Medical abortions are criticized: here’s how they work

Medical abortions became the preferred method of terminating a pregnancy in the United States even before the Supreme Court overturned Roe v. Wade. They usually involve taking prescription medication two days apart – at home or at a clinic.

In contrast, abortion procedures are an invasive medical technique that empties the uterus. They are sometimes called surgical abortions, although they do not involve surgery.

In the United States, pill abortions typically involve the drugs mifepristone and misoprostol. As more states seek to limit abortion, demand for the pills is expected to increase. But they have been targeted by abortion haters, including Christian conservatives who have sued in Texas to overturn the Food and Drug Administration’s approval of mifepristone. A hearing on the lawsuit was held on Wednesday.

HOW DRUGS WORK

Mifepristone is taken first, swallowed by mouth. The drug dilates the cervix and blocks the effects of the hormone progesterone, which is needed to maintain pregnancy.

Misoprostol, a drug also used to treat stomach ulcers, is taken 24 to 48 hours later. The pill is designed to dissolve when placed between the gums and teeth or in the vagina. It causes the uterus to cramp and contract, causing bleeding and pushing out pregnancy tissue.

While the two-drug combination is slightly more effective, misoprostol is sometimes used alone for abortions. This practice is more common in countries where mifepristone is banned, but US clinics were preparing to switch to the single drug if the lawsuit prevailed.

HOW MEDICINES ARE USED

Abortion drugs are approved until the 10th week of pregnancy.

The pills can be taken in a doctor’s office or clinic, where patients sometimes undergo ultrasound or lab tests beforehand. Some providers also offer the pills during telehealth visits and then mail the medications to patients.

The use of the pills has increased in recent years and they account for more than half of all abortions in the United States.

SIDE EFFECTS

Studies and real-use evidence show that when taken together, the pills are up to 99% safe and effective. Side effects may include nausea, vomiting, and diarrhea.

The bleeding is normal. Very heavy bleeding – soaking more than two pads per hour for more than two hours – is rare but requires medical attention.

Dr. Stephanie Rand, an obstetrician and abortion specialist in New York with the advocacy group Physicians for Reproductive Health, says pregnancy tests should not be used immediately to determine if a medical abortion was successful because the pregnancy hormone can linger in the body for several weeks. Bleeding, with blood clots that include lighter colored tissue, are signs of success, she said.

Serious complications are very rare. The Food and Drug Administration says more than 3.7 million American women have used mifepristone since it was approved more than 20 years ago. The agency has received 26 reports of deaths of women using the drug, including two involving ectopic pregnancies, which develop outside the womb.

The drugs are not recommended for some patients, including those with suspected ectopic pregnancies or with implanted IUD birth control devices.

COSTS

Costs vary by location, but are similar to abortion procedures and can total over $500. Health insurance coverage varies, with some plans making the pills free or low cost and others not covering them at all.

Mifepristone is sold under the brand name Mifeprex and misoprostol under the brand name Cytotec, but both pills are available as generics.

FEDERAL RULES

The FDA approved mifepristone for terminating pregnancy in 2000 when used with misoprostol. At the time, it placed several limits on how the drug could be prescribed and dispensed.

In December, the agency dropped the biggest restriction: the requirement that patients pick up the drugs in person. The FDA said a scientific review of the drug’s use – including during the COVID-19 pandemic – showed women could safely receive the pills in the mail after an online consultation, without any increases. side effects or complications.

The decision allowed mail delivery of the pills across the country, a change long sought by health professional groups and abortion rights supporters. Yet millions of women will struggle to access the pills due to a patchwork of state laws targeting abortion broadly and pills specifically.

About half of US states are expected to ban or severely restrict abortion.

LEGAL DISPUTES

Legal experts predict years of court battles over access to the pills, as abortion-rights advocates present test cases to challenge state restrictions.

There are strong arguments and precedents on both sides, experts note, although there is little certainty as to which side might win.

The Biden administration’s Justice Department has already announced plans to challenge state restrictions on medical abortion. And federal attorneys are likely to be joined by third parties, including abortion rights groups like Planned Parenthood and even the companies that make the pills.

Probably the main argument against restrictions on pills is the long-standing principle that federal laws, including FDA rulings, take precedence over state laws. Indeed, few states have ever attempted to completely ban an FDA-approved drug because of previous rulings in favor of the agency.

Yet states that completely ban abortion will likely interpret them as banning abortion pills. Many laws do not distinguish between abortion procedures and medical abortion.

“In the short term, states that ban abortion are going to assume that their bans also include medical abortion and that will be banned,” said Greer Donley, a professor specializing in reproductive health care at the University of Ottawa Law School. University of Pittsburgh.

STATE PILL LAWS

Even though blanket bans are successfully challenged, 15 states have limited access to abortion pills, including six that require an in-person medical visit. These laws could withstand legal challenges. States have long had authority over how doctors, pharmacists and other providers practice medicine.

States also set the rules for telemedicine consultations used to prescribe medications. Typically, this means that healthcare providers in states with restrictions on abortion pills could face penalties, such as fines or license suspension, for attempting to send pills through the post office.

Women have already crossed state lines to places where access to abortion pills is easier. This trend should increase.

Meanwhile, some women will still get the drugs through online pharmacies in Canada and abroad, often with telehealth consultations from foreign doctors. The practice is technically illegal but largely unenforced, and advocates believe women will increasingly choose the method as more states ban abortion.

“Anti-abortion states are going to do everything they can to restrict medical abortion, but in practice people have access and will continue to access it by mail from international pharmacies,” Donley said.

YEARS OF UNCERTAINTY

Donley expects lawsuits based on various legal theories to play out for a few years before clear decisions emerge.

A key question is how the highest court in the land might decide if and when it takes up these court cases. While the Supreme Court rejected a constitutional right to abortion, conservative justices also generally defer to the primacy of the FDA over drug decisions.

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The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute Department of Science Education. The AP is solely responsible for all content.

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