More than half of recent abortions in the U.S. were carried out by medication abortion. The Food and Drug Administration permanently allowed patients to obtain abortion pills through Telehealth and mail delivery in December 2021, but accessibility still depends on which state a patient lives in. If the Supreme Court decides to overturn the landmark Roe v. Wade decision on the right to abortion, medication abortions are expected to increase even more if access to abortion clinics is threatened. 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.
- 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 and 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. Medication abortions are now the most common types of abortions. Our most recent data available is from 2020, and we've learned that medication abortion accounts for 54% of all abortions.
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.
The FDA approved mifepristone and misoprostol, the two medications in a medication abortion, in the year 2000. They recently updated these approvals in 2016, and they are continuously updating the protocols to provide them. Medication abortion is extremely safe. We analyzed 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.
The safety profile of abortion pills are so safe, research is being conducted right now to determine whether they could eventually become over-the-counter. And our preliminary research suggests that it definitely has the potential to someday become over-the-counter.
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 pharmacies. So 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. 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.
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 in any medical evidence that they're necessary. In our research following patients of telehealth for abortion, some patients living in states where telehealth is restricted, they have been able to order the pills and have them delivered to a friend or a family member living in a state where 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. The legal risk is actually greater than any kind of medical risk.
If Roe v. Wade is overturned, states will be able to determine at what point in pregnancy they can ban abortion. And so some states will ban abortion altogether, but other states will do what Texas did and have about a six-week limit 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.
So as abortion becomes more legally restricted, I believe that abortion pills will have a greater role in getting people access to medical abortion care as quickly as possible.