Abortion Pills Are Used For Most U.S. Abortions. What Are They?
The draft Supreme Court decision overturning Roe v. Wade means abortion access is once again in jeopardy. Nearly half of U.S. states will immediately ban abortion upon a Roe v. Wade overturn.
Medication abortion, or abortion by pill, is currently the most common method of abortion in the United States. In 2020, 54% of abortions in the United States were medication abortions, according to research from the Guttmacher Institute.
If the Supreme Court decision is overturned, it’s expected that the ease and convenience of an abortion pill may make medication abortion an even larger share of all abortions nationwide.
Ira talks with Ushma Upadhyay, associate professor of obstetrics, gynecology and reproductive sciences at Advancing New Standards in Reproductive Health at UC San Francisco. Upadhyay explains how medication abortion works, how its regulated, and its role in a possible post Roe v. Wade era.
What is medication abortion?
Medication abortion is the combination of two medications that induce abortion. The first is mifepristone (Mifiprex), a pill that blocks the hormone that allows a pregnancy to grow, and the second is misoprostol (Cytotec), which are tablets that cause the cervix to dilate and the uterus to contract. The pregnancy is expelled from the vagina.
What’s the difference between medication abortion and Plan B?
Plan B, or emergency contraception, is taken within the first 72 hours after unprotected sexual intercourse. Medication abortion is a set of medications that someone takes to end a pregnancy after they’ve determined that they’re already pregnant.
The FDA has approved its use in pregnancies up to 10 weeks, but research shows that medication abortion is effective at up to 12 weeks of pregnancy, “and actually, it’s even effective beyond that,” said Upadhyay, but more doses of the misoprostol is needed further along in the pregnancy for it to be most effective.
Is medication abortion available via telehealth?
Yes, although 19 states have outlawed telemedicine abortions.
What is the process like to get prescribed a medication abortion through a telehealth appointment?
The patient can go to a virtual clinic website to begin the process. Some providers offer secure messaging, so the patient doesn’t have to communicate over video or phone. From there, the clinician will determine if the patient is eligible, and if they are, they will be sent a packet of abortion medications by mail.
After one week, the provider will follow up with the patient to check on expected symptoms, like bleeding and cramping. At four weeks, the patient will take an over-the-counter pregnancy test to ensure the abortion was successful (the pregnancy hormone remains in the urine for a few weeks after termination).
If someone is living in a state where medical abortion isn’t legal, can they go to a state where it is legal and receive the prescription that way?
Upadhyay leads a research study called the CHAT (California Home Abortion by Telehealth) Study. Patients in her study have traveled across state borders to receive consultations, and receive abortion pills at a post office box or other place where they could receive mail.
She notes that one patient in Texas had medications mailed to a friend in a state where abortion pills are legal, and then the friend mailed the medications to her in Texas.
“Patients are starting to get creative about getting these medications,” she said.
What about websites that ship abortion pills from overseas?
It is technically illegal for Americans to order prescription drugs from abroad. However, the ability of the federal government to restrict mail-order prescriptions is limited, and exists in somewhat of a legal gray area.
However, some states are looking to crack down on the shipment of abortion pills from abroad.
Aid Access is a telehealth provider of medication abortion based in Europe, which makes their services available where abortion is limited by law, including in the United States. Aid Access provides the same abortion medications available in the United States, just shipped from India, which takes longer to arrive by mail.
“It is highly trustworthy,” said Upadhyay, though she adds “the legal risks are much greater than any type of safety concern.”
A recently passed Connecticut law protects providers who prescribe medication abortions. What protections does the bill offer?
“I was very excited to see that Connecticut law passed,” said Upadhyay.
The law protects abortion patient’s records from discovery by other states who are tyring to prosecute people seeking abortion. And besides protecting providers who are caring for patients in other states, it also protects those providers from being extradited to other states for prosecution. “I would really love to see states that care about protecting abortion access implementing similar laws,” she said.
How would an overturn of Roe v. Wade effect access to medication abortion?
When Texas banned abortion after 6 weeks of pregnancy in September of 2021, there was a spike in those seeking medication abortions. Daily requests increased by 1180% in the week after the bill was passed.
Upadhyay views medication abortion as primary care. “Special equipment and tests are no longer needed, and any primary care provider could offer medication abortion to their patients,” said Upadhyay.
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Ushma Upadhyay is an associate professor of Obstetrics, Gynecology and Reproductive Sciences at Advancing New Standards in Reproductive Health, UC San Francisco in San Francisco, California.
IRA FLATOW: This is Science Friday. I’m Ira Flatow. The draft Supreme Court decision overturning Roe v. Wade means abortion access is once again in jeopardy. What you may not know is that medication abortion– and by that, I mean abortion by pill– is actually the most common method of abortion in the US. While almost half of the states will immediately ban abortion upon a Roe v. Wade overturn, it is expected that the ease and convenience of an abortion pill may make medication abortion an even larger share of all abortions.
Joining me now to help explain how medication abortion works, how it’s regulated, and its role in a possible post Roe v. Wade world is my guest Ushma Upadhyay, PhD, associate professor of obstetrics, gynecology, and reproductive sciences at Advancing New Standards in Reproductive Health at UC San Francisco. Welcome to Science Friday.
USHMA UPADHYAY: Thank you so much for having me. I’m a huge fan.
IRA FLATOW: Oh, thank you very much. All right, let’s start with the basics. What is medication abortion? How does it work?
USHMA UPADHYAY: Medication abortion is the use of two medications. The first is mifepristone, and this is a pill that blocks the hormone that allows a pregnancy to grow. And then the second is misoprostol. And these are tablets that cause the cervix to dilate and for the uterus to contract, and then it expels the pregnancy.
IRA FLATOW: Now, many people are familiar with another pill called Plan B, which is an emergency contraceptive. This is not the same thing, is it?
USHMA UPADHYAY: That’s correct. Plan B, or emergency contraception, is taken within the first 72 hours after unprotected sexual intercourse. So there’s a small window to take that. Medication abortion is a set of medications that someone takes to end a pregnancy after they’ve determined that they’re already pregnant.
IRA FLATOW: And this can be used early on in pregnancy?
USHMA UPADHYAY: Yes. It is currently approved by the FDA up to 10 weeks. But science, research, shows that it is effective up to 12 weeks. And actually, it’s even effective beyond that, but more doses of the misoprostol, the second set of pills, is needed as a person is further along in pregnancy for it to be most effective.
IRA FLATOW: You know, many people may not realize, as I said at the beginning, how common medication abortions are. We think of abortion as a procedure only done in a clinic. How many abortions are performed via medication?
USHMA UPADHYAY: That’s right. I do believe that many people don’t even know that medication abortion is a thing, that people can have this option. Currently, our latest data available, from 2020, finds that 54% of all abortions are medication abortions.
IRA FLATOW: More than half.
USHMA UPADHYAY: Yeah.
IRA FLATOW: Now, due to the pandemic, in 2021, the FDA authorized people to get a prescription for abortion pills through telehealth. How widely is this available?
USHMA UPADHYAY: Currently, telehealth is available in 22 states. And this allows people to have a medical consultation with a clinician remotely. And they can receive their medications by mail.
IRA FLATOW: Can you go into the clinic? I mean, what happens during an in-person consultation for abortion medication?
USHMA UPADHYAY: They often get tests, like an ultrasound, and they are assessed for eligibility to ensure that they’re within the first 12 weeks of pregnancy. And it’s also done to ensure that the pregnancy is not ectopic. And that means that it hasn’t implanted outside the uterus, which is a very rare occurrence. More and more clinics are omitting those additional tests because our latest research shows that those tests are not necessary, that they don’t result in increased efficacy or safety rates.
IRA FLATOW: So people can sort of assess their pregnancy, possibly when it began and maybe missing a period?
USHMA UPADHYAY: Yeah, that’s right. There’s been a few papers published showing that people are very accurate in determining how far along they are in pregnancy. So people keep track of their menstrual periods now. There are so many apps available. We can trust people to know their bodies, to know how many weeks pregnant they are. And really, providers are just ensuring that they’re less than about 11 or 12 weeks of pregnancy.
IRA FLATOW: OK. So what does a telehealth appointment to receive medication abortion look like?
USHMA UPADHYAY: A patient will go to one of the virtual clinic websites. Some will offer a secure messaging way of communicating. So a person doesn’t even have to have a video or a phone. And the clinician will determine whether the patient is eligible. And if they are, they will be sent a packet of abortion medications by mail.
And then at about one week, the provider will follow up with the patient, ensure that all of the symptoms that they were expecting occurred, that she had the expected amount of bleeding and cramping. And then at about four weeks, the patient will take an over-the-counter pregnancy test to ensure that the abortion was successful. And it takes about four weeks because pregnancy hormone remains in the urine for a few weeks afterwards.
IRA FLATOW: And what about if someone lives in a state where a medical abortion prescription is not legal? Can they go to a state where it is legal and do telehealth?
USHMA UPADHYAY: Yes. We have a study where we are following patients of these virtual clinics. It’s called the CHAT study. And we have reports of patients who have traveled across the border to have their consultation and receive the abortion pills at a post office box or other place where they could receive mail. Patients are starting to get creative about getting these medications.
IRA FLATOW: And unfortunately, that’s the word. You have to be creative.
USHMA UPADHYAY: Yes. Yes, that’s right.
IRA FLATOW: Yeah, and you recently conducted research about the safety of prescribing abortion pills with an in-person exam versus telehealth. And what did you find?
USHMA UPADHYAY: What we did is we collected data on almost 4,000 patients across the US from 14 different clinics. And we assessed the efficacy and safety of these medication abortions. So about a third received them through telehealth, and the remaining received them in the clinic. But none of the patients actually ever had an in-person exam or an ultrasound. In fact, some clinics were even offering medication abortion with curbside pickup, and that would be after a telehealth consultation with a clinician.
And we found, overall, very high safety and efficacy rates, similar to our previous studies. 95% were completed without any additional medical intervention. And 99% experienced no serious adverse events.
IRA FLATOW: Now, I understand that there are other means for people to access medication abortion outside from getting them from doctors in the US. Can you tell me about how the site Aid Access works?
USHMA UPADHYAY: Aid Access is a telehealth provider of medication abortion that is based in Europe. And they make their services available to places where abortion is limited by law. And within the last year, they’ve begun to offer medication abortion access for people in the United States.
So it is a clinician in Europe. It is highly trustworthy. The medications are the same medications that are FDA approved. And it’s just that they are coming from another country, so it does take a little bit longer to arrive to the United States.
And then, also, the downside is that it opens a person up to criminalization. There are legal risks to ordering through Aid Access. And the legal risks are much greater than any type of safety concern. These methods are very safe and effective.
IRA FLATOW: Speaking of legal risks, I know that states like Connecticut have already passed a law protecting doctors who prescribe medication abortions. What’s in the law? How will it and other regulations like that regulation affect access to abortion, especially in states where abortion may be banned or severely limited?
USHMA UPADHYAY: I was very excited to see that Connecticut law passed. It protects abortion patients’ records from discovery by other states who are trying to prosecute people seeking abortion. And then, as you said, it protects providers who are caring for patients in other states from criminal and civil liability. And it protects those providers from being extradited to other states for prosecution, and so that is so important.
And I would really love to see other states that care about protecting abortion access implementing similar laws, and if they could also add the additional protection for telehealth, specifically protecting doctors from offering the same telehealth services that they can offer within their state to patients in other states. And then the only issue is that patients are opened up to legal risks. And my concern is that people of color will be targeted because of the system. And if anyone goes to a clinic or an emergency department just because they need care, they have questions, they could be singled out and prosecuted.
But one thing I’ll note is that if someone goes to an emergency department, there is no test that they can do to determine whether she took these medications. And so they don’t have to reveal that they took them if they feel that it will open them up to legal risk.
IRA FLATOW: So if Roe v. Wade is overturned, how would that impact access to medication abortion?
USHMA UPADHYAY: Well, we see the science really supports more expanded models of care for medication abortion. So I think that now that we know that special equipment isn’t needed, special tests are not needed, any primary care provider could offer medication abortion to their patients. So as this method evolves, patients will no longer have to drive to an isolated abortion clinic. So there’s really a lot of progress that we can make in making abortion pills more accessible and more commonplace and hopefully less stigmatized in the long run.
IRA FLATOW: Thank you very much for filling us in.
USHMA UPADHYAY: Thank you so much for having me.
IRA FLATOW: Ushma Upadhyay is associate professor of obstetrics, gynecology, and reproductive sciences at Advancing New Standards in Reproductive Health at UC San Francisco.
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