should be available around the clock. While hospital emergency departments are open at all hours, they are often very expensive—and very hostile—locations to perform suction curettage. Your committee might want to consider after-hour availability of suction curettage in clinics or physician's offices that might be dispensing antiprogestins.

Spontaneous abortion is a prototype for expulsion of uterine contents without medical supervision, and the morbidity and mortality are negligible. Over the past five years, I have been in charge of the emergency room in the largest maternity hospital in North America, where I have personally supervised the care of about 2,000 patients with spontaneous abortions each year. The morbidity is really negligible. So, with medical supervision in a doctor's office, the safety should be even greater.

Acceptability of Medical Versus Surgical Abortion

Given that we are going to be using prostaglandins along with RU 486, how can we make this regimen less clumsy, less cumbersome? A very interesting study from France published in the fall of last year showed that among women who had received this combination regimen of mifepristone plus sulprostone, three times as many women were unsatisfied with this regimen as with the curettage offered under either local or general anesthesia. This shows that we have a long way to go in making this more palatable for women in Europe and in the United States.

Number of Visits Required

The second issue that generated debate this morning is the practice of four visits for mifepristone plus prostaglandin abortions. The scientific basis for two of these visits is debatable. This practice evolved in countries with very different health care systems for abortion services than the United States. In France, the United Kingdom, and Sweden, abortions take place in publicly supported facilities. In contrast, most abortions in the United States take place in free-standing abortion clinics. The response of public hospitals in the United States to the Roe v. Wade decision in 1973 was tantamount to default. Moreover, since 1977, the federal government has been prohibited from paying for abortions.

The European model of abortion provision is unlikely to be compatible with the United States health care delivery system because of the cumbersome requirement for multiple visits. In the United States, abortion services are currently limited largely to metropolitan areas, with more than 80 percent of U.S. counties having no provider. For



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