Taking pills to terminate a pregnancy is responsible for a growing share of abortions in the United States, both legal and non-legal. If the Supreme Court overturns Roe v. Wade as expected, drug abortion will play a bigger role, especially among women who lose access to abortion clinics.
What is Drug Abortion?
It is a regimen of pills that women can take at home, a method increasingly used around the world.
The protocol approved for use in the United States includes two drugs. The first, mifepristone, blocks a hormone called progesterone that is needed to continue a pregnancy. The second, misoprostol, causes uterine contractions.
When can it be used?
The Food and Drug Administration has approved drug abortion for up to 10 weeks of pregnancy. According to World Health Organization guidelines, it can be used at home for up to 12 weeks and in a medical office after 12 weeks.
Is it effective and is it safe?
Yes on both counts.
In US studies, the combination of these pills causes a complete abortion in more than 99 percent of patients and is as safe as the traditional abortion procedure performed by a doctor in a clinic. A variety of studies have found that drug abortion has few side effects, and a recent Lancet study found that patients are generally satisfied with it. Growing evidence from abroad suggests that abortion pills are safe even in women who do not have a doctor to advise them.
“Some people still assume we’re talking about something dangerous or done out of desperation, but this information is becoming more mainstream,” said Abigail RA Aiken, an associate professor at the University of Texas at Austin who leads a research group there. . about medication abortion.
Who uses this method?
About half of people who have legal abortions are in the United States (and three-quarters in Europe). During the pandemic, drug abortion became more common as patients wanted to avoid going to clinics in person, and a change in federal law made it easier for them to get prescriptions through telemedicine.
It usually comes down to patient personal preference, said Dr. Maria Isabel Rodriguez, an associate professor of obstetrics and gynecology at Oregon Health and Sciences University who has worked on abortion research and policy design. “Some people like surgery because it’s over faster, they can get anesthesia and it’s done in a certain amount of time,” she said. “Medication can feel more private. Some want it in their own home, some say it feels more natural to them, and some say it’s easier to handle a loss.”
Medicated abortion is also used by people who live in places where legal abortion is restricted or by people who cannot reach a clinic. The number of abortions in the US is higher than officially reported by doctors, research shows, as people order pills online. That number of invisible abortions could rise as more states ban abortion.
Who Prescribes Abortion Pills?
Physicians with special registration required by the FDA
But it recently lifted rules requiring a face-to-face meeting. That means more providers are offering drug abortions through telemedicine. The doctor and patient meet online, after which the doctor mails pills to the patient’s home. (Some brick-and-mortar pharmacies are certified to fill prescriptions for the pills, but this isn’t common yet.)
New startups specializing in telemedicine abortions, such as Hey Jane and Just the Pill, have begun offering the service in states that allow it. But 19 states prohibit telemedicine prescription or mail delivery. In those places, patients still have to personally go to a doctor to pick up the pills. Other states prohibit drug abortion after a certain number of weeks.
If Roe is destroyed, about half of the states are expected to ban abortion altogether, and drug abortion is expected to become a legal battleground.
What about pills from abroad?
Online pharmacies abroad sell the pills. An organization called Aid Access offers women in all 50 states advice and prescriptions from European doctors before shipping pills from India. These extralegal channels are becoming increasingly popular as abortion is becoming more difficult to access in some states. After Texas passed a law in September banning abortions after about six weeks, the number of requests to Aid Access for abortion pills tripled.
The FDA has asked these groups to stop selling these drugs in the United States because they circumvent US drug safety protocols. But researchers who have analyzed the pills in labs have found that pills ordered through these services are generally authentic.
The second of the two drugs in the official regimen, misoprostol, can also terminate a pregnancy if used alone. It is about 80 percent effective on its own, although sometimes it must be taken more than once. That pill is also used to treat ulcers and is available over the counter in many countries, including Mexico. But the only FDA-approved method in the United States is to use both pills.
The issue of abortion around the world
An evolving landscape. Women’s access to abortion is still debated worldwide. Here is an overview of the situation in some countries:
Are pills from abroad legal?
New. It is illegal to sell prescription drugs to Americans without a prescription from a licensed physician in the United States. But enforcement of foreign providers is uncommon, as with other drugs Americans order from abroad. And sales would be hard to stop because the drugs generally come in the mail in unmarked packages.
“I’m not there, so I don’t have any legal risk,” says Dr Rebecca Gomperts, the Dutch doctor who runs Aid Access, and says she has lawyers who advise her, both at home and in the United States. “I know where I am, I obey the law.”
In general, recent state laws do not punish women for obtaining an abortion, but have focused enforcement on abortion providers. The exception is older laws in South Carolina, Oklahoma, and Nevada. That could change if Roe is destroyed and illegal drug abortions become more common.
“It is not a codified crime to self-abort” in all but those three states, said Farah Diaz-Tello, senior adviser and legal director of If/When/How, a reproductive rights policy and advocacy group. “But it is not lawful for a person to seek prescription drugs without a prescription.”
How’s the process?
The first pill, mifepristone, usually has no discernible effect on patients. The second, misoprostol, taken 24 to 48 hours later, causes cramping and bleeding that increase in intensity, said Dr. Rodriguez.
The process takes about six to eight hours and is most intense for about an hour. She advises patients to stay at home, with no other obligations. Ibuprofen and a heating pad are also recommended, as the pain can be strong and the bleeding is much heavier than with a period. After the pregnancy is over, the cramping and clotting stop, although women generally bleed for about a week, similar to a period.
In rare cases, less than 1 percent of the time, a patient will have heavier than expected bleeding and require medical attention. Likewise, it is rare that the abortion is incomplete and must be followed up with a new dose or surgical abortion. Women with these complications can be treated by a doctor experienced in treating miscarriage; the symptoms and treatment are the same. Once a drug abortion has started, it cannot be reversed.