How abortion pills and medical abortions work?

AAccess to bortion in the US is declining rapidly. Now that the US Supreme Court has been overthrown Roe vs. wade, experts predict that people are increasingly trying to terminate pregnancies at home using drug abortion (also known as medical abortion or abortion pills). Abortion pills are already the most common way to terminate a pregnancy in the US, accounting for 54% of abortions in 2020, and that number is expected to grow.

Here’s what you need to know about the safety and efficacy of abortion pills.

What are abortion pills?

Drug abortions, which are approved by the U.S. Food and Drug Administration up to the 10th week of pregnancy, involve taking two medications 24 to 48 hours apart. The first, called RU 486 or mifepristone, is a hormone that blocks progesterone and stops the pregnancy from progressing; the second, misoprostol, causes contractions and bleeding that empty the uterus.

How safe is a drug abortion?

Very safe. “We have a lot of safety data,” said Dr. Daniel Grossman, a gynecologist and researcher at the University of California, San Francisco. Serious complications requiring hospitalization are “incredibly rare — less than half a percent.”

dr. Lauren Owens, a gynecologist at the University of Michigan, adds that “historically, medical abortion has been very tightly regulated because of the stigma on abortion, but not because of medical necessity.”

Are abortion pills legal now? Roe vs. wade has been rolled back?

It may get harder to get the pills, but there will be solutions. People may still be able to access medical abortions through telehealth services and mail-order pharmacies, which rely on foreign doctors and pharmacies to get around US regulations. Aid Access, an organization that helps people in the US and around the world access medical abortion pills, sends the pills after patients answer a few questions on a health screening questionnaire and pay (usually between $200-$300); the group also provides medical counseling to international doctors via email. It takes up to two weeks for the pills to arrive.

However, there are currently restrictions on drug withdrawal in 19 states requiring a physician to be physically present when the medication is administered. Several states have also specifically banned sending pills to residents of those states.

read moreMeet the Pharmacist Expanding Access to Abortion Pills in the US

Advocates and doctors expect self-administered abortions – when someone terminates a pregnancy without the help of a doctor – to increase significantly afterroe† Examples include getting prescriptions from online pharmacies (rather than a telehealth provider) or through friends from other states. There are more risks with this method, and Robin Tucker, a nurse practitioner with Aid Access, cautions people to check carefully that the organization, company, or person shipping the pills is legit and vetted. She recommends visiting the Plan C website, which lists reliable abortion pill providers in every state. Plan C also does some quality control on the pills themselves.

If people need medical advice throughout the process, Tucker recommends calling the Miscarriage and Abortion Hotline—a confidential, private, and secure phone line manned by medical professionals who can answer questions.

Is there a chance that drug abortion won’t work?

Yes, but it is small. Studies have shown that drug abortion is effective in terminating a pregnancy between 95-99% of the time before the 9th week of pregnancy. Abortion pills gradually become less effective as the pregnancy progresses.

How do you know if abortion pills have worked?

People should wait between four and five weeks to take a pregnancy test to make sure the pills are working. This timing puts many people past the medical abortion window. If a woman is bleeding profusely and passing some tissue, it is very unlikely that she is still pregnant. But in some rare cases, the pregnancy will continue; drug abortion, for example, will not terminate an ectopic pregnancy. If a person is experiencing no symptoms and still believes they may be pregnant even after a drug abortion, experts recommend seeking medical attention and possibly an ultrasound.

Read more: Within the effort to promote abortion pills for a post-roe America

If you think you are still pregnant, can you still have a medical abortion?

Grossman says it’s reasonable to think this would work, and Tucker says she’s seen some people have success on the second attempt. But people should get and take the second round of pills within 10 weeks, Tucker says.

Do you run into problems if you have to seek medical care with a drug abortion?

Traditionally, abortion restrictions are aimed at providers and not at patients. In the case of Aid Access, providers are out of the country and therefore do not run the risk of prosecution. But that doesn’t necessarily mean that pregnant people aren’t legally vulnerable. Greer Donley, an assistant professor at University Pittsburgh Law School, says not all states have protections for patients who attempt abortion. She is concerned that patients could be reported to authorities at the hospital, for example if a health care provider suspects an abortion. “People will be scrutinized if they don’t show the right grief response people expect; if they’re poor women of color, they’re much more likely to be targeted,” she says.

dr. Debora Bartz, an obstetrician at Brigham and Women’s Hospital in Boston, emphasizes that people don’t need to tell their doctor if they’ve had a drug-induced abortion. “There’s no way for a health care professional to differentiate between a natural miscarriage or a drug-induced abortion if the patient herself doesn’t disclose that she took these drugs,” says Bartz — a point where Grossman and Tucker both agree. agree .

If people are concerned about their legal risk, they can contact the toll-free and confidential hotline, the Repro Legal Helpline, operated by If/When/How, an advocacy and support organization dedicated to reproductive rights. It is staffed by attorneys who can provide free legal advice to those concerned about their risk.

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