Happy anniversary mifepristone: a decade of promise and challenges.

September 29, 2010, marks the 10th anniversary of Food and Drug Administration's approval of Mifeprex (mifepristone) in the United States. That moment 10 years ago brought women the promise of increased access to early, safe, noninvasive abortion and the potential mainstreaming of abortion services into the larger scope of routine comprehensive women's health care [1,2]. The arduous 12-year path to approval required an intensive level of collaboration among key professional, advocacy and research organizations, working closely to navigate abortion-related politics and meet the natural challenges of introducing a new medical option to women and their health care providers. The motivation for working with such purpose was the potential to improve access to abortion and improve health care for women and families. Mifepristone can increase access to abortion for three compelling reasons: women can choose this method at earlier gestational ages than is typical for suction procedures; it can be obtained from primary care physicians (and advanced practice clinicians in some states) without the need for surgical facilities; and it can be completed in the privacy of the woman's home. Mifepristone promises to expand abortion services by going outside the domain of a typical abortion clinic. It has the potential to increase the number and types of abortion providers while expanding access to care. Ideally, mifepristone can become a ubiquitous and essential component of women's health care practice, embraced not just by obstetrician/gynecologists but by all primary care clinicians. Mifepristone use has steadily increased over the past decade and is a likely factor in the trend toward very early abortions [2,3]. Since FDA approval, more than 1.3 million US women have chosen this method (personal communication with manufacturer, 2010). And the number of mifepristone abortions and abortion providers has increased significantly, even as the number of abortions and providers has decreased during the same period [2]. According to the latest Guttmacher data, the proportion of abortions performed in the US at less than 9 weeks of gestation increased 5% in just 4 years, from 58% in 2000 to 63% in 2004 (the most recent available data) [2]. Preliminary estimates indicate that mifepristone accounted for roughly 27% of eligible abortions in 2009 in the United States compared to 22% in 2005 [3].