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Abortion Pill Access in the United States

 Brooke Karmie  |  03 June 2021

The abortion pill, otherwise known as medication abortion or chemical abortion, is the termination of a pregnancy by using two drugs known as Mifepristone and Misoprostol. First, Mifepristone is taken orally to block progesterone, a hormone necessary to support a baby's growth throughout pregnancy. Then, 24-48 hours after, the first pill is followed by Misoprostol, a drug used to induce labor and, in this case, to cause the uterus to contract and expel the embryo.[1]

Chemical abortions have been approved by the Federal Food and Drug Administration since 2000.[2] They accounted for 39% of all abortions in 2017, a drastic jump from 29% in 2014 and just 5% of abortions in 2001.[3] Keep in mind the United States does not have consistent reporting requirements for abortion, which means the actual number is likely much higher as some states are not required to report at all.

 

To put that into numerical perspective, in 2017, an estimated 862,320 abortions were performed in the United States.[4] This means that around 336,304 abortions were performed using the abortion pill.

 

Chemical abortions have increased steadily since the FDA approval in 2000 due to a shifting legal landscape for the abortion industry and various factors. In recent years the rise in access to the abortion pill is largely due to greater access through telemedicine and limited regulations.

 

Much like the abortion reporting laws in the United States, regulations on the abortion pill are inconsistent and vary from state to state.

 

The biggest regulations regarding the abortion pill involve: when the abortion pill can be given, who can administer the pill and various abortion pill provider requirements.

 

The abortion pill can be given up to 77 days or 11 weeks into pregnancy in the United States.[5] In 33 states have "physician-only" laws requiring the abortion pill be administered by a doctor, whereas 17 states allow any advanced practice clinicians, such as nurse practitioners, physician assistants, and midwives, to administer.[6]

 

Due to the FDA's implementation of a Risk Evaluation and Mitigation Strategy (REMS) for chemical abortions, unlike most medications, Mifepristone can only be obtained from medical providers who have been certified in the REMs. They must become a certified prescriber confirming they are (1) able to assess the duration of a pregnancy, (2) diagnose ectopic pregnancies, and (3) provide surgical abortion in the case of an incomplete abortion. The REMs also requires that the provider obtain a signed Patient Agreement Form from any patient before providing her with the pill.[7]

 

Though the regulations of the abortion pill are minimal, several organizations and groups such as the American Civil Liberties Union have filed suits against the FDA challenging the requirements, stating that they are “burdensome” on patients.[8]

 

Most significantly, in July of 2020, a federal district court required the FDA to suspend the REMs regarding chemical abortions throughout the pandemic as the case continued through the courts. The Trump Administration successfully appealed this rule, and the REMs were reinforced.[9]

 

The court battles are continual, especially as we see the growth of telemedicine, or the purchase of drugs like Mifepristone over the internet, virtually, or by phone and receiving it in the mail.

 

The lines continue to be blurred on regulations regarding the abortion pill. With the current administration, we will likely see loosened federal regulations, potentially the suspension of REMs, and the increased allowance of abortion pill access through telemedicine.

 

Loosened regulations on the abortion pill literally opens the door to more risks and dangers to women; Planned Parenthood, the nation’s largest abortion provider, states on their website that after taking the abortion pill, “you may feel tired or crampy for a day or so, and you’ll have bleeding and spotting for a while. Most people go back to normal activities the day after a medication abortion.”[10] However, they fail to mention that the “bleeding and clotting” women experience after taking the pill is debilitating, and the clots are often lemon-sized. Side effects, as they mentioned, can last "awhile," which can mean from a few days to several weeks.[11]

 

Planned Parenthood also states on their website that, “you can go back to work, school, driving, and most other normal activities the next day [following the abortion pill] if you feel up to it,”[12] but again fail to mention that the abortion itself can take as long as several days to occur.

 

Other life-threatening complications that may arise after taking the chemical abortion pill include: incomplete abortion, uterine damage, infection, and septic shock.[13]

 

The REMs were put in place by the FDA due to the severity of the risks involved in chemical abortions. Suspending the REMs and loosening restrictions not only dismisses the severity of the pill and its side effects but poses an even greater risk to women.

 

Access through telemedicine and without the requirement of certified administers means that women will be taking the abortion pill without direct consultation, without certified instruction and risk awareness, and there will be no required follow-up.

 

Loosened restrictions mean that women will be administering their abortion alone, and they will be left to deal with the often severe and sometimes life-threatening side effects alone in their homes, schools, places of work, or anywhere else they choose to take the pills.

 

The lack of regulation and potential loosened restrictions poses a profoundly alarming threat to the health and safety of the women in our society, and we need to be aware of the increasing access and decreasing regulations of the abortion pill in the United States.

 

__________________________

[1] https://www.oasismedicaltn.com/the-abortion-pill

[2] https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information

[3] https://www.guttmacher.org/report/abortion-incidence-service-availability-us-2017

[4] "Induced Abortion in the United States." Guttmacher Institute. September 2019.

[5] https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information

[6] https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion/

[7] https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information

[8] https://www.aclu.org/legal-document/chelius-v-azar-complaint?redirect=legal-document/chelius-v-wright-complaint

[9] https://www.acog.org/-/media/project/acog/acogorg/files/advocacy/pi-order-medication-abortion-71320.pdf?la=en&hash=D20597427CA8EBEA568D45EB9672AA80

[10] https://www.plannedparenthood.org/learn/abortion/the-abortion-pill/what-can-i-expect-after-i-take-the-abortion-pill

[11] https://willowwomenscenter.org/2019/05/29/risks-taking-ru486-pill/

[12] https://www.plannedparenthood.org/learn/abortion/the-abortion-pill/what-can-i-expect-after-i-take-the-abortion-pill

[13]  https://willowwomenscenter.org/2019/05/29/risks-taking-ru486-pill/

Brooke Karmie

Development Coordinator

Cleveland Pregnancy Center