It has been almost 50 years since the Supreme Court Roe vs. Wade The ruling confirmed that pregnant people have the constitutional right to choose abortion – and for so many years, opponents have attempted to undermine that right through court challenges and restrictions.
Now, new laws in Texas and Mississippi, and another upcoming Supreme Court ruling, could make access to a safe and legal abortion nearly impossible in many states.
These legal challenges and restrictions throw a more in-depth look at mifepristone and misoprostol, the two-drug combination that can be used for medical abortion.
“Abortion pills,” which can be prescribed during a telehealth visit and sent by mail under certain circumstances, are an important alternative to a surgical abortion, especially for people in states without access to an abortion clinic. .
This Thursday, the FDA permanently eased restriction on sending abortion pills to the sick. The news comes as anti-abortion groups mount several legal challenges to how people access these drugs,
According to the American College of Obstetricians and Gynecologists (ACOG), about 1 in 4 women abort before the age of 45. About 40% do it with medication rather than surgery in a clinic, as do 60% who have an abortion before 10 weeks gestation. Medicines are a safe and effective way to have an abortion.
Note that we didn’t say easy – the rules for medical abortions have been strict since mifepristone was first approved over 20 years ago. They are governed by something called REMS, which stands for risk assessment and mitigation strategy. This is a safety plan put in place by the FDA that traditionally meant that only certain providers, usually in abortion clinics or hospitals, could administer the drug, and only in person.
In 2020, due to the pandemic and a lawsuit by medical groups including ACOG, the government relaxed REMS restrictions so people can get abortion drugs by mail after an appointment. of telemedicine with a certified provider. Now, the FDA has eased this restriction permanently, which means abortion drugs can be mailed to patients in states that allow them.
More … than 60 drugs have REMS, but experts say mifepristone is on the list for largely political, not medical, reasons.
“We have decades of evidence supporting that mifepristone is safe and that these additional restrictions are unnecessary and are not based on science,” said Nisha Verma, Darney-Landy member of ACOG.
“ACOG very strongly supports lifting these regulations for good,” Verma said, and the group has submitted letters to the FDA with supporting data and evidence.
Now that medical abortions will be permanently available by mail and telemedicine in most states, here’s what you need to know about them and how access may change.
what is a medication Abortion?
A medical abortion is a combination of mifepristone and misoprostol. Mifepristone (the brand name is Mifeprex) blocks the hormone progesterone, which a pregnancy needs to continue. The misoprostol then causes the uterus to contract and the pregnancy to come out.
Mifepristone was approved by the FDA in 2000, after years of intense debate and controversy over the drug, which was previously called RU-486. Mifepristone is sometimes used off-label (or not for FDA-approved use) to treat fibroids, endometriosis, brain tumors, and other types of cancer.
First approved in 1988, misoprostol is also used to treat miscarriages and stomach ulcers, as well as sometimes to induce labor and reduce bleeding after childbirth.
How do you take Abortion pills?
Basically, you take one tablet of mifepristone, followed by misoprostol 24 to 48 hours later.
Health care providers may also prescribe antibiotics and anti-nausea medications at the same time to treat side effects.
The FDA has approved mifepristone and misoprostol to induce an abortion if used within the first 70 days after the first day of your last period, or in the first 10 weeks of pregnancy.
Verma said they are sometimes used for up to 11 weeks by providers because research suggests they are still safe and effective.
The REMS restrictions on medical abortions have made it more difficult for people to reach that window of effectiveness, she said. In Georgia, half of all women live in one of the 96% of counties that do not have an abortion clinic or provider who can dispense the pills, Verma said.
This means that before the pandemic, many people had to travel long distances, find transportation and childcare, and take time off work to access the pills, even though “we know we could just as well. easily, securely and efficiently send them to them by mail. ,” she said.
The lifting of the restrictions made it easier to view patients via telehealth and mail medications.
Is abortion medications available in every state?
No. Verma noted that even with the FDA’s easing of the restriction, not all states will allow the drug to be mailed.
States can pass laws that still restrict the use of mifepristone, which would override the FDA’s lifting of the restriction on sending the drug. “It is definitely a concern,” she said. “Some states already have laws in place that prevent sending mifepristone by mail or telehealth for an abortion.”
Already, 19 states require people to be physically present to obtain a medical abortion, which effectively prohibits the acquisition of the drug by telemedicine and by mail.
Which shouldn’t have a medical abortion?
If you have an IUD, it must be removed before you take mifepristone. Some people should not take the drug, especially those who have an ectopic pregnancy, bleeding problems, are taking blood thinners, or have an allergy to the drugs.
The drug is also not recommended if you are currently taking long-term corticosteroids, which are anti-inflammatory drugs; have problems with your adrenal glands; or have inherited porphyria, a group of conditions that lead to a build-up of chemicals in the body that are bound to proteins in red blood cells.
What are the side effects?
Side effects of the procedure include cramping and bleeding, much like a miscarriage.
The bleeding may be heavier than a period and you may have large blood clots; you may also have nausea, diarrhea, fever, or chills.
is a drug asafe abortion?
Yes. Medical abortions are “very, very safe,” Verma said. “Part of what’s so frustrating about these additional regulations on mifepristone is that they feel very much based on policy and not science and evidence.”
There are other drugs with similar safety profiles that are not regulated in this way, she said. A study published in December in the New England Journal of Medicine seems to emphasize the safety of drugs.
Laura Schummers, postdoctoral fellow in the Department of Family Medicine at the University of British Columbia in Vancouver, and colleagues looked at abortions in Canada before mifepristone became available and after similar restrictions on mifepristone were lifted in November 2017.
Canada was the first to lift restrictions and treat the drug like any other drug. That means any doctor or nurse practitioner can prescribe it, and it can be dispensed at any pharmacy and taken at home, Schummers said.
In the United States, there are still additional restrictions that have not been lifted – for example, drugs cannot be prescribed by just any doctor – only people with special certification can provide it. You still cannot fill a prescription for the drug at all retail pharmacies (those that dispense the drug must be certified), and additional consent forms may be required from providers and patients.
In Canada, researchers found that the safety of abortion did not change after all restrictions were lifted, according to the study.
“So that means the abortion was safe to start with, with very rare adverse events or complications, and remains safe after this big regulatory change,” Schummers said.
How can you access these drugs?
For more information, Planned Parenthood offers information on where you can get abortion pills.