- “Abortion by pill” is used to terminate at least 54% of pregnancies in the United States, according to 2020 data from the Guttmacher Institute.
- The two medical abortion pills, mifepristone and misoprostol, are taken about two days apart to end the pregnancy.
- What happens during a “medical abortion”? An expert told USA TODAY, “It’s more like a miscarriage.”
Abortion by pill is used to terminate at least 54% of pregnancies in the United States. The number has grown rapidly since the process became easier to access in 2016 and during the COVID-19 pandemic and is expected to increase further if Roe vs. Wade is overturned.
The two pills, mifepristone and misoprostol, are taken about two days apart. In many areas, only a telemedicine visit is needed to get them from a pharmacy. Cheaper and less invasive than an abortion procedure, when used within the first 10 weeks of gestation, they safely end 99.6% of pregnancies with very low complication rates.
“Abortion over the past two decades has become less medicalized due to increased access to these forms of abortion, which are safe, much more private and can be performed at home,” said Dr Ana Langer, reproductive health expert and coordinator of the Women and Health Initiative at the Harvard TH Chan School of Public Health.
Called “medication abortion” or “pill abortion,” this method was first cleared by the Food and Drug Administration in 2000 when mifepristone, or RU-486, was approved for use up to the seventh week. of pregnancy.
In 2001, only 5% of all abortions were medical, a number that rose to nearly 25% in 2011 and 39% in 2017.
According to Guttmacher Institutea research group that supports abortion rights.
The figure is thought to be even higher now after the easing of federal restrictions in December 2021.
These restrictions have gone back and forth over the past two years. Prior to 2020, all medical abortions required an in-person appointment.
Then, in July 2020, a federal judge ruled that the FDA must allow the drugs to be shipped after a telehealth visit because during the pandemic, an in-person requirement was an unreasonable impediment.
That came back in January 2021 when the Supreme Court overturned the federal judge’s ruling and said women must pick up the pills in person at a hospital or doctor’s office.
In April 2021, the rules changed again when the FDA temporarily changed the requirements for an in-person visit, after data was released showing the telemedicine visit and mail-in pills were safe.
The requirement was permanently removed in December 2021, allowing telemedicine visits and mailing of pills.
Abortion pills are more like a miscarriage
People choose medical abortion both because it’s more private and because it feels more emotionally right for them, said Dr. Karen Meckstroth, medical director of the Center for Pregnancy Options at UCSF.
“People want to take it home because they want to be in their own space with a friend or loved one,” she said.
Although the process may be more painful than a procedural or vacuum abortion, for some people it also feels more natural.
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“It’s more like a miscarriage,” said Ushma Upadhyay, a professor of obstetrics and gynecology at the University of California, San Francisco, who studies contraception and abortion care.
A pill abortion is also easier to fit into someone’s schedule, which is especially important for people who have little flexibility with their work and childcare needs.
“They like it because they’re able to control the schedule so they can have it on the weekends so they don’t have to miss work,” she said.
First mifepristone, then misoprostol
The process begins with a consultation with a medical professional. Once the patient is deemed eligible, the drugs are prescribed at a cost that generally ranges between $250 and $300.
“They can take the first pill with us, but they don’t have to,” Meckstroth said.
The first pill, mifepristone, works to block the body’s ability to absorb progesterone, a hormone that allows pregnancy to develop.
Between 24 and 48 hours later, the patient takes misoprostol. It usually comes in the form of four tablets which are either placed two in each cheek to dissolve or inserted into the vagina, depending on the formulation.
“It tastes a little chalky, a little bitter,” Meckstroth said. “The recommendation is to leave them on for 30 minutes, then rinse with water and swallow the remains.”
Within half an hour to a few hours, misoprostol causes the cervix to dilate and the uterus to contract, emptying the embryo from the uterus.
This can cause cramping, bleeding, chills, nausea, and sometimes vomiting. The worst pain and heaviest bleeding usually lasts no more than an hour or two, and the process is complete within 24 hours.
Patients continue to bleed for just over two weeks, which is normal, she said.
“It’s like having an early miscarriage and we recommend people take ibuprofen or Tylenol for the pain,” Meckstroth said. In some cases, narcotic pain relievers may also be administered.
Medical abortion around the world
As a method of abortion, medical abortion has expanded the number of places offering abortions nationwide and globally.
“It has allowed the number of clinics and practitioners offering abortion to increase. No special equipment is needed, it is available on prescription and doctors don’t have to keep it in their office,” Upadhyay said. . “In India, it’s available over the counter. In the UK, it’s called Pills by Post. Canada also allows access to pharmacies.”
Several states already have laws that restrict access, including requiring patients to visit their health care provider in person. If Roe v Wade were to be canceled, these rules should quickly increase
Doctors say it’s not medically necessary. In March, a study of more than 3,700 patients in 14 medical centers found medical abortion without ultrasound to be as safe and effective as those performed with ultrasound.
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Jurisdiction issues will be complex, and medical professionals predict that many women will self-abort at home with pills they obtain through various means. A group called Plan C pills has created a website with information on each state’s laws.
Already, several organizations are conducting telemedicine consultations for women in states where the procedure is legal, including Abortion on demand, Hi Jane and My choice. Internationally, groups like Access to aid provide pills shipped from India after consultation with doctor in Europe.
“Self-managed abortions in this way are very safe and effective, but it puts women at legal risk,” Upadhyay said, although she noted that no medical test can show that a person has taken pregnancy. mifepristone and misoprostol.
At Harvard, Langer studied abortion globally and doesn’t think rates in the United States will fall in the long term, although they might temporarily.
“When a woman decides to end a pregnancy, she will find a way to do it,” she said. “They may arrest a few women but it won’t make any difference. It has been documented in many countries.”