Medical abortion and the potential for new abortion providers: a cautionary tale

The prochoice movement has expressed much hope that medical abortion will increase the pool of abortion providers because it does not require surgical training and does not need to be performed in specialized settings. By offering a detailed case study of the events surrounding a methotrexate abortion in a rural community health center by a family practice physician who had not previously performed surgical abortion, this article suggests that the diffusion of medical abortion to new providers and new settings may be more complex than some have suggested. The article illustrates that abortion is not only a medical procedure, but also a social process involving relations with large, often unfriendly bureaucracies as well as with the local community in which the abortion takes place. While still retaining optimism that medical abortion will ultimately increase the number of providers and hence increase access to abortion, the author believes that such a change will be considerably more gradual than commonly thought.