Health News Index September/October, 1998

The September/October 1998 edition of the Kaiser Family Foundation/Harvard Health News Index includes questions about major health stories covered in the news, including questions about the Uninsured, Late Term Abortions and Emergency Contraception. The survey is based on a national sample of 1,202 Americans conducted October 10-18, 1998 which measures public knowledge on health stories covered in the news media during the previous month. The Health News Index is designed to help the news media and people in the health field gain a better understanding of which health stories in the news Americans are following and what they understand about those health issues. Every two months, Kaiser/Harvard issues a new index report.

Medicare: Options for Reform, A Public Dialogue on Health Care: The Future of Medicare – (Spanish)

• Report: Medicare: Opciones para la reforma

AIDS. . .A Crisis Among African-American Youth

A BET Teen Summit Town Hall

Produced in partnership with the Kaiser Family Foundation

Why is HIV important to ME?

Many people still think HIV doesn’t affect them. What many people don’t know is that heterosexualsex is the fastest growing way HIV is being transmitted today. And, HIV infections are on the riseamong young people – one in every four Americans newly infected with HIV is under 22 yearsold. Among 13 to 24 year olds, 63% of new HIV infections are among African Americans. Mostimportantly, you can keep yourself healthy, because HIV is preventable.

How is HIV transmitted?

The most common ways that HIV is spread are during vaginal or anal intercourse, and by sharingcontaminated needles. HIV can also be transmitted during oral sex, and during pregnancy orbreastfeeding (from HIV-infected mother to child). The virus is transmitted through body fluidssuch as blood, semen, vaginal fluids and breast milk. Certain factors, such as having a sexuallytransmitted disease (STD) like chlamydia or gonorrhea (which often have no symptoms), canincrease your risk of getting HIV… read on for more info.

What should I do?

PROTECT YOURSELF. Use a condom every time you have vaginal, anal or oral sex. You can’t tellby looking at someone whether or not they are HIV-positive or have other STDs. These diseasescan affect anyone, and many don’t have any visible symptoms. For more information on condomsand protection during oral sex, see below, and “It’s Your (Sex) Life.”If you are injecting drugs, know that using “dirty” – or previously used – needles increases yourchances of acquiring HIV.

GET TESTED. Though getting tested for HIV may seem very scary, if you are HIV-positive, it isimportant to know as soon as possible. Treatments are available today that are effective whenstarted early on. It can take up to six months for HIV to be detectable in your blood, so if you ifyou’ve had unprotected sex within the last six months, you should play it safe and get testedagain after six months have passed. Getting tested by your doctor, nurse or clinic, where you canbe tested for other STDs like herpes and chlamydia at the same time (you have to ask for thesetests, they don’t do them automatically) is probably your best option. There are also home testsavailable in drug stores that allow you to send in an anonymous blood sample for HIV testing.For more information about getting tested for HIV, see below, and check out “It’s Your (Sex) Life.” To find a testing center near you, call the CDC National AIDS Hotline at1-800-342-2437 (AIDS).

What factors increase my risk of getting HIV?

If you have any STD (like herpes, gonorrhea, or chlamydia), the sores or irritation around yourgenitals makes it easier to get infected with HIV. Any rash, like an allergic reaction to spermicide,can cause the same problem. Having sex during a woman’s period is riskier because of the contactwith blood. Blood contains more HIV than any other body fluid. Some people have anal intercourseto avoid pregnancy. This is a common way of getting HIV, because anal sex often causessmall tears or irritation that lets the virus into the body.

What about oral sex?

According to the Centers for Disease Control and Prevention (CDC), it is possible to get HIV duringoral sex. Oral sex often involves semen, vaginal secretions or blood – all fluids that can containHIV. During oral sex, the virus could enter the body through tiny cuts or sores in the mouth. TheCDC recommends you use a condom every time you have oral sex, for both men and women. Fororal sex on a woman, the CDC says you can use Saran Wrap, dental dams (square pieces of latexavailable in some drugstores) or cut open condoms as a barrier between the mouth and the vagina.

Do condoms really work?

Outside of abstinence, condoms are the most effective means of preventing the spread of HIV.But, they must be used correctly. It takes practice to learn how to use a condom the right way.Use a new condom each time you have sex. Use them with water-based lubricants made forcondoms, NOT baby oil, vaseline, or other oily lubricants – these cause condoms to break!After sex, withdraw the penis with the condom ON, carefully, so that it doesn’t leak. Learn howto put on a condom the right way (with latex ring on the outside). If you start to put on a condominside-out, throw it away. You can’t turn it over and use it after it has already touched the penis.Practice with condoms before you have sex, and you will be less nervous, and more likely to usethem correctly! Check out “It’s Your (Sex) Life” for more information.

What about some of the new ways to get tested for HIV?

There are lots of new HIV tests. There are tests you can do at home where you prick your fingerfor blood and mail the sample to a laboratory. This is pretty easy, but these kits are expensive($40-$50)! You have to call a number to get your results or to ask questions. At some clinics,there are rapid HIV tests where you can get results within an hour. The main drawback is thatthese tests may not be as reliable as the other kinds. If you hate needles, there are saliva HIVtests available now. The results still take about two weeks. No matter what kind of test youuse, the best way to get tested for HIV is with a trained counselor to support you. To find atesting center near you, call the CDC National AIDS Hotline at 1-800-342-2437 (AIDS).

What about the new HIV treatments?

There are new treatments that work for many HIV-positive people. New medications have beenable to kill the HIV virus and allow HIV-positive people to live longer, healthier lives. However,these medicines are often difficult to take, and have many side effects. The treatments also dono work for everyone. These treatments (also known as “the cocktail”) have given people morehope that we can fight HIV, but they are not a cure.

Resources for more information on HIV/AIDS

CDC National HIV & AIDS Hotline: 1 800 342 AIDS

This hotline will provide information about HIV/AIDS,answer questions about testing and prevention, and willprovide referrals to callers. They will also send out freeliterature on HIV and AIDS.

National Teenage AIDS Hotline: 1 800 440 TEEN

Fridays and Saturdays, 6 pm to midnight, EST.Sponsored by the American Red Cross, this hotline usesa staff of peer educators to provide information aboutHIV/AIDS and other STDs and to refer callers to othernumbers.

CDC National STD Hotline: 1 800 227 8922

This hotline will answer general questions about STDs,their symptoms, transmission, treatment and testing, andcan also provide referrals to clinics and other hotlines.

Planned Parenthood National Hotline: 1 800 230 PLAN

This hotline will automatically connect you to the PlannedParenthood provider nearest you. Planned Parenthood isa source for contraception, testing for sexually transmittedinfections including HIV, pre-natal and post-natal care,pregnancy options counseling, and adoption referrals.

Fall 1998

• Fact Sheet:

• Report:

This study examines whether the ratings assigned to television shows accurately reflect their content, according to the guidelines developed by the industry. The study analyzes the level and intensity of violence, sex or adult language in a show as well as the context in which it was presented.

This full report is available only in print (Publication #1434). The executive summary and chartpack is available below.

A companion survey of parents views on the TV ratings system, Parents, Children and the Television Ratings System: Two Kaiser Family Foundation Surveys (#1398), is available separately.

• News Release: Major New Study of the V-Chip TV Rating System
• Chart Pack
• Executive Summary

While there has been much attention to the few abortions that occur late in pregnancy, there has been little focus on what options are available during the early weeks, even days, of pregnancy, when most women seek abortions. The drugs mifepristone (also known as RU-486) and misoprostol have been available in France, England, and Sweden for much of the last decade as an earlier medical alternative to surgical abortion. Since becoming available, an estimated one-half million women in Europe have used the drugs to end unintended pregnancies. In the United States, mifepristone, is still undergoing the Food and Drug Administration’s (FDA) approval process, and has been available only to a limited group of women participating in clinical trials.

In this Emerging Issues in Reproductive Health Briefing a panel of experts including Janet Benshoof, JD, President, Center for Reproductive Law and Policy and Beverly Winikoff, MD, Senior Medical associate, the Population Council discussed the availibility of mifeprestone, methotrexate, and other very early methods of abortion in this country, as well as what is currently available, what is on the horizon, who provides these options today, and who is likely to in the future. A companion survey also released at this briefing is available separately as #1431 Two National Surveys: Views of Americans and Health Care Providers on Medical Abortion.

• Fact Sheet
• News Release

New Survey Finds The Public More Worried About Managed Care And More Supportive Of Patient Protection Legislation, But Criticisms Still Register

September 17 1998

Most Say Congress is Playing Politics with Patients Rights in an Election Year

Washington, D.C. – A new survey released today shows that Americans are increasingly concerned about managed care and support for consumer protection proposals has grown. However, criticisms by opponents that regulation will drive up costs and cause employers to drop coverage continue to register with the public. In addition, most people believe that politicians have been using the issue to gain political advantage in an election year, rather than making a serious attempt to pass laws to protect consumers.

The Kaiser/Harvard Survey on Americans’ Views on the Consumer Protection Debate found that since last fall more people are following the managed care debate, and the increased scrutiny has taken a toll on the managed care industry. Compared with previous Kaiser/Harvard surveys, more Americans see managed care plans as doing a “bad job” in serving consumers and worry that their plans are more concerned about profits than about their health care. More people are also reporting that they or someone they know has had problems with their health plans.

In addition, at a time when the public has been wary of “big government” and opponents of managed care regulation have taken to the airwaves, when presented with the arguments for and against regulation, respondents’ support for government involvement to protect consumers in managed care plans has risen from 52 percent in September 1997 to 65 percent.

“The President’s troubles may have sidetracked legislative action for now, but this issue is likely to return to the legislative agenda because the public’s underlying concerns are still there,” said Drew Altman, Ph.D., President of the Kaiser Family Foundation.

Attitudes Towards Health Plans

More Americans now see managed care plans as doing a bad job serving consumers (36 percent, up from 21 percent a year ago) than a good job (30 percent, down from 34 percent). The public also appears to be increasingly worried about how their health plan will treat them, with 33 percent “very” worried that their plan is more interested in saving money than in providing them with the best treatment if they are sick, up from 18 percent just a year ago.

Such worries are most common for those in the most restrictive forms of managed care (43 percent very worried). At the same time, the percentage of those reporting that they or someone they know has had at least one problem with their health plan rose from 48 percent to 57 percent in an eight-month period.

And although managed care issues have been prominent in the news, those who hold unfavorable views continue to report that they base their opinions more on their own experience (37 percent) or the experience of friends and family (35 percent) than on media coverage (18 percent). In fact, 30 percent of Americans report that they or someone they know has had an HMO or other managed care plan deny treatment or payment for something a doctor recommended.

Attitudes Towards Regulation

The number of Americans supporting government regulation of health plans has risen significantly in the past year. When presented with arguments for and against regulation, 65 percent say “government needs to protect consumers from being treated unfairly and not getting the care they need” versus 28 percent who say “additional government regulation is a bad idea and would raise the cost of health insurance.” By comparison, 52 percent responded favorably towards government regulation when presented with this tradeoff in September 1997.

Support has also risen for the most controversial and hotly debated consumer protection measure – the right of consumers to sue their health plans – from 64 percent in December 1997 to 73 percent.

However, as with our earlier surveys, support for consumer protection drops substantially when possible consequences are raised:

• Support for comprehensive consumer protection legislation drops from 78 to 40 percent (with 40 percent opposed) when people are told that it could raise the cost of a typical family health insurance policy by $200 per year (approximately the cost estimated by the Congressional Budget Office for a leading patient protection proposal).
• While an overwhelming majority support specific consumer protection measures, support for these also drop substantially when respondents are presented with criticisms made by opponents that they may get the government too involved in the health care system, raise costs, or cause employers to drop health coverage.

Politics and Patient Rights

When asked how important candidates’ stands on specific issues will be in the upcoming election, 47 percent cited education, 42 percent taxes, and 40 percent Social Security as important factors to their vote. Managed care regulation was cited by 34 percent, as was Medicare, ahead of two other major issues that have been hotly contested by the Congress: tobacco regulation (17 percent) and campaign finance reform (15 percent).

Republicans (77 percent), Democrats (78 percent) and Independents (79 percent) are equally supportive of consumer protection legislation, including controversial measures like allowing consumers to sue health plans. While support for the right to sue plans has increased slightly among Democrats (increasing from 70 percent to 75 percent in eight months), it has increased more significantly among Republicans, rising from 56 percent to 74 percent over the same period.

“Regulation of managed care ranks higher as an issue for the public than others currently being debated by the Congress, such as regulation of tobacco and campaign finance reform,” said Robert J. Blendon, Sc.D., Professor of Health Policy and Political Analysis at Harvard University.

The increasingly combative nature of the managed care debate has also registered with the public. Forty-one percent of those surveyed said they have seen, heard or read television, radio and print ads that are being used by candidates and interest groups to influence the debate. The public is cynical, however, about the motives of elected officials, with 66 percent saying that Members of Congress are using the debate over consumer protection to gain political advantage in an election year, and only 25 percent saying that they are serious about consumer protection.

In terms of trust in handling this issue, the public gives neither party a big edge. However, should the Congress fail to pass consumer protection legislation, those surveyed would be more likely to hold Republicans responsible (35 percent) than Democrats (20 percent). Seventeen percent would blame both parties equally.

Consumer Protection Legislation Generally Includes Five Broad Measures

Proposals before Congress to expand the regulation of health plans include a number of consumer protection measures, including:

• Requiring plans to provide more information to enrollees
• Making it easier for people to obtain coverage for an emergency room visit
• Providing easier access to ob-gyns, pediatricians, and other medical specialists
• Allowing consumers to appeal a health plan’s decision to an independent reviewer
• Giving consumers with employer-sponsored health coverage expanded rights to sue their health plans

Methodology

This Kaiser Family Foundation/Harvard University Survey of Americans’ Views on the Consumer Protection Debate was designed and analyzed by researchers at the Kaiser Family Foundation and Harvard University. The survey was conducted by telephone by Princeton Survey Research Associates with 1,200 adults, 18 years and older, nationwide between August 6 and August 20, 1998. The margin of error is plus or minus 3 percent for the national sample. The margin of sampling error may be higher for some of the sub-sets in this analysis.

Because many people are unsure – or don’t know – what kind of health insurance they have, insured respondents under age 65 in this survey (715 respondents) were asked a series of questions about their health plan to establish what kind of coverage they have. They were asked if they were required to do any of the following by their plan: choose doctors from a list and pay more for doctors not on the list; select a primary care doctor or medical group; and/or obtain a referral before seeing a medical specialist or doctor outside the plan. Respondents were listed as being in “heavy” managed care if they reported their plans had all of the characteristics described above. Respondents were listed as being in “light” managed care if they reported their plans had some but not all of the characteristics listed above. And, respondents were listed as having “traditional” insurance if they reported their plans as having none of the characteristics.

Previous Kaiser/Harvard surveys are cited for the purpose of comparison. They are: the Kaiser/Harvard National Survey of Americans’ Views on Consumer Protections in Managed Care with 1,204 adults (age 18 or older) between December 12-30, 1997 (margin of error plus or minus 3 percent); and the Kaiser/Harvard 1997 National Survey of Americans’ Views on Managed Care with 1,204 adults nationwide between August 22 and September 23, 1997 (margin of error plus or minus 3 percent). Additional comparisons are made with preliminary data from a new Kaiser/Harvard national survey.

The Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries.

Copies of the questionnaire and top line data for the findings reported in this release are available by calling the Kaiser Family Foundation’s publications request line at 1-800-656-4533 (Ask for publication #1438). Also available are the top line data from the Kaiser/Harvard National Survey of Americans’ Views on Consumer Protections in Managed Care (#1356) and the Kaiser/Harvard 1997 National Survey of Americans on Managed Care (#1328).

Return to top

New Survey Finds The Public More Worried About Managed Care And More Supportive Of Patient Protection Legislation, But Criticisms Still RegisterPress Release Survey (PDF Format Only) Chart Pack (PDF Format Only)

Will 1999 Be The Year For Mifepristone (RU-486)?And, An Update on Women’s Other Options for Very Early Abortion

September 16, 1998

Briefing Participants:

Janet Benshoof PresidentCenter for Reproductive Law & Policy120 Wall Street, 18th FloorNew York, NY 10005Press Contact: Margie Kelly212/514-5534

Jacqueline E. Darroch, PhDSenior Vice PresidentThe Alan Guttmacher Institute120 Wall StreetNew York, NY 10005

Vanessa Northington Gamble, MD, PhDAssociate ProfessorHistory of Medicine and Family Medicine, and DirectorCenter for the Study of Race and Ethnicity in MedicineUniversity of Wisconsin-Madison Medical School1300 University AvenueMadison, WI 53706-1532608/265-5996

Elizabeth Newhall, MDPartnerEverywoman’s Health, P.C., and Medical DirectorDowntown Women’s Center401 North Graham, #445Portland, OR 97227503/284-5220

Felicia H. Stewart, MDDirector of Reproductive Health ProgramsKaiser Family Foundation2400 Sand Hill RoadMenlo Park, CA 94025Press Contact: Tina Hoff,650/854-9400, ext. 210

Carolyn Westhoff, MD, MSAssociate Professor of Clinical Obstetrics and Gynecology and Public HealthNew York Presbyterian HospitalColumbia Presbyterian CampusColumbia University630 West 168th Street, Room 16-80New York, NY 10032Press Contact: Karin Eskenazi212/305-5587

Beverly Winikoff, MDSenior Medical AssociateThe Population CouncilOne Dag Hammarskjold PlazaNew York, NY 10017Press Contact: Sandra Waldman212/339-0525

Other Resources:

Mifepristone and Methotrexate Research

Mitchell D. Creinin, MDDirector of Family Planning & Family Planning ResearchDepartment of OB/GYN & Reproductive ScienceUniversity of Pittsburgh School of MedicineMagee-Women’s Hospital300 Halket StreetPittsburgh, PA 15213-3180412/641-1440

David Grimes, MDVice President of Biomedical AffairsFamily Health InternationalPO Box 13950Research Triangle Park, NC 27709-3950919/544-7040

Richard Hausknecht, MDMedical DirectorPlanned Parenthood of New York City208 East 72nd StreetNew York, NY 10021212/369-1116

Mifepristone Clinical Trials

Lawrence LaderPresidentAbortion Rights Mobilization51 Fifth Avenue, 10th FloorNew York, NY 10003212/255-0682

Eric Schaff, MDAssociate ProfessorDepartment of Family MedicineUniversity of Rochester885 South AvenueRochester, NY 14620716/442-7470

Methotrexate Clinical Trials

Michael Burnhill, MDVice President of Medical AffairsPlanned Parenthood Federation of America810 Seventh AvenueNew York, NY 10019-5818Press Contact: Steve Plever212/261-4310

Manual Vacuum Aspiration Research

Paul Blumenthal, MDAssociate ProfessorJHU Department of OB/GYNJohns Hopkins Bay View Medical Center4940 Eastern AvenueBaltimore, MD 21224410/550-0335

Forrest C. Greenslade, PhDPresidentIPASPO Box 100Carrboro, NC 27510919/967-7052

Patients’ Experiences With Medical Abortion

S. Marie Harvey, DrPHCo-DirectorPacific Institute for Women’s Health2999 Overland Avenue, Suite 111Los Angeles, CA 90064310/842-6828

Provider Training

Jodi MageeExecutive DirectorPhysicians for Reproductive Choice & Health1780 Broadway, 10th FloorNew York, NY 10019Press Contact: Ciara Wilson212/765-2322

Vicki SaportaExecutive DirectorNational Abortion Federation1755 Massachusetts, NW, Suite 600Washington, DC 20036Press Contact: Stephanie Mueller202/667-5881

Policy And Politics

Elizabeth CavendishLegal DirectorNational Abortion & Reproductive Rights Action League (NARAL)1156 15th Street, NW, Suite 700Washington, DC 20005202/973-3000

Marie BassProject DirectorReproductive Health Technologies Project1818 N Street, NW, Suite 450Washington, DC 20036202/530-2900

Return to top

Will 1999 Be The Year For Mifepristone (RU-486)?

Press Release Fact Sheet Q&A Resource List

Abortion in the U.S.

• Most abortions in the U.S. today are performed surgically, typically using vacuum aspiration (VA).
• 9 in 10 abortions occur within the first 12 weeks of pregnancy.⁵
• Surgical abortions can be performed as early as pregnancy is first detected, using electric VA or manual vacuum aspiration (MVA).²¹
• Medical abortions are procedures using medications to induce abortion, such as mifepristone (also called RU-486) or methotrexate in combination with misoprostol.

Unintended Pregnancy And Surgical Abortion

• Almost half (49%) of the 6.3 million pregnancies each year are unintended; 54% of unintended pregnancies end in abortion.
• In 1994, there were about 1.43 million abortions in the United States; the abortion rate was 24.2 per 1,000 women aged 15-44.10
• The U.S. abortion rate and the percent of pregnancies ending in abortion have declined slightly but steadily since 1980. Since 1990, all measures of abortion, including the annual incidence, have declined.6
• About 15,000 women have abortions each year because they became pregnant after rape or incest.⁶
• 48% of women 15*44 have at least one unplanned pregnancy sometime in their lives; 28% have one or more unplanned births, 30% have one or more abortions and 11% have both.⁹
• An estimated 43% of women will have an abortion by the time they are 45, given current abortion rates.⁹

Who Has Abortions

• 55% of women having abortions are younger than 25; 33% are aged 20-24 and 22% are teenagers.⁸
• Six in 10 abortions occur to white women; however, their abortion rate is below that of minority women. Black women are nearly 3 times as likely as white women to have an abortion and Hispanic women are about twice as likely.⁸
• Two-thirds of all abortions are to never-married women.⁸

Who Provides Surgical Abortions

• 93% of abortions take place in clinics or doctors’ offices.⁶
• The number of known current abortion providers (hospitals, abortion clinics, family planning clinics that offer surgical services, and physicians’ offices) declined by 8% between 1988 and 1992 (from 2,582 to 2,380).⁶
• In 1992, just 12% of all ob/gyn residency programs provided routine first-trimester abortion training; three in 10 programs offered no first-trimester training.¹²
• According to a national survey of ob/gyns in 1997, 36% of ob/gyns say they “ever perform” surgical abortions.¹⁸

Barriers & Access To Surgical Abortion Services

• 84% of all U.S. counties lacked an abortion provider in 1992.6V52% of all abortion facilities provide services only through the 12th week of pregnancy.⁷
• In 1992, 4 in 10 clinics and physicians’ practices would not perform surgical abortions before 6 weeks since the beginning of a woman’s last menstrual period (LMP). Another quarter of facilities do not perform abortions until even later in pregnancy.⁷
• One-quarter of women who have non-hospital abortions travel at least 50 miles from their home to the abortion facility.⁷
• From 1996 to 1997, the number of arsons doubled and bombings tripled against abortion providers.¹³

Very Early Abortion Methods^3,14,21

Medical Abortion

• Among women participating in the U.S. clinical trials who underwent an abortion within 49 days (7 weeks) LMP, the use of mifepristone (with misoprostol) was 92% effective in terminating pregnancy.¹⁶
• Two percent of women who had a mifepristone abortion 49 days LMP in clinical trials required hospitalization, surgical intervention, and/or intravenous-fluid administration.¹⁶
• Several published studies on the use of methotrexate (with misoprostol) for abortion have found the drug to be up to 96% effective in terminating pregnancy within 63 days LMP.^1,2,4
• Of 178 women who underwent pregnancy termination with methotrexate within 63 days LMP in one study, 7 required surgical intervention.¹
• A review of 12 international published studies conducted between 1979 and 1993 of patient attitudes and reactions to early first-trimester medical abortion found that 60-70% of women chose medical abortion when offered a choice between surgical and medical abortion.¹⁹
• Over 2,000 U.S. women, who had a medical abortion with mifepristone and misoprostol during the U.S. clinical trials (1994-1995), found the method highly acceptable: 96% would recommend it to others, 91% would choose it again and 88% found it very or moderately satisfactory.²⁰

Who Pays For Surgical Abortions

• In 1993, the average amount paid for a non-hospital abortion at 10 weeks was $296; however, the cost ranged from $140 to more than $1,700.⁷
• About 13% of all abortions are paid for with public funds, virtually all of which are state funds. Currently, 16 states pay for all or some abortions for poor women.¹⁵
• In the private sector, over two-thirds of typical fee-for-service and managed care plans routinely cover abortions.¹⁷

Provider & Public Opinion On Medical Abortion

• As of 1997, most providers said they were at least somewhat familiar with mifepristone; fewer were familiar with methotrexate.¹⁸
• About half of all ob/gyns (54%) said they would offer mifepristone abortions if approved in the U.S., including 35% of ob/gyns who do not perform surgical abortions.¹⁸
• Among providers familiar with mifepristone, most said they considered it safe (96% of ob/gyns) and effective (94% of ob/gyns).¹⁸
• As of 1997, 43% of women and 51% of men had heard of either mifepristone or methotrexate; among women who had heard of the methods, 72% knew they could be used to end a pregnancy.¹⁸

References

1. Creinin M, Darney P. “Methotrexate and Misoprostol for Early Abortion.” Contraception. 1993; 48:339-348.

2. Creinin M. “Methotrexate for Abortion at 42 Days Gestation.” Contraception. 1993; 48:519-525.

3. Expanding Options For Early Abortions Packet. Overview and Fact Sheets. Reproductive Health Technologies Project, Washington D.C.: 1998.

4. Hausknecht R. “Methotrexate and Misoprostol to Terminate Early Pregnancy.” The New England Journal of Medicine. 1995;333:537-540.

5. Henshaw S. “Abortion Services in the United States, 1995-1996.” Family Planning Perspectives. (Forthcoming, Nov/Dec 1998).

6. Henshaw S, Van Vort J. “Abortion Services in the United States, 1991 and 1992.” Family Planning Perspectives. 1994; 26:100-106, 112.

7. Henshaw S. “Factors Hindering Access to Abortion Services.” Family Planning Perspectives. 1995; 27:54-59, 87.

8. Henshaw S, Kost K. “Abortion Patients in 1994-1995: Characteristics and Contraceptive Use.” Family Planning Perspectives. 1996; 28:140-147, 158.

9. Henshaw S. “Unintended Pregnancy in the United States.” Family Planning Perspectives. 1998; 30:24-29.

10. “Induced Abortion.” Facts in Brief. Jan. 1997, New York, N.Y. The Alan Guttmacher Institute.

11. Forrest JD. “Timing of Reproductive Life Stages.” Family Planning Perspectives. 1993; 82.

12. MacKay H, Trent MacKay A. “Abortion Training in Obstetrics and Gynecology Residency Programs in the United States, 1991-1992.” Family Planning Perspectives. 1995; 27:112-115.

13. National Abortion Federation Website (http://www.prochoice.org)

14. Schaff E, Eisinger S, Franks P, Kim S. “Methotrexate and Misoprostol for Early Abortion.” Fam Med. 1996;28:198-203.

15. Sollom T, Gold R, Saul R. “Public Funding for Contraceptive, Sterilization and Abortion Services, 1994.” Family Planning Perspectives. 1996; 28:166-173.v

16. Spitz I, Benton L, Bardin W, Robbins A. “The Safety and Efficacy of Early Pregnancy Termination with Mifepristone and Misoprostol: Results from the First Multicenter U.S. Trial.” The New England Journal of Medicine. 1998; 338:1241-1247.

17. Uneven & Unequal: Insurance Coverage and Reproductive Health Services. 1994, New York, N.Y. The Alan Guttmacher Institute.

18. Views of Americans and Health Care Providers on Medical Abortion: What They Know, What They Think, and What They Want.. 1998, Menlo Park, CA. Kaiser Family Foundation.

19. Winikoff B. “Acceptability of Medical Abortion in Early Pregnancy.” Family Planning Perspectives. 1995;27:142-148 & 185.

20. Winikoff B, Ellertson C, Elul B, Sivin I. “Acceptability and Feasibility of Early Pregnancy Termination by Mifepristone-Misoprostol.” Archives of Family Medicine. 1998; 7:360-366.

21. Winkler J, Blumenthal P, Greenslade F. “Early Abortion Services: New Choices for Providers and Women.” Advances in Abortion Care. 1996; 5. Carrboro, NC. IPAS.