How medical abortion works and what Roe’s end could mean : NPR

Containers of mifepristone and misoprostol – drugs used to terminate a pregnancy – sit on a table inside a Planned Parenthood clinic in Fairview Heights, Illinois.

Jeff Roberson/AP


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Jeff Roberson/AP


Containers of mifepristone and misoprostol – drugs used to terminate a pregnancy – sit on a table inside a Planned Parenthood clinic in Fairview Heights, Illinois.

Jeff Roberson/AP

Roe vs. Wade could soon be reversed – meaning abortion is “certain or likely” to be banned in 26 states, according to the Guttmacher Institute, a research group that supports abortion rights. If clinics that offer abortions close, women who can’t travel to other states may turn to telehealth prescriptions or underground networks for abortion pills, making this method of pregnancy termination even more common.

Here’s what you need to know about the pills and how they work.

What is a medical abortion?

Medical abortion, also known as medical abortion, typically uses a combination of two drugs to end a pregnancy. This method of abortion does not require surgery and can be performed at home.

The first pill is mifepristone, which blocks a hormone known as progesterone that the body needs for pregnancy to continue.

The second drug, misoprostol, is taken 24 to 48 hours later. This drug causes cramping and bleeding and empties the uterus.

The World Health Organization says that if mifepristone is not available, misoprostol can be used alone. But the two drugs are more effective together.

Why might a person prefer a medical abortion?

Medical abortions now account for more than half of all abortions in the United States. The option of taking pills (rather than undergoing a procedure at a clinic) has become an increasingly common choice for those wishing to have an abortion since mifepristone was approved by the Food and Drug Administration in 2000.

That may be because it feels more private and less invasive than surgery, says Dr. Gabriela Aguilar, a physician and clinical instructor at NYU Grossman School of Medicine.

“Many people prefer to terminate a pregnancy in the comfort of their own home, surrounded by their support system and loved ones…rather than having to travel to a clinic or hospital for a procedure,” explains Aguilar. The drug route may also seem less invasive, she notes, “because there is no instrumentation with medical abortion.”

Pills can make it easier to get an abortion if a clinical provider is too far away or hard to reach.

Many people still choose a surgical or procedural abortion, for several reasons. Surgical abortions – an office procedure that often only takes five or 10 minutes – are very effective and rarely require repeat procedures. Patients may want the in-clinic option to complete the process quickly, avoid the discomfort of the medication process, or because it involves the presence of trained medical and support staff. Another reason to choose the procedure is that a pregnancy may be too advanced to use medication – pills are most often recommended for pregnancies less than 10 or 11 weeks old.

Is medical abortion different from plan B?

Yes. Plan B is emergency contraception, not an abortion. Plan B and another drug called Ella work by delaying or preventing ovulation. Plan B is most effective if taken within three days of unprotected sex. It can be taken within five days. Both are more effective the earlier they are taken.

How effective is medical abortion?

Abortion pills are very effective. A study of over 13,000 women found that the two-drug regimen was 97.7% effective for pregnancies up to nine weeks.

The later in pregnancy the pills are taken, the less effective they are.

Dr. Aileen Gariepy, professor of obstetrics and gynecology at Weill Cornell Medicine, says the drug route is more effective for abortion than for managing miscarriages – another reason the pills are sometimes prescribed. For miscarriages, she says the pills work best when a person is already showing symptoms of a miscarriage, such as bleeding and cramping.

Why are abortion pills used for miscarriage?

The same pill regimen used for abortion can be used for miscarriage management, depending on the stage of pregnancy.

Some people learn that their pregnancy is not viable during a prenatal appointment – for example, because the embryo has stopped developing but is still in the womb. A medical abortion or surgical abortion can be used to help completely empty the uterus so that there is no risk of excessive bleeding or infection.

Up to what stage of pregnancy can medical abortion be used?

The FDA has approved the two-drug regimen for pregnancies up to 10 weeks. The World Health Organization says medical abortions can be performed safely at home for up to 12 weeks.

Gariepy says patients seeking an abortion are usually referred to the surgical option after 11 weeks. “It’s not because [medication abortion] is dangerous ; it’s just not as effective as pregnancy beyond 11 weeks,” she says.

Yes deer is reversed, the math could change for people who would have to travel long distances to get to a surgical clinic — especially if the state they’re traveling to has a long wait.

In the case of pregnancy, which is 11 weeks and 3 days, “it might be best to try and see if medical abortion will work,” says Gariepy.

Is medical abortion safe?

Yes. The American College of Obstetricians and Gynecologists assures that medical abortion is a safe and effective way to perform abortion. And the diet is also FDA approved.

But it can be uncomfortable. Cramping and bleeding may occur for several hours after taking the second drug, misoprostol.

“I tell most people it feels like really bad menstrual cramps,” says Aguilar. “I’ve had patients tell me they don’t feel anything – they just feel a little cramping or ‘It wasn’t as bad as my period.’ And then I’ve had other patients tell me that’s the worst experience they’ve ever had, so I think there’s a wide range of experiences, probably more related to the baseline experience of a person’s pain and tolerance.

A follow-up visit with a doctor — in person or via telehealth — is important to ensure the patient heals and is no longer pregnant, Gariepy says.

Who can prescribe abortion pills?

Mifepristone, the first drug in the sequence, is more tightly regulated by the FDA than many other drugs. Due to FDA requirements, mifepristone can only be prescribed by a certified healthcare provider who meets certain qualifications, and pharmacies that dispense mifepristone must also be certified.

In December 2021, the FDA dropped the requirement that mifepristone could only be dispensed in person, but in 19 states telemedicine appointments for medical abortion remain prohibited.

Does insurance cover abortion pills?

Insurance coverage will vary depending on whether the patient has public or private insurance and the state in which they live.

The Hyde Amendment prevents federal funds like Medicaid from being used to pay for abortions, except in cases of rape or incest, or if the pregnancy would endanger the woman’s life. However, a 2019 study by the Government Accountability Office found that Medicaid programs in 14 states do not cover mifepristone even in these cases.

The Kaiser Family Foundation found that in 2020, 33 states had no plans available in the Affordable Care Act market that provide abortion coverage. According to Kaiser, six states — California, Illinois, Maine, New York, Oregon and Washington — require state-regulated private health plans to cover abortion, including ACA Marketplace plans.

Some insurances cover surgical abortion, but not medical abortion.

So-called “self-insured” plans — which are not regulated by state insurance laws — may cover abortion because federal law does not prohibit or require such coverage in self-insured plans, notes Kaiser.

According to Planned Parenthood, the cost of a medical abortion can be as high as $750, but it’s often lower. Abortion funds in the United States may be able to help with the cost of an abortion if a person’s insurance does not cover it.

Are there some people who shouldn’t take the pills?

Medical abortions are not a good option for those whose pregnancy has progressed too far.

Others who shouldn’t use abortion pills, Gariepy says, are people with a rare condition called porphyria, who take chronic steroids, who have had a mifepristone allergy in the past, or who are severely anemic.

The Cleveland Clinic also notes that medical abortions are not safe for those with a blood clotting disorder, chronic kidney failure, or who have an IUD (intrauterine device).

They are also not a good choice for treating an ectopic pregnancy (a pregnancy outside the womb), or for those who do not have access to emergency medical care or cannot make a follow-up visit. , says the clinic.

What happens if Roe vs. Wade is overturned?

In states where abortion is expected to be prohibited if deer is cancelled, medical abortion will become illegal. But access to abortion pills will still be available to those who are able to travel to states with abortion protections.

Some may attempt to acquire the drugs from out-of-state vendors through the mail. A growing number of states have taken steps to make this approach illegal, but experts say that in practice it is difficult to control.

Others may decide to order the drugs from overseas pharmacies, although this carries the risk of getting non-FDA approved products and patients not receiving proper care before and after taking the drug. .

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