Editor’s note, June 24, 10:30 a.m.: This article was originally published on June 22, before the Supreme Court ruled on June 24 to quash Roe v. Wade. Click here for the latest coverage of this decision by Vox and its implications for reproductive health in the United States.
Medical abortion, or taking a combination of the drugs mifepristone and misoprostol, is an increasingly common method of ending pregnancies in the United States. The reasons vary and overlap: some women do not have access to in-person abortion clinics; others prefer to terminate their pregnancy in the comfort of their own home. Others seek out the pills because they are much cheaper than surgical abortion.
With more in-person clinic closings and a Supreme Court threatening to overturn deer v. Wadea small but growing number of reproductive experts encouraged discussion of an idea called “advance provision” – or, more colloquially, stocking up on abortion pills in case you need them later.
It’s an idea with merit: mifepristone has a shelf life of about five years, misoprostol about two years, and both drugs work better the earlier in pregnancy they are taken. In states that tighten abortion restrictions, there is often a race against time to access care. In Texas, for example, if you do not realize until after eight weeks that you are pregnant, which may only be a few weeks after a missed period. – you would have already passed the new state legal deadline for obtaining abortion pills. But if you already had them stored at home, or if your friend or neighbor had some, then you would be able to take them away.
In a 2018 nationally representative survey of women aged 18-49, 44% expressed support for advance provisioning and 22% said they were personally interested. Those who had previously had a medical abortion and those who said they faced greater barriers to reproductive health care were more likely to support the idea.
Data on these types of abortions – often called “self-directed” or “self-administered” – are more difficult to track. Research published in 2020 estimated that 7% of women will self-manage an abortion in their lifetime, although this was calculated assuming that deer was still in place. New data from Guttmacher released last week on the incidence of abortion in the United States revealed that there were 8% more abortions in 2020 than in 2017, but self-managed abortions are excluded from this count.
“We know there are thousands of self-managed abortions that we don’t capture,” Rachel Jones, researcher at Guttmacher, told Vox. “If the Supreme Court overturns Roe and abortion becomes illegal in 26 states and people can’t travel to another state, then self-management will be the only other option they have for an abortion.”
Talking more candidly about self-managed abortion runs counter to long-held American cultural norms. For years, US reproductive rights groups have pointed out that the decision to end a pregnancy “is made between a woman and her doctor.” Internationally, where abortion has been more heavily criminalized, there is less pressure to involve health professionals. It was in the legally restrictive context of Brazil in the late 1980s that women were the first to use misoprostol to self-manage their abortions.
Rebecca Gomperts, the Dutch doctor who founded Aid Access in 2018 to provide abortion pills to American patients, was one of the most vocal advocates of advance provision and began offering it as an option to people in all 50 states. last fall. Pill costs range from $110 to $150, with a sliding scale for those short on funds. Recently, in Politico, Gomperts encouraged doctors to start prescribing mifepristone and misoprostol to those who aren’t pregnant, so they have the drug on hand if they need it later.
“Abortion pills are something you actually can’t die from,” she said. “There’s no way you can overdose on it. And what we know from the research is that you don’t need to do an ultrasound for a medical abortion.
The idea of getting medication in advance is not new. Doctors also commonly prescribed emergency contraception to women before it was available over the counter.
Currently, the major abortion rights groups are mostly remain silent on the advance provision, leaving lesser-known organizations like Aid Access and Plan C to try to spread the word. (NARAL and Guttmacher declined to comment, and Planned Parenthood did not return requests for comment.)
Aid Access and Forward Midwifery are among the few groups currently offering US patients the option of ordering pills in advance, although Plan C co-director Elisa Wells said she knows others are considering it. . “I just had a conversation with a supplier in Montana,” she told me. “We think it will become more common. Sometimes we call it the “just in case” plan because unplanned pregnancies are so common.
It is a safe option for most patients
When it comes to terminating a pregnancy safely, medical abortion is more than 95% successful, according to Guttmacher. Less than 0.4% of patients require hospitalization. The National Academies of Science, Engineering, and Medicine have also affirmed that medical abortion is a safe method of terminating pregnancy, with a very low risk of complications.
Research published earlier this year in the medical journal Lancet found that self-managed abortions were specifically very effective and with high rates of patient satisfaction.
Gomperts also calls for more attention to misoprostol-only abortions, which are common internationally. The drug may be easier to access for women because misoprostol is less strictly regulated; it is used for other conditions, including stomach ulcers and the management of miscarriages, and is sold without a prescription in many countries.
Although medical abortion is a safe option for almost anyone with an early pregnancy, the pills are not recommended for people taking blood thinners, who have bleeding disorders, or who are at high risk of extra pregnancy. -uterine. (Ultrasounds are recommended for those in the latter category.)
Yet one of the benefits of early provision — and of medical abortion in general — is the greater number of people likely to provide the pills, including primary care physicians. Another benefit is that it might be easier to share pills with those who need them quickly but don’t have access to them. Research suggests that medications are best taken within the first 10 to 12 weeks of a pregnancy.
Beware of legal risks and criminalization
Outside of groups that exploit international law like Aid Access, advance provision is unlikely to be a legal option in all states. Some states, for example, require patients to have an ultrasound before a provider can give them abortion pills. Other states are cracking down on abortion pills themselves.
While few states currently ban self-directed abortion, many have existing laws that overzealous prosecutors could use to prosecute women, such as fetal homicide laws. “I’m concerned that if people stockpile, without knowing the legal risks or how to cover their digital footprints, they could be subject to criminalization,” said Renee Bracey Sherman, founder of abortion storytelling group We Testify.
The National Foundation for the Right to Life also released model legislation in mid-June that encourages states to criminalize those who “aid or abet” illegal abortions, including those who provide instructions over the phone or over the Internet on self-directed methods.
Even in states with fewer legal concerns, pre-provision won’t be the right option for everyone. “That’s a potentially high cost for a patient who probably won’t be covered by insurance,” said Daniel Grossman, physician and professor of obstetrics and gynecology at the University of California, San Francisco. Not everyone can afford to spend $150 to have a backup method available, and some people will still need or prefer in-person clinic care.
It has not yet become mainstream
In the days following the leak of the Supreme Court’s draft decision to overturn Roe vs. Wade, telehealth abortion providers reported spikes in internet searches and pill orders. Yet most Americans are not only familiar with abortion drugs, but also with the few groups that currently supply the pills in advance. Some activists say leaders and better-resourced organizations should do more to promote self-managed abortion as an option.
In December 2021, three UCSF reproductive health researchers, including Grossman, published a paper calling early provision “an unexplored model of care that we believe holds promise and deserves further study.”
Grossman told Vox he thinks more people should ask their primary care and reproductive health providers if they would be willing to prescribe or give them abortion pills to save for later use. “Even if the doctor is unwilling, I think it’s worth sparking a conversation with them and getting their provider thinking,” he said. Grossman previously told Jezebel that he found it difficult to get other researchers and healthcare providers to give it the attention it deserves ahead of time.
“We have ibuprofen for a headache, cough syrup for a cold, and a plan B for a broken condom,” said We Testify’s Bracey Sherman. “It’s already normal for other health care and we should normalize it for abortion.”
Wells, of Plan C, said historic restrictions on abortion have likely made some groups and individuals more reluctant to talk about prearrangement. “I think there’s probably a lot of fear in not wanting to break the rules,” she said.
Another limiting factor for discussion, Wells suggested, is how heavily medicalized abortion has been in the United States, to the point where people believe the drugs should be or are best administered by a medical professional. Attitudes are different internationally, she said.
“We’ve become so invested in saying we need safe abortions and that doctors, clinicians and clinics can provide that,” Wells said. “Clinicians have done a wonderful job, and we need to have all these different types of care options available, but [self-managed abortions] can be a bit threatening message for this whole system.