Drug abortions are on the rise: what they are and where do women get them

Taking pills to end a pregnancy accounts for a growing share of abortions in the United States, both legal and unlawful. If the Supreme Court overturns Roe v. veal as expecteddrug abortion will play a more important role, especially among women who lose access to abortion clinics.

It is a pill regimen that women can take at home, a method increasingly used around the world.

The protocol approved for use in the United States includes two drugs. The first, mifepristone, blocks a hormone called progesterone which is necessary for the continuation of pregnancy. The second, misoprostol, causes uterine contractions.

The Food and Drug Administration has approved drug abortion up to 10 weeks of pregnancy. Guidelines of the World Health Organization let’s say it can be used for up to 12 weeks at home and after 12 weeks in a doctor’s office.

Yes on both counts.

In US studies, the combination of these pills results in a complete miscarriage over 99 percent of patients, and it’s as safe as the traditional abortion procedure administered by a doctor in a clinic. A string of research has found that drug abortion has low adverse event rates, and a recent Lancet study found that. patients are generally satisfied with it. Growing evidence from abroad suggests abortion pills are safe even among women who don’t have a doctor to recommend them.

“Some people still think we’re talking about something dangerous or done out of desperation, but more and more this information is becoming more mainstream,” said Abigail RA Aiken, an associate professor at the University of Texas at Austin. there he leads a research group on drug abortion.

About helped of people who legally abort in the United States (and three-quarters in Europe). During the pandemic, drug abortion became more common because patients wanted to avoid going to the clinic in person, and a change in federal law made it easier for them to get prescriptions through telemedicine.

It usually depends on patients’ personal preferences, said Dr. Maria Isabel Rodriguez, an associate professor of obstetrics and gynecology at Oregon Health and Sciences University, who has worked on abortion research and policy design. “Some people like surgery because it’s done faster, they’re able to have anesthesia, and it’s done in a definite time,” she said. “Medicines may seem more private, some want it at home, some say it’s more natural to them, and some say it’s more possible to process a leak.”

Drug abortion is also used by those who live in a place that restricts legal abortion or by those who cannot reach a clinic. The abortion rate in the United States is higher than officially reported by doctors, the evidence suggests, because people order the pills online. That invisible abortion rate it could increase if more states moved to ban abortion.

Doctors with a special registration required by the FDA

but what recently revoked rules who requested an appointment in person. This means that more providers are offering drug abortions through telemedicine. The doctor and patient meet online, then the doctor sends the pills to the patient’s home by mail. (Some physical pharmacies have been certified to fill prescriptions for the pills, but this is not yet common.)

New start-ups specializing in telemedicine abortions, such as Hey Jane and Just the Pill, have begun offering the service in states that allow it. but 19 states ban pills prescription via telemedicine or delivery by post. In those places, patients still need to see a doctor in person to take the pills. Other states ban drug abortion after a certain number of weeks.

If Roe is overturned, about half of states should ban abortion altogether and drug abortion is expected become a legal battleground.

Online pharmacies overseas sell the pills. An organization called Access to aid offers women from all 50 states advice and prescriptions from European doctors before shipping the pills from India. These extralegal channels are becoming increasingly popular as abortion becomes more difficult to access in some states. After Texas passed a law in September that banned abortion after about six weeks, requests for access to aid for abortion pills tripled.

The FDA has asked these groups to do so stop selling these drugs in the United States, saying they bypass U.S. drug safety protocols. But the researchers who analyzed the pills in the labs found that they ordered the pills using these services they are generally authentic.

The second of the two drugs in the official regimen, misoprostol, can also terminate a pregnancy when used alone. It is about 80% effective on its own, although it sometimes has to be taken more than once. That pill is also used to treat ulcers and is available over the counter in many countries, including Mexico. But the only FDA approved method in the United States is to use both pills.

No. It is illegal to sell prescription drugs to Americans without a prescription from a physician licensed in the United States. But the application of foreign suppliers has been rare, as it is with other drugs that Americans order from abroad. And sales would be hard to stop because drugs generally arrive in unmarked packages in the mail.

“I’m not there, so I don’t have any legal risk,” said Dr. Rebecca Gomperts, the Dutch doctor who runs Aid Access, says she has lawyers who advise her, both at home and in the United States. “I know where I am from, I’m respecting the law.”

In general, recent state laws do not punish women for obtaining abortions, but have focused enforcement on abortion. The exception is the older laws of South Carolina, Oklahoma, and Nevada. That could change if Roe is turned upside down and illicit drug abortions become more common.

“Self-management of abortion is not a codified crime” in all three states except these three states, said Farah Diaz-Tello, legal advisor and chief legal officer of If / When / How, a reproductive rights policy. and a defense group. “But it is not permissible for a person to seek drugs without a prescription.”

The first pill, mifepristone, typically has no discernible effect on patients. The second, misoprostol, taken 24 to 48 hours later, causes cramps and bleeding that increase in intensity, said Dr. Rodriguez said.

The process takes six to eight hours and is most intense for about an hour. Advise patients to stay at home, with no other obligations. Ibuprofen and a heating pad are also recommended, because the pain can be severe and the bleeding is much heavier than for a period. After the pregnancy has passed, the cramping and clotting stop, although women generally bleed, like a period, for about a week.

In rare cases, less than 1% of the time, a patient has heavier-than-expected bleeding and needs medical attention. Likewise rarely, the abortion is not complete and must be followed up with another dose or a surgical abortion. Women who have these complications can be treated by a doctor with experience in treating miscarriages; the symptoms and treatment are the same. Once a drug abortion has begun, it cannot be undone.