Now, medical abortion – ending a pregnancy through the use of drugs – is the next focus of issues surrounding abortion care.
Why are people talking about it now?
Abortion pills were used in more than half of abortions in the United States in 2020, according to data from the Guttmacher Institute, a research organization that supports abortion rights.
After the Dobbs v. Jackson Women’s Health Organization decision which annuls deerdemand for abortion pills continued to rise, with some Republican lawmakers seeking to restrict access in the future.
How do medical abortions work?
The most common medical abortion regimen uses two drugs, mifepristone and misoprostol.
The Food and Drug Administration approved mifepristone in 2000 and then the two-drug protocol in 2016 to end teenage pregnancies. It can be used for 70 days or 10 weeks of gestation, which begins on the first day of a person’s last menstrual cycle. The protocol is to take mifepristone on the first day, then misoprostol 24 to 48 hours later.
The protocol can be done at home, said Holli Jakalow, professor of obstetrics and gynecology at Columbia University’s Irving Medical Center. She added that patients can see a provider or take a pregnancy test four weeks after the diet to check that it was successful.
Mifepristone blocks the hormone progesterone, making the uterus unable to sustain pregnancy, Jakalow said. Misoprostol then causes the uterus to contract and the pregnancy to be expelled.
“People can safely take these pills and go through the pregnancy safely at home and not have problems like bleeding or needing urgent medical attention,” said Emily Godfrey, primary care physician and researcher in family planning at the University of Washington Medical School. “It’s a very, very safe way to get through a pregnancy.”
Jakalow added that in cases where mifepristone is not available, it is possible to follow a medical abortion protocol with only misoprostol. Mifepristone and misoprostol require a prescription from a licensed healthcare provider.
World Health Organization guidelines state that misoprostol alone can be used for medical abortions for pregnancies up to 12 weeks or 84 days gestation. It can also be used for pregnancies over 12 weeks but at different doses.
Stephanie Rand, a New York-based obstetrics-gynecology and family planning specialist, said people usually don’t experience symptoms after the first medication, but they will experience cramping and bleeding after taking misoprostol as they go along. and during their pregnancy.
Other possible symptoms within 24 hours of taking misoprostol include increased nausea and vomiting, diarrhea, fever and chills, Rand said.
In rare cases, people may have excessive bleeding and infections. In the case of mifepristone, the FDA said adverse events reported to organizations “cannot with certainty be causally attributed” to the drug.
Are medical abortions safe?
While anti-abortion activists have questioned the safety of medical abortions, studies have shown that medical abortion is highly effective and has a low complication rate, especially for first-trimester pregnancies. One study found over a five-year period that more than 13,000 women who used the two-drug regimen for 63 days of gestation had high success rates.
The protocol terminated the pregnancy in 97.7% of the group.
Although medical abortions have become increasingly common, there are exceptions to the use of mifepristone outlined by the FDA, such as if a person has an ectopic pregnancy, has bleeding problems, or has an IUD. .
Rand isn’t worried about the safety of the procedure – she’s worried about its legality.
“I’m not worried if these drugs will be safe for people,” Rand said. “I worry: will people be safe or will they be criminalized? »
Are abortion pills still legal?
The short answer – it depends on where you live, and it will be subject to litigation in the future.
The Supreme Court’s decision placed the discretion of abortion access in the hands of the states. For people living in places with trigger bans – laws designed to ban abortion if deer were to fall – abortion by any method is illegal, with few exceptions under state law.
Since the Supreme Court’s decision, 15 states have banned or mostly banned abortion, which includes medical abortions, as induction laws broadly include drugs and drugs that terminate pregnancy in their definitions of abortion.
“It’s up to the states, really, how they want to go about making abortion unacceptable,” said Khiara M. Bridges, a professor at the University of California at Berkeley School of Law.
Laurie Sobel, associate director of women’s health policy at the Kaiser Family Foundation, said the reversal of deer created an open question of who has the power to regulate mifepristone for abortion – the FDA or the states.
“We’re in a bit of a gray area,” Sobel said.
How were abortion pills restricted before?
Even before deer was overturned, many states had passed laws that added specific requirements to the process of obtaining abortion pills, such as counseling patients. In five states, this advice requires patients to be told that personality begins at conception, according to the Guttmacher Institute.
More than 30 states also only allow doctors to dispense mifepristone, according to a Kaiser Family Foundation analysis published in April.
Before the pandemic, mifepristone had to be collected from hospitals, clinics or doctor’s offices.
When the FDA lifted that requirement in December 2021, it allowed mifepristone to be prescribed through telehealth appointments and mailed to patients in states where the drug was legal.
But that didn’t affect the 19 states that had already banned receiving medical abortion medication through telehealth appointments, according to Elizabeth Nash, a state policy analyst at the Guttmacher Institute.
Nash said she expects lawmakers to continue limiting medical abortions.
“What I anticipate is that states will try to enforce abortion bans to the fullest extent possible,” she said.
Can the federal government protect access to abortion pills?
While the Dobbs decision authorizes states to restrict access to abortion, the looming legal crisis over abortion pills remains centered on state versus federal authority.
Attorney General Merrick Garland pledged to “protect and preserve access to reproductive care” in a statement released after the Supreme Court ruling, specifically mentioning mifepristone.
“In particular, the FDA has approved the use of the drug mifepristone,” Garland’s statement read. “States cannot ban mifepristone due to disagreement with the FDA’s expert judgment on its safety and efficacy.”
But Bridges, a UC Berkeley law professor, said despite Garland’s statement, the issue is likely to be “a long-term battle.”
“This declaration is ambitious, because it is a huge legal question that will have to be litigated,” she said. “And the question is whether federal law will prevail over state law on this issue.”
A federal court in Mississippi is considering this issue. GenBioPro – which makes mifepristone – filed a lawsuit in 2020 challenging restrictions against medical abortion.
On Thursday, the company said FDA approval of the drug should override any state bans, citing Garland’s statement, Reuters reported.
Evan Masingill, president of GenBioPro, said in a statement that the company believes in “reproductive autonomy.”
“Medical abortion care is safe, effective, and the FDA has clear guidelines on how to administer it, whether at a health center or delivered to their home,” Masingill said in a statement. “These guidelines are what should determine how medical abortion care is administered in all states and we look forward to making this argument in court.”
The Justice Department declined to comment on the case.
Even with legal issues still to be resolved, the Supreme Court ruling has limited access to abortion pills in the United States, leading some patients to cross state lines for telehealth appointments. in order to access medicines where they are still legal.
Confusion over abortion pills has also raised concerns about emergency contraceptives, such as Plan B. But emergency contraceptives aren’t related to abortion — they’re taken to prevent pregnancy rather than expel one. a.
Health experts say the Supreme Court’s ruling will lead to an increase in telehealth consultations for medical abortions, buying pills online and “self-directed” medical abortion – when someone searches for medical abortions themselves. medications and applies the protocol by himself.
“It’s happened before,” Sobel said. “It’s going to be very difficult to police or enforce against state laws because it’s by mail and the mail is private.”