More than half of recent abortions in the United States have been performed by medical abortion. Use of the two-pill method rose from 39% in 2017 to 54% in 2020, according to a preliminary study by the Guttmacher Institute, a research organization that supports abortion rights.
In December 2021, the United States Food and Drug Administration permanently allowed patients to obtain abortion pills via telemedicine and mail. Regardless of the FDA’s decision, accessibility through telehealth visits still depends on the state in which the patient lives.
If the Supreme Court decides to overturn Roe v. Wade Act of 1973, which guarantees a constitutional right to abortion, at least half of U.S. states are likely to ban the procedure, according to the Center for Reproductive Rights. If access to abortion clinics is threatened, medical abortions should play a greater role in women’s reproductive health.
To help offer guidance on medical abortion, Yahoo News spoke with Ushma Upadhyay, associate professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco. (Some answers have been edited for length and clarity.)
Yahoo News: What is medical abortion and what are the side effects?
Ushma Upadhyay: A medical abortion is the use of two types of drugs. The first is mifepristone, which prevents a pregnancy from developing. And the second is misoprostol, which allows the uterus to contract and empty the contents of the uterus. It takes up to 11 weeks of pregnancy and the process usually takes place at home. it occurs over a 24 hour period and the bleeding lasts up to a few weeks.
A person taking a medical abortion can expect to have severe cramping and bleeding for the first 24 hours. Some people experience nausea and vomiting and sometimes diarrhea during this early phase of the abortion.
How safe is medical abortion?
The FDA approved mifepristone and misoprostol, the two medications in medical abortion, in 2000. They recently updated those approvals in 2016, and they continually update the protocols to provide them.
Medical abortion is extremely safe. We analyze data from over 11,000 medical abortions and follow people over time. And we found a complication rate of less than a third of 1%. It therefore has a safety rating of over 99%. This safety rating is even better than that of Tylenol and Viagra, which means it is safer than Tylenol, Viagra, and many other over-the-counter medications.
Research is currently underway to determine if [abortion pills] could eventually become over-the-counter. And our preliminary research suggests it definitely has the potential to go over-the-counter one day.
How do patients obtain medical abortions?
Patients do not have to go to a specialized clinic to obtain abortion pills. They could ask their primary care providers now that it’s available by prescription and in online pharmacies. To obtain a medical abortion, a patient can either have a telehealth visit or an in-person visit.
In many states, about 22 currently, someone can get it through telehealth services, which means they don’t even have to make an in-person visit. A telehealth visit is simply having a video consultation or even just a chat. They don’t even need to have a video to assess their eligibility for these abortion pills. And they can receive the drugs by mail. There is a clinician who will attend to the patient, but this is done remotely using telehealth technologies.
Providers will assess a patient’s gestational age or if she is eligible, if she is in the first 11 weeks by asking the date of her last menstrual period or other questions to make sure she is in this range. eligibility window. But other than that, there is no other requirement for an ultrasound or test before a patient can receive these drugs.
Then the in-clinic option is when a patient will walk into the clinic and speak to a clinician face-to-face. Many clinics no longer require an ultrasound before abortion. It just requires a consultation, and you can take the pills and take them home.
How accessible are medical abortions?
Not everyone can receive these FDA-approved drugs by mail. Residents of 19 states cannot do so, due to state laws that ban telehealth for abortion. And these laws are not based on any medical evidence that they are necessary.
In our research following abortion telehealth patients, we found that some patients were able to order the pills; some patients living in states with restricted telehealth have been able to order the pills and have them delivered to a friend or family member living in a state where it is allowed. And then that friend or family member sends the pills to the patient. So it’s not necessarily legal. There could be legal risks associated with this option, but we have documentation that some patients attempt this method.
We find that some people living in restricted states are ordering these FDA-approved drugs through other sources. So there’s a website called Plan C that people go to; they learn the different options from there. One of the websites people order from is called Aid Access. It takes a little longer to ship to those states where medical abortion, medical abortion telehealth, is limited, but they are safe and effective. Patients who live in restricted-access states and who order these drugs through the mail expose themselves to some legal risk. Legal risk is actually greater than any type of medical risk.
What is the difference between medical abortion and the morning after pill?
A medical abortion is different from Plan B, which is emergency contraception. Emergency contraception is taken within the first 72 hours after sex. And then medical abortion is used after a person is already pregnant, which happens a few weeks later. Many people have heard that for emergency contraception, effectiveness decreases with increasing weight. Obese people therefore have lower efficacy rates. For medical abortion, this is not true. There are no eligibility criteria. There is no weight requirement or any decrease in efficiency with increasing weight.
How will medical abortions be affected if Roe v. Wade’s 1973 is struck down by the Supreme Court?
If Roe v. Wade is overturned, states will be able to determine when in pregnancy they can prohibit abortion. Some states will completely ban abortion, but others will do what Texas did and have a limit of about six weeks or seven weeks. So in these states, people can get access to a medical abortion faster than they can get an appointment for a procedural abortion. Medical abortion has an important role to play because many different types of providers can prescribe medical abortion. It doesn’t have to be an obstetrician — it could be a nurse practitioner, a family medicine clinician, an adolescent health specialist. They can confirm that the patient is less than 11 weeks pregnant and confirm that she is not at risk of ectopic pregnancy and write a prescription for the patient. So, as abortion becomes more legally restricted, I believe abortion pills will play a bigger role in getting people access to medical abortion care as quickly as possible.