Medical abortions are on the rise: what they are and where women are getting them

Taking pills to terminate a pregnancy accounts for a growing share of abortions in the United States, legal or not. If the Supreme Cour...


Taking pills to terminate a pregnancy accounts for a growing share of abortions in the United States, legal or not. If the Supreme Court overturns Roe v. wade as expectedmedical abortion will play a greater role, especially among women who lose access to abortion clinics.

It is a regimen of pills that women can take at home, a method that is increasingly being 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 a pregnancy to continue. The second, misoprostol, causes uterine contractions.

The Food and Drug Administration has medical abortion approved up to 10 weeks of pregnancy. World Health Organization guidelines 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 American studies, the combination of these pills causes a complete abortion in more than 99% of patients, and is as safe as the traditional abortion procedure administered by a doctor in a clinic. Various research has shown that medical abortion has low rates of adverse events, and a recent Lancet study found that patients are generally satisfied. A growing body of evidence from overseas suggests that abortion pills are safe even in women who do not have a doctor to advise them.

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

About half of people who obtain legal abortions in the United States (and three-quarters in Europe). During the pandemic, medical abortion became more common because patients wanted to avoid going to clinics in person, and a change in federal law made it easier for them to get prescriptions via telemedicine.

It usually comes down to personal patient preference, 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 birth design. policies. “Some people like surgery because it’s quicker, they can have anesthesia, and it’s over in a set time,” she said. “Medication can feel more private, some want it in their homes, some say it feels more natural to them, and some say it feels more possible to deal with a loss.”

Medical abortion is also used illicitly by those who live in a location that restricts legal abortion or by those who cannot get to a clinic. The abortion rate in the United States is higher than officially reported by doctors, according to evidence, because people order pills online. That invisible abortion rate could increase if more states decide to ban abortion – the bans would apply to both surgical and medical abortions.

Doctors with special registration required by the FDA

But he recently lifted rules which required an in-person appointment. This means more providers are offering medical abortions through telemedicine. The doctor and the patient meet online and then the doctor sends pills to the patient’s home by post. (Some physical pharmacies are 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 started offering the service in states that allow it. But 19 states ban pills to be prescribed by telemedicine or delivered by mail. In these places, patients should always see a doctor in person to pick up the pills. Other states prohibit medical abortion after a certain number of weeks.

If Roe is overturned, about half the states would have to completely ban abortion. These laws will affect all methods of abortion, including procedural abortions and pills.

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

The FDA asked these groups to stop the sale of these drugs in the United States, claiming they circumvent US drug safety protocols. But researchers who analyzed the pills in labs found that pills ordered using these services are usually 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 needs to be taken more than once. This pill is also used to treat ulcers and is available without a prescription 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 licensed physician in the United States. But enforcement from foreign suppliers has been sparse, as is the case with other drugs Americans order from abroad. And sales would be hard to stop because the drugs usually arrive in unmarked packages in the mail.

“I’m not here, so I have no legal risk,” said Dr Rebecca Gomperts, the Dutch doctor who runs Aid Access, and says she has lawyers advising her, both at home and in the USA. “I know where I am from, I respect the law.”

In general, recent state laws do not punish women for obtaining abortions, but have focused their enforcement on abortion providers. The exception is the older laws of South Carolina, Oklahoma, and Nevada. That could change if Roe is overthrown and if illicit medical abortions become more common. These last months, some states have moved increase criminal penalties for prescribing, supplying or delivering pills.

“It is not a codified crime to self-manage abortion” in all but these three states, said Farah Diaz-Tello, senior attorney and legal director of If/When/How, a policy and advocacy group. defense of reproductive rights. “But it’s not legal for a person to ask for prescription drugs without a prescription.”

The first pill, mifepristone, usually has no noticeable effect on patients. The second, misoprostol, taken 24 to 48 hours later, causes cramping and bleeding that intensifies, Dr. Rodriguez said.

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

In rare cases, less than 1% of the time, a patient bleeds more than expected and requires medical attention. Also, rarely, the abortion is not complete and must be followed by another dose or surgical abortion. Women who have these complications can be treated by a doctor experienced in the treatment of miscarriages; symptoms and treatment are the same. Once a medical abortion is started, it cannot be reversed.

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Newsrust - US Top News: Medical abortions are on the rise: what they are and where women are getting them
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