Now, a Choice for Women --and a Choice for Doctors

Dr. Richard Roberts is one of only a few physicians in Belleville, Wis., a dairy farming community of 1,500. He is a family practice doctor, meaning that he does just about everything--treating sniffles, delivering babies, caring for the dying. He even makes house calls.

But he has never performed an abortion. He prefers to send his patients north to Madison, 20 miles away, where other doctors are willing to do the surgery.

For Roberts and other physicians, the government’s decision to approve RU-486, the two-drug regimen known as the “abortion pill,” creates a difficult and painful tug of war between personal feelings about abortion and professional obligations to patients.

“It does make it upfront and personal,” Roberts said. “Until now, I’ve been saved from having to make that decision. This is going to make it harder.”

Despite his dilemma, he said, he leans toward offering the medication if his patients request it. “When you are a family doctor, you are always engaged with the total care of the patient,” he said.

Throughout the years-long debate over RU-486, its advocates have predicted that the drug would change abortion in this country dramatically, increasing its availability both by providing an alternative to surgery and by broadening access to women who do not now have it.

No one expects surgical abortions to end, because there are distinct disadvantages to using the abortion drugs. They include cramping and bleeding, followed later by what amounts to a miscarriage away from the doctor’s office. And, unlike surgical abortion, which usually involves a single visit to a doctor’s office, taking the drugs will require at least three doctor’s visits.

Nevertheless, experts believe that the licensing of RU-486 eventually will increase the number of health care providers who become involved in terminating pregnancies because the option will appeal to many women.

Moreover, there are indications that even doctors who do not perform abortions will join the ranks of those who offer the drugs.

The Menlo Park-based Kaiser Family Foundation conducted a survey earlier this year of obstetricians/gynecologists and family practice physicians to determine how likely they would be to offer the abortion drugs, if approved by the Food and Drug Administration: 44% said they would be likely to offer the pills. Of those, nearly one-third do not now perform surgical abortions.

The FDA’s decision “presents the opportunity to make abortion what it always should have been: a part of mainstream, primary care medicine,” said Eric Schaff, a family practice physician in Rochester, N.Y., who has studied the drugs. “Women will now be able to get the full range of reproductive care through their family doctors.”

But no one expects these changes to occur overnight. Rather, they likely will develop gradually over years, as more and more health professionals become comfortable offering the drugs.

The only caveat that could limit its appeal, at least at first, is the agency’s requirement that a doctor using the drugs be trained to operate in the rare event that surgical abortion is needed to finish the job--or that he or she makes advance arrangements with a doctor who is.

“If you are not comfortable doing a D and C [dilatation and curettage, a procedure that removes the lining and contents of the uterus] for abortion, you are not going to be comfortable using a pill in which you might have to do a D and C,” said William Parker, a Santa Monica obstetrician/gynecologist. “I just don’t think many doctors will want to offer it.”

Elizabeth Newhall, a Portland, Ore., obstetrician/gynecologist who has studied the drugs, agreed that change “will take longer than any of us had hoped initially.” But she believes the procedure will gain widespread acceptance as more physicians are trained to use it. She thinks at first it will be used mainly among those already providing abortions.

But Newhall is convinced that, over the long term, health care providers other than doctors will use the drugs, although they are not now authorized to do so. Such providers, including midwives, nurse practitioners and physician assistants, would use the drug because “they have an interest in providing the service, and it’s safe enough for them to do so,” she said.

Patricia Anderson, executive director of the Berkeley-based Medical Students for Choice, said she expects medical students to ask for training in the procedure, including learning the surgical techniques required.

“Information on surgical abortion is relatively nonexistent in medical schools and residencies and training programs,” she said. “Maybe now [they] will rush to educate. But I think students . . . will need to ask for this because of the political issues around abortion.”

In some cases, acceptance may depend on location. The highly visible anti-abortion movement and some states’ laws regulating abortion services may still scare many doctors away, at least at first.

For example, when Dr. James H. Armstrong Sr. offered to talk about his experience with the pill at a weekly staff meeting at his hospital in Kalispell, Mont., where abortion providers are few and opponents are vocal, the hospital turned him down two years in a row.

“They said it was too controversial,” said Armstrong, the only abortion provider within 100 miles. “They’re afraid of the commotion.”

But Newhall, who directs the Downtown Women’s Center in Portland, believes that the effect of abortion foes will diminish as the number of providers increases. “This will end the big war because there will be so many providers, it will be impossible to get them all,” she said.

While many advocates believe that the pill will serve as an incentive for women to determine a pregnancy earlier--because they can end it earlier--Dr. Carolyn Westhoff, medical director of the family planning clinic at Columbia Presbyterian Medical Center in New York, pointed out that surgical abortions can be performed as early as a pregnancy is confirmed. Old habits and tradition have led to the practice of making women wait for surgical abortions, she said.

Thus, “for many women, it really will become a choice between approaches, not timing,” she said.

A patient of Schaff’s, the Rochester physician, had a surgical abortion three years ago. But when she became pregnant a second time, she opted to participate in the clinical trial of the pill.

For her, the difference between the two procedures was dramatic. It was important to have the “ability to do it privately and not have to confront picket lines at a clinic,” where the surgical procedure had been “invasive and emotionally distressing. The whole idea of anesthesia and someone taking you home from a doctor’s office made it a much more complicated scenario. You feel more in control [with the pill].”

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Cimons reported from Washington and Roan from Los Angeles. Times staff writers Aaron Zitner and Melissa Lambert in Washington also contributed to this story.