Almost a year after the controversial "abortion pill" became available in the Tampa Bay area, the alternative to surgery has proved effective but rarely the first choice for women seeking to end a pregnancy.
Less than one in five such patients took the drug RU-486, or mifepristone, since it was distributed to area medical clinics early this year. Food and Drug Administration approval for its use in the United States took a decade, and people on both sides of the abortion issue predicted that RU-486 would inflame the volatile debate.
Instead, RU-486's introduction appears to be measured. And relatively calm.
"I've been very pleased with the numbers, and the number of patients asking about it. I think for a new procedure, it has had a pretty good beginning," says Barbara Zdravecky, president and chief executive officer of Planned Parenthood of Southwest and Central Florida.
Mifepristone, sold under the brand name Mifeprex, is available at approximately two-thirds of Planned Parenthood's health centers nationwide, where about 5,000 women used the drug this year. More than 30 took it at the Sarasota clinic, the only one of six Planned Parenthood facilities in southwest and central Florida that performs abortions.
"As people's base of knowledge gets better, I expect the numbers to go up," as is typical of any new procedure or medication, Zdravecky says.
Privately owned clinics reported similar percentages. At Tampa Women's Health Center, about one-fifth of the women seeking abortions chose RU-486 over surgery, says registered nurse Susan Moore.
"The patients who use it love it. I remember only two complaints, one for pain (due to cramping) and one for continued bleeding," Moore says. A surgical abortion was required in the latter case to remove remaining tissue, she says.
No complications were reported by Planned Parenthood other than normal cramping and nausea.
One fatality occurred in Canada, attributed to a resultant bacterial infection.
RU-486 has been prescribed for years in Europe and cleared FDA review in the United States on Sept. 28, 2000. Those who wanted the drug available here contend that it will improve access to abortion: Physicians can more easily administer a pill than do surgery.
Opponents say a pill will make abortion rates, which have declined for a decade, soar. Its side effects are more serious than stated, says Randall O'Bannon, director of education at the National Right to Life Committee in Washington, D.C.
"You lose more blood in the procedure than you do in a surgical operation," O'Bannon says.
"This is something that operates after the embryo has already implanted in the uterine wall," he says. "They're trying to change the image of abortion, and it's the same old product."
Most physicians took a wait-and-see stance on RU-486, continuing to refer patients seeking abortions to other providers. Women's clinics perform 70 to 90 percent of all abortions in the United States.
Only 6 percent of gynecologists and 1 percent of general practitioners offered mifepristone, according to a survey by the Kaiser Family Foundation released Sept. 24. In comparison, surgical abortions are performed by about 27 percent of gynecologists and 1 percent of general practitioners.
Availability of the pill appeared secondary to most women, who cited cost and convenience as most important in seeking services, say those who counsel them.
"By the time you tell patients (RU-486) requires three visits, I think they think surgery is easier," Moore says.
"RU-486 (becomes) just one option."
Mifepristone works by stopping production of progesterone, the hormone necessary for an embryo to develop on the uterine wall. The pill is taken orally at the doctor's office. Two days later at home, the patient takes another drug, misoprostol, to initiate contractions. The embryo is expelled within four to 10 hours.
There are several reasons a woman might choose surgery over the less invasive, self-administered pill:
Cost: At most clinics, surgery is less expensive, about $325, than the pill, which costs about $425. At Planned Parenthood in Sarasota, the cost of each is $375, Zdravecky says, "to ensure no one is forced to make a decision based on economics."
Convenience: Surgery requires only minutes and one followup visit three weeks later. If a woman uses RU-486, at least three office visits are necessary. A mifepristone pill is taken at the doctor's office, and the woman returns two days later to confirm that the pregnancy is terminated. If not, four misoprostol pills are prescribed, to be inserted vaginally by the woman at home. An additional doctor's visit is required to confirm.
Timing: RU-486 must be taken within three weeks of a missed period, so a woman must be quickly aware that she is pregnant and decide what to do.
Effectiveness: Area clinics report the effectiveness of RU-486 at more than 90 percent, or about the same as surgery. If abortion fails to occur after taking the pill, surgery is required.
Privacy: With the pill, the abortion occurs at home, not in a doctor's office. But many women viewed a surgical procedure as more private because it is over quickly. "We have a lot of women who don't want (the father) to know," Moore says.
In declining to prescribe the pill, surveyed physicians cited lack of demand from patients, their own lack of interest in providing abortions and concerns about protests or violence.
RU-486 is no "miracle pill," says O'Bannon. "A lot of doctors had second thoughts."
As doctors and patients become more comfortable with the drug's performance and safety, Zdravecky says, the use of RU-486 is likely to increase.