Medical abortion in social context

Early medical abortion regimens, especially those that include mifepristone, have the potential to reshape the landscape of abortion provision in the United States. Because medical abortion does not require surgical training, it may attract new providers of abortion services from a variety of specialties, including advanced practice clinicians. The diffusion of abortion services into myriad clinical and office-based settings may reduce the violence that has been associated with abortion provision. However, a number of factors may slow the spread of medical abortion, at least initially. These factors include the need for accurate means to date early pregnancies, the need to arrange backup surgical services for the small number of patients who require them, the obligation to conform to existing legal mandates governing surgical abortion, and possible difficulties negotiating appropriate malpractice coverage and reimbursement. Educational initiatives are needed to help clinicians to overcome these barriers and to actualize mifepristone’s potential in women’s health care. (Am J Obstet Gynecol 2000;183:S10-S15.)