On December 16, the FDA decided to permanently waive the requirement that mifepristone, the first drug in a two-drug regimen taken for medical abortion, must be administered in person by a healthcare professional. Now people can receive abortion pills in the mail. It comes after the agency said in April that it would temporarily stop enforcing the requirement – set out in the drug’s Risk Evaluation and Mitigation Strategy (REMS) guidelines – for the rest. of the COVID-19 pandemic. However, there are still limitations depending on where you live.
How We Got Here: FDA Permanently Allows Abortion Pills in the Mail
Director of the FDA’s Center for Drug Evaluation and Research, Patrizia Cavazzoni, MD, wrote in a letter posted on the American Civil Liberties Union (ACLU) website that the FDA has concluded that REMS should be amended to “minimizing the burden on health care delivery of complying with REMS and ensuring that the benefits of the drug outweigh the risks.
Prior to the April interim ruling, the Center for Drug Evaluation and Research had assessed telemedicine abortion studies to determine the risk factor for medical abortion by mail during the pandemic. He felt that the studies did not show an increase in safety issues, the FDA Acting Commissioner Janet Woodcock, MD, said in her own letter at the time. The April ruling had offset a January Supreme Court decision to keep the distribution restriction in place.
Colleen McNicholas, DO, an obstetrician and chief medical officer for Planned Parenthood of the St. Louis and Southwest Missouri Area, told POPSUGAR in April that, previously, if you had to take the first medication at the health center or doctor’s office or you could instead pick it up and then just take it home with you was entirely up to state law. Ahead, learn more about medical abortions.
How do abortion pills work?
The FDA first approved mifepristone, known as Mifeprex, in 2000, and it’s ordered, prescribed, and dispensed by a trained healthcare professional for up to 70 days — or up to 77 days in some case – of pregnancy; the FDA’s decision now means mifepristone can be distributed specifically by mail in states without limitations (more on that later). Then, as approved by the FDA, a different pill, misoprostol, is taken 24-48 hours after taking Mifeprex at your location of choice, which means it can be taken at home.
How you qualify for a medicated abortion pill will depend on where you live, but in terms of gestation, Dr. McNicholas explained, the FDA has approved the drug for up to 70 days gestation, and the medical community has since developed and supported use for up to 77 days. days.
Dr McNicholas said mifepristone prevents a pregnancy from progressing because it blocks progesterone, one of the hormones that keeps pregnancy going in the womb. The misoprostol then causes the uterus to contract and result in cramping and bleeding that push out the pregnancy tissue, which usually begins within one to four hours. According to the National Planned Parenthood website, a person may also experience the following side effects:
Nausea and light bleeding may start after taking mifepristone, although this is not common. The expulsion of pregnancy tissue can usually last five hours or more, and the cramps can persist for a few days. Planned Parenthood noted that if you don’t have any bleeding within 24 hours of taking misoprostol, you should call your doctor. You’ll have a follow-up appointment a week or two after the medical abortion, which Melissa Grant, COO of abortion and reproductive health services provider Carafem, told POPSUGAR can happen virtually (after checking the symptoms, providers may later ask you to take a home pregnancy test to confirm a negative test result).
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How effective are the abortion pills?
According to Planned Parenthood, if you’re eight weeks pregnant or less, a medical abortion works about 94 to 98 percent of the time. For people between 10 and 11 weeks pregnant, it is about 87% effective. Although rare, if the abortion doesn’t work and you’re still pregnant, you may need additional medication or in-clinic intervention. Complications of medical abortion are also rare, but can include pregnancy tissue left in the uterus, infection, allergic reaction, blood clots in the uterus, and excessive bleeding. Call your doctor if you feel sick more than 24 hours after taking misoprostol.
Where can you get abortion pills?
Typically, you get these pills from a doctor’s office or clinic like Planned Parenthood or Carafem. Grant suggests using the National Abortion Federation as a resource where you can find a list of accredited providers across the country. Some doctors will give you mifepristone in their office and then write a prescription for misoprostol to pick up separately from a certified pharmacy, or they might already have misoprostol on hand and send you home with it; now it should be easier for many to receive both by mail or through a mail order pharmacy.
The cost varies and also depends on many factors such as the facility you are visiting, state law, other tests you may need to undergo before or after your medical abortion, and insurance coverage. However, she noted that the national average for medical abortion in a private practice is generally between $400 and $450. People who choose to buy the pills virtually, she said, tend to pay a reduced cost.
The FDA decision opens up the possibility of an entirely virtual medical abortion process, such as abortion on demand and access to help. Carafem also offers video consultations in some states for medical abortions. Plancpills.org also offers help finding medical abortions by state.
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Carafem participated in the TelAbortion study, which was sponsored by Gynuity Health Projects, a nonprofit reproductive health organization, used telemedicine for medical abortions and mailed these medications. He completed registration at the end of September. “We did this primarily because we serve a large number of rural clients, particularly in the South and Midwest, who travel great distances to receive medical abortions,” Grant said.
A victory, but not a total victory for medical abortions
“It’s important that people have safe options that respect their own personal needs, their own personal belief systems, if they decide they want to have an abortion.”
Although the FDA rulings (in April, then this week) were victories for abortion access, roadblocks remain at the state level. For example, on December 2, Texas reduced the window in which doctors are allowed to prescribe abortion pills from 10 weeks of pregnancy to seven weeks and specifically prohibited doctors from mailing abortion pills. Doing so is now a crime (note: pregnant people are not considered responsible). Additionally, laws in 19 states already ban virtual medical abortions because they require clinicians to be physically present when the drug is administered.
Grant and Dr. McNicholas both wanted to point out that mifepristone and misoprostol used for medical abortion are not only effective but also safe. “The extra barriers do nothing to make it safer and, instead, actually delay appointments, increase costs, and create more stress and conflict for people in the situation,” Grant said.
Abortion is not a rare experience (the abortion rate in 2014 was one in four at age 45). The Guttmacher Institute estimates that in 2017, 39% of abortions were medical abortions, and it estimated that among abortions that occurred within a 10-week gestation window, medical abortions accounted for 60% that year. CDC data revealed that 42% of all abortions reported to them in 2019 (629,898 in total) were medical abortions.
Grant added that untreated pregnancies are often complicated by financial instability and poor access to health care. “It’s important that people have safe options that respect their own personal needs, their own personal belief systems, if they decide they want to have an abortion,” she said. “Whether you prefer to have an abortion at home with a pill, in the clinic with medication, in the clinic with a procedure and perhaps an additional painkiller, these are all legal and safe options that the patient themselves should be able to choose.”