What you need to know about abortion pills since Roe v. Wade fell?

The Supreme Court’s destruction of Roe v. Wade has led to a series of changes to abortion laws across the country, opening the gates to legal battles in states with or without “trigger bans” on the procedure.

On Friday, President Joe Biden signed an executive order to protect access to reproductive health care, but the effort is yielding little for people in states that have already banned abortion.

Now medical abortion – terminating pregnancy through the use of medication – is the next point of interest when asking about abortion care.

Why are people talking about this now?

According to data from the Guttmacher Institute, a research organization that supports abortion rights, as of 2020, abortion pills were used in more than half of abortions in the United States.

After the Dobbs v. Jackson Women’s Health Organization decision, which was quashed roeDemand for abortion pills has continued to rise as some Republican lawmakers want to restrict access going forward.

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, then the two-drug protocol in 2016 to terminate early pregnancies. It can be used up to 70 days or 10 weeks of pregnancy, which starts on the first day of one’s last menstrual cycle. The protocol involves taking mifepristone on the first day, then misoprostol 24 to 48 hours after that.

The protocol can be done at home, said Holli Jakalow, a professor of obstetrics and gynecology at Columbia University Irving Medical Center. She added that four weeks after the regimen, patients can see a healthcare provider or take a pregnancy test to check if it was successful.

Mifepristone blocks the hormone progesterone, preventing the uterus from supporting a pregnancy, Jakalow said. Misoprostol then causes the uterus to contract and expel the pregnancy.

“People can safely take these pills and get through the pregnancy safely at home and have no problems like bleeding or emergency medical care,” said Emily Godfrey, a primary care physician and family planning researcher at the University of Washington School of Medicine. “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 using misoprostol alone. Both mifepristone and misoprostol require a prescription from a certified health care provider.

World Health Organization guidelines state that misoprostol can only be used for medical abortions for pregnancies up to 12 weeks or 84 days gestation. It can also be used in pregnancies over 12 weeks, but in different doses.

Stephanie Rand, a New York-based obstetrician and family planning specialist, said people usually experience no symptoms after the first medication, but will feel cramping and bleeding after taking misoprostol once their pregnancy is over.

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 experience excessive bleeding and infections. In the case of mifepristone, the FDA has stated that the side effects reported to the organizations “cannot be attributed with certainty” 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 few complications, especially in first-trimester pregnancies. One study over a five-year period found that more than 13,000 women who took the two-drug regimen over 63 days of gestation had high success rates.

The protocol terminated pregnancy in 97.7 percent of the group.

Although medical abortions are becoming more common, there are exceptions to the use of mifepristone as described by the FDA, such as if a person has an ectopic pregnancy, has bleeding problems, or has an IUD.

Rand isn’t concerned about the safety of the procedure — she’s concerned about its legality.

“I’m not worried about whether these drugs will be safe for people,” Rand said. “I’m concerned about: 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 the subject of a lawsuit in the future.

The Supreme Court decision placed the discretion of access to abortion in the hands of states. For people living in trigger-ban places – laws designed to ban abortion if roe – abortion by any means is illegal, with some exceptions that depend on state law.

Since the Supreme Court ruling, 15 states have banned or largely banned abortion, including medical abortions because the trigger laws largely include drugs and drugs that end pregnancy in their definitions of abortion.

“It’s up to states to determine how they want to make abortion unacceptable,” said Khiara M. Bridges, a professor at the Berkeley School of Law at the University of California.

Laurie Sobel, the associate director of women’s health policy at the Kaiser Family Foundation, said the overthrow of roe has created an open question about who will have the power to regulate mifepristone for abortion – the FDA or states.

“We’re kind of in a gray zone,” Sobel said.

How Are Abortion Pills Rather Limited?

Even before roe was brought down, many states had passed laws adding specific requirements to the process of getting abortion pills, such as counseling for patients. According to the Guttmacher Institute, counseling in five states requires patients to be told that personality begins at conception.

According to an analysis by the Kaiser Family Foundation published in April, more than 30 states only allow doctors to dispense mifepristone.

Before the pandemic, mifepristone had to be collected from hospitals, clinics or medical 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 medication was legal.

But this didn’t affect the 19 states that had already banned receiving medical abortion drugs through telehealth appointments, according to Elizabeth Nash, a state policy analyst at the Guttmacher Institute.

Nash said she expects lawmakers to continue to restrict medical abortions.

“What I expect is that states will try to enforce abortion bans as best they can,” she said.

Can the Federal Government Protect Access to Abortion Pills?

While the dobbs decision allows states to restrict access to abortion, looming legal crisis over abortion pills continues to focus 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, which specifically mentioned mifepristone.

“In particular, the FDA has approved the use of the drug Mifepristone,” Garland’s statement said. “States may not ban Mifepristone based on disagreement with the FDA’s expert judgment as to its safety and efficacy.”

But Bridges, the UC Berkeley law professor, said that despite Garland’s statement, the issue will likely be “a lengthy battle.”

“That statement is ambitious because that is a huge legal issue that needs to be litigated,” she said. “And the question is whether federal law takes precedence over state law on that point.”

A federal court in Mississippi is considering this question. GenBioPro — which makes mifepristone — filed a lawsuit in 2020 to challenge restrictions on medical abortion.

On Thursday, the company said FDA approval of the drug should lift 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”.

“Medication abortion care is safe, effective, and the FDA has established clear guidelines for its administration, both in a health center and home delivery,” Masingill’s statement said. “These guidelines are what should govern how medication abortion care is administered in all states and we look forward to taking this argument to court.”

The Justice Department declined to comment on the matter.

Even as legal questions remain to be resolved, the Supreme Court’s decision has restricted access to abortion pills in the United States, forcing some patients to cross state lines for telehealth appointments to access the drugs where they are still legal.

The confusion over abortion pills has also raised concerns about emergency contraceptives, such as Plan B. But emergency contraceptives have nothing to do with abortion — they are used to prevent a pregnancy rather than expel one.

Health experts say the Supreme Court’s decision will lead to an increase in telehealth consultations for medical abortions, buying the pills online, and “self-administered” medication abortion — when someone seeks out the drugs themselves and carries out the protocol themselves.

“It’s already happening,” Sobel said. “That will be very difficult to control or enforce state laws because it will go through the mail and the mail will be private.”