patients.

In the two years since the U.S. Food and Drug Administration approved RU-486, known by the generic name mifepristone, accurate information on the drug hasn't reached the general public and "many misconceptions and gaps in understanding about medical abortion persist," the report states.

It also says anti-abortion activists have sought to discourage or prevent medical providers from offering the option, using many of the same tactics used to oppose surgical abortion.

"It appears that there are still major obstacles to overcome before this method will actually increase abortion access for underserved women," said Marie Harvey, a professor of public health at the UO and director of the Research Program on Women's Health at the university's Center for the Study of Women in Society. "There's still a lot to be done to help (health care) providers incorporate this into their practices."

Harvey is the lead author of the report, titled "Understanding Medical Abortion: Policy, Politics and Women's Health." Her co-authors are Christy Sherman of the Oregon Research Institute, public health professor Sheryl Thorburn Bird of Oregon State University, and research assistant Jocelyn Warren.

Harvey said the study's conclusions weren't surprising, given that mifepristone has been available for only two years. In Europe, where the drug has been in use for 20 years, it took a decade before it was widely available, and that in a culture where abortion is far less controversial than in America, she said.

"I wasn't totally surprised," she said. "The goal was to put the data together in hopes of educating and maybe helping things move forward faster."

The report's release Monday came just two days before the 30th anniversary of the controversial Roe vs. Wade decision, in which the U.S. Supreme Court affirmed a woman's right to an abortion. Harvey said the report wasn't written with the anniversary in mind, but they later arranged a concurrent release when it became apparent the work could be completed in time.

Mifepristone is the first alternative to surgical abortion for women who want to terminate a pregnancy. Because it is non-invasive - patients take two drugs that cause the uterus to expel a fertilized egg - it offers women an FDA-approved alternative that has been found safe and effective.

Mifepristone also can be taken as soon as pregnancy is confirmed, while patients must wait at least six weeks into a pregnancy before a surgical abortion. Also, the report indicates both patients and physicians find it an acceptable alternative.

Pro-choice supporters hope that mifepristone will make abortions more widely available because it requires less specialized equipment and training and can be dispensed at a doctor's office instead of at an abortion clinic.

The report notes that 85 percent of the counties in the United States have no abortion provider, even though current trends indicate that 43 percent of the women in this country will have had an abortion by age 45.

Abortions opponents vigorously fought FDA approval of mifepristone, claiming the drug can be dangerous and wasn't adequately tested. They continue to push for laws that restrict how it is dispensed.

The report rebuts the claims and says numerous studies both in the United States and in Europe have shown the drug to be safe and effective.

Medical abortions - those induced by a prescription drug - do have drawbacks. For patients, they require three visits to a doctor instead of two in a surgical abortion. For doctors, the procedure means additional staff training and insurance implications and still requires a surgical backup for rare cases in which an abortion must be ended surgically.

The study didn't try to determine how often mifepristone is currently used, but Harvey said it still lags well behind surgical abortion.

Kitty Piercy, public affairs director for Planned Parenthood in Eugene, said no local providers currently offer medical abortions. That's partly because of the bureaucratic requirements for offering the procedure and partly because of the controversial nature of abortions and mifepristone, which took 12 years to gain FDA approval.

Also, public awareness of the drug is low and a number of misconceptions remain. Harvey noted that some people still confuse mifepristone with the "morning-after pill," an emergency contraceptive that can prevent pregnancy from occurring. Mifepristone is only used after a pregnancy is established.

The report calls for building public awareness of the medical evidence on mifepristone and another drug used to induce abortions, methotrexate, and reducing the barriers that discourage doctors from offering the procedure.

It recommends allowing physician assistants and nurse practitioners to dispense the drug, encouraging family practitioners and gynecologists to offer it, and fighting restrictions that complicate abortion access, such as informed consent laws.

"I think eventually it will be part of the medical mainstream," Harvey said. "I know that a number of physicians are happy to have this because many, like family practitioners who do reproductive health, would like to provide abortion services to their patients rather than having to refer them out.

"I do think it will increase over time and become an accepted procedure."