As I had expected, though the clinical aspects of medication abortion were quite simple, the social aspects were not. New providers also had to deal with protestors, as it became clear that one could not inform one’s patients of this new service without protestors finding out. Also, those primary care providers who only planned to offer a few abortions each month found that the costs of malpractice, the cumbersome procedure the FDA established for offering the drug, and the need to comply with various state regulations (such as parental notification or consent) made incorporating medical abortion into one’s practice appear just too burdensome.
I'm not sure chemical abortions will ever really be as popular as surgical abortions.
In France, about half of abortions are chemical procedures. One thing this author overlooks (or fails to mention) is that abortion is a poorly paid procedure there. Numerous public abortion facilities have closed in that country because abortion does not pay the bills. It's far cheaper to send women home with abortion pills than to have a surgical centre.
Chemical abortions are the cheap abortions. All you need is a nurse to hand you the first dose, and then send you home with the rest of the prescription and you come back for a check up.
And there being cheap is, in my opinion, the reason they are preferred in Europe (or at least France) but not in the US.
The reason I say they are cheap doesn't necessarily have to do with the overhead. I am also talking about the actual quality of the experience. If you go into a decent abortion clinic for a surgical abortion, you get out in about two hours. Your abortion is done in five minutes. A nurse might hold your hand. If something goes wrong, medical professionals are on hand to assist you. You are the centre of attention and the presence of medical experts reduces the likelihood of physical problems or bad experiences. It's an efficient way to deal with your problem and potential consequences, and it's relatively not unpleasant.
But with chemical abortions, you go home, by yourself, to bleed for a couple of days. For those who have never had a miscarriage, it hurts worse than a regular period and the bloodflow is heavier. And I had mine very early. I shudder to think of nulliparous women having abortions at 7 or 8 weeks of pregnancy. Now, as you are bleeding, life doesn't stop. Children must be fed, housework completed, etc. True, you do get adequate. You probably have to take time off your job for a few days--I can't imagine a woman working through that kind of bloodflow or pain.
And this is besides the experience of passing clots and possibly seeing your dead unborn child. And the side effects: nausea, vomitting, chills.
And then you have to return for your follow up. What a pain!
Chemical abortions can be started earlier than surgical abortions, but they are not an efficient way to carry out the objective of terminating a pregnancy. And the woman is on her own to deal with her abortion, with no on hand access to medical expertise. The medical side of the equation does not have to invest as much involvement in the abortion, and on the woman's side, this unpleasant experience is drawn out.
This is what makes them cheap to me (as compared to surgical abortion), and I suspect to many others.
Who wants to spend three days bleeding when you can have it over in two hours?
Abortion pays relatively well in the US. So abortionists are going to
give women what they want.Which is a quicker, less unpleasant abortion. When abortion pay starts to be decrease to the point that it's not so financially attractive (especially considering the stigma), I suspect that more chemical abortions will be offered, as fewer doctors will offer to do abortions, and chemical abortions will seem like the viable alternative (sorry for the pun!).
