More than half of recent abortions in the U.S. were carried out by medication abortion. Use of the two-pill method increased from 39% in 2017 to 54% in 2020, according to preliminary research by the Guttmacher Institute, a research organization that supports abortion rights.
In December 2021, the U.S. Food and Drug Administration permanently allowed patients to obtain abortion pills through telemedicine and mail delivery. Regardless of the FDA’s ruling, accessibility through telehealth visits still depends on which state the patient lives in.
If the Supreme Court decides to overturn the 1973 Roe v. Wade decision, 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, medication abortions are expected to play a bigger role in women’s reproductive health.
To help offer guidance on medication abortion, Yahoo News spoke to Ushma Upadhyay, an associate professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. (Some responses have been edited for length and clarity.)
Yahoo News: What is medication abortion, and what are the side effects?
Ushma Upadhyay: A medication abortion is the use of two types of medications. The first is mifepristone, which stops a pregnancy from growing. And the second is misoprostol, which allows the uterine to contract and empty the contents of the uterus. It's taken up to 11 weeks of pregnancy, and the process happens usually at home; it occurs over the course of 24 hours, and bleeding lasts up to a couple of weeks.
Someone taking a medication abortion could expect to have severe cramping and bleeding in the first 24 hours. Some people experience nausea and vomiting and sometimes diarrhea during that first phase of the abortion.
How safe is medication abortion?
The FDA approved mifepristone and misoprostol, the two medications in a medication abortion, in 2000. They recently updated these approvals in 2016, and they are continuously updating the protocols to provide them.
Medication abortion is extremely safe. We analyze data from over 11,000 medication abortions and followed people over time. And we found a complication rate of less than a third of 1%. So it has an over 99% safety rating. This safety rating is better than even Tylenol and Viagra, meaning that it's safer than Tylenol, Viagra and many other over-the-counter medications.
Research is being conducted right now to determine whether abortion pills could eventually become over-the-counter. And our preliminary research suggests that it definitely has the potential to someday become over-the-counter.
How do patients obtain medication abortions?
Patients do not have to go to a specialized clinic to get abortion pills. They could ask their primary care providers now that it is available by prescription and online pharmacy. To get a medication abortion, a patient could either have a telehealth visit or an in-person visit.
In many states, about 22 currently, someone can obtain it through telehealth services, which means they don't even have to make an in-person visit. A telehealth visit just entails having a video consultation or even just a chat. They don't even have to have video to assess their eligibility for these abortion pills. And they can receive the medications by mail. There is a clinician that will care for the patient, but it's just done remotely through telehealth technologies.
Providers will assess a patient's gestational age or whether they're eligible, whether they're in the first 11 weeks by asking the date of their last menstrual period or other questions to ensure that they are within that eligibility window. But other than that, there's no other requirement for an ultrasound or test before a patient can get these medications.
Then the in-clinic option is when a patient will come into the clinic and speak to a clinician face-to-face. Many clinics are now not requiring a pre-abortion ultrasound. It just requires a consultation, and you can pick up the pills and take them home.
How accessible are medication abortions?
Not everyone can receive these FDA-approved medications by mail. People in 19 states are unable to, because of state laws that ban telehealth for abortion. And these laws are not based on any medical evidence that they're necessary.
In our research following patients of telehealth for abortion, we have found that some patients have been able to order the pills; some patients living in states where telehealth is restricted have been able to order the pills and have them delivered to a friend or a family member living in a state where it is permitted. And then that friend or family member mails the pills to the patient. So it's not necessarily legal. There might be some legal risks to that option, but we do have documentation that some patients are attempting that method.
We're finding that some people living in restricted-access states are ordering these FDA-approved medications through alternate sources. So there's a website called Plan C that people are going to; they're learning about the different options from there. One of the websites where the people are ordering from is called Aid Access. It does take a little bit longer to ship to these states where medication abortion, telehealth for medication abortion, is restricted, but they are safe and effective. Patients who are living in restricted-access states who are ordering these medications through the mail are putting themselves at some legal risk. The legal risk is actually greater than any kind of medical risk.
What’s the difference between medication abortion and the "morning after" pill?
A medication abortion is different from Plan B, which is emergency contraception. Emergency contraception is taken within the first 72 hours after sexual intercourse. And then medication abortion is used after a person is already pregnant, which happens a few weeks later. Many people have heard that for emergency contraception, the effectiveness declines with increased weight. So obese people have lower rates of effectiveness. For medication abortion, that is not true. There is no eligibility criteria. There's no weight requirement or no decline in effectiveness with increased weight.
How will medication abortions be affected if the 1973 Roe v. Wade decision is overturned by the Supreme Court?
If Roe v. Wade is overturned, states will be able to determine at what point in pregnancy they can ban abortion. Some states will ban abortion altogether, but other states will do what Texas did and have about a six-week or a seven-week limit. So in those states, people may be able to access medication abortion more quickly than be able to get an appointment for a procedural abortion. Medication abortion has a large role to play because many different types of providers can prescribe medication abortion. It doesn't have to be an ob-gyn — it can 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 they're not at risk of ectopic pregnancies and write that patient a prescription. So as abortion becomes more legally restricted, I believe that abortion pills will have a greater role in getting people access to abortion care as quickly as possible.