In light of last month’s Supreme Court decision that overturned Roe v. Wade and revoked the constitutional right to abortion, much of the Biden administration’s response has focused on protecting access to medical abortion.
Mifepristone – a pill used to medically induce abortion in combination with another drug, misoprostol – is approved by the US Food and Drug Administration, and some have argued that its federal approval could override state laws that attempt to prohibit it.
Medical abortion has steadily grown in acceptance since becoming an option about 20 years ago and is now used in more than half of abortions, surpassing the vacuum or surgical procedure for the first time in 2020, according to data from the Guttmacher Institute, a research group that supports abortion rights.
But medical abortion is not always an appropriate option – sometimes for medical reasons but more often in the context of individual circumstances – and experts say it is essential to protect access to abortion so widely. as possible.
“Medical abortion is the main focus of all my research, but I am the first to say that it is not a panacea and cannot be the solution for everyone,” said Ushma Upadhyay , associate professor at the University of California, San Francisco. Bixby Center for Global Reproductive Health.
GenBioPro, the maker of generic mifepristone, lists a few reasons why people avoid using the abortion pill on their website. They include drug allergies, long-term steroid use for things like autoimmune disorders, and a history of a bleeding disorder. It is also not a viable option for the few people who become pregnant while an IUD is in place.
Overall, experts say these clinical exceptions are rare.
“It’s very rare that medical abortion is absolutely contraindicated for someone,” said Dr. Jen Villavicencio, equity transformation lead at the American College of Obstetricians and Gynecologists.
Dr. Alice Mark, a Massachusetts abortion provider and acting medical advisor to the National Abortion Federation, estimates that she only has a patient with these considerations once or twice a year.
More restrictive, perhaps, are the time limitations for the drug.
The FDA has specifically approved the use of mifepristone during the first 10 weeks of pregnancy, and the vast majority of abortions occur within this time frame. Nearly 80% of abortions in the United States in 2019 were performed at nine weeks or earlier, according to the United States Centers for Disease Control and Prevention.
But there are two main reasons a person may seek an abortion after the first 10 weeks of pregnancy, Upadhyay said: There is new information learned or barriers to care that prevent earlier action.
“A lot of people have delayed recognition of pregnancy, especially young people, teenagers, people who have never been pregnant before,” she said.
Otherwise, there could be new knowledge about their health or the health of the fetus, changes in their economic situation or their relationship with the partner, or other new information.
Even when patients have made up their minds, barriers to access can add delays to the timeline.
“Participants in our research have told us that by the time they collect the funds to travel and pay for the abortion, they will call the clinic and find out the price has gone up. [with the increased gestational age]. And then they have to spend more time collecting the funds,” Upadhyay said.
These barriers are generally the same as those that exist throughout health care for the most disadvantaged populations.
While it may be easier to find an abortion provider than a GP — at least before the Supreme Court ruling changed the provider landscape — most don’t have the economic resources to fund a “an urgent health emergency,” said Kirsten Moore, director of the Expanding Access to Medical Abortion Project.
“There’s a real burden on the patient to put it all together,” she said. “I don’t think finding the abortion provider per se is the challenge. It’s about finding the resources to bring it all together.
Clinical considerations aside, experts say individual preferences and the nuances of each situation mean medical abortion isn’t right for everyone.
“Most people who come to my clinic kind of know what choices are available to them when they get there. And I think a lot of people trying to decide on abortion do their own research,” Mark said.
There’s a medical screening for every patient, just like any other procedure, but “the main consideration is really like, ‘What would be best for you in your life?’ ” she says.
Generally, medical abortion allows the person to manage the process at home or at their own pace. This option may offer more privacy, but usually comes with more pain, cramping, and bleeding for longer. The suction procedure, on the other hand, is a faster process that includes pain management and confirmation by a medical professional that it is complete. It may be a better option for people for whom pregnancy is already a traumatic experience, experts say.
If you’re already a low-income mother of two and you’re pregnant and don’t want to be, you might like the idea of a non-invasive option that you can manage at home. But you might also be dealing with more than anyone else on a regular basis, so you might just want to walk into a clinic and be done with it,” Moore said.
In all cases, medical abortion and the vacuum aspiration procedure have been shown to be safe and effective.
“Each patient may have their own unique needs and preferences, and it’s important that my patients can choose the method that’s right for them,” Villavicencio said.
“In the future of abortion care in a post-Roe landscape, there will be new benefits with every intervention – medical abortion, for example, because of its proven safety via mail-order and medical procedure. (surgical) abortion because patients who must travel to another state will know for sure that she is no longer pregnant immediately after the procedure is completed.