What you need to know about abortion pills since Roe v. Wade fell

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The repeal of the Supreme Court Roe v. calf has brought about a series of changes to abortion laws across the country, opening the gates to litigation in states with or without “trigger bans” on the procedure.

On Friday, President Joe Biden signed an executive order protecting access to reproductive health services, but the effort does little for people in states that have already banned abortion.

Now, medical abortion—the termination of pregnancy through the use of drugs—is at the center of abortion treatment issues.

Why are people talking about this now?

As of 2020, abortion pills were used in more than half of abortions in the United States, according to data from the Guttmacher Institute, a research organization that advocates for abortion rights.

After this Dobbs v. Jackson Women’s Health Organization decision that was overturned roedemand for abortion pills has continued to rise as some Republican lawmakers seek to limit access in the future.

How do medical abortions work?

The most common medical abortion regimen uses two drugs, mifepristone and misoprostol.

The Food and Drug Administration approved mifepristone in 2000, then the two-drug protocol in 2016, to terminate early pregnancies. It can be used up to 70 days or 10 weeks of gestation beginning on the first day of a person’s last menstrual cycle. The protocol involves taking mifepristone on day one, then misoprostol 24 to 48 hours thereafter.

The protocol can be performed at home, said Holli Jakalow, a professor of obstetrics and gynecology at Columbia University’s Irving Medical Center. She added that four weeks after the cycle, patients can consult a provider or take a pregnancy test to check success.

Mifepristone blocks the hormone progesterone, preventing the uterus from supporting pregnancy, Yakalow said. Misoprostol then causes the uterus to contract and push out the pregnancy.

“People can safely take these pills and get through the pregnancy safely at home and not have problems like bleeding or urgent medical care,” said Emily Godfrey, a primary care physician and family planning researcher at the University of Washington School of Medicine. “It’s a very, very sure way of going through a pregnancy.”

Yakalow added that in cases where mifepristone is not available, it is possible to follow a medical abortion protocol with misoprostol alone. Both mifepristone and misoprostol require a prescription from a certified healthcare provider.

World Health Organization guidelines state that misoprostol alone can be used for medical abortions in pregnancies up to 12 weeks or 84 days gestation. It can also be used in pregnancy longer than 12 weeks, but in different dosages.

Stephanie Rand, a New York-based gynecology and family planning specialist, said people typically don’t experience symptoms after the first medication, but experience cramping and bleeding after taking misoprostol throughout the pregnancy.

Other possible symptoms within 24 hours of taking misoprostol include increased nausea and vomiting, diarrhea, fever and chills, Rand said.

In rare cases, excessive bleeding and infection may occur. In the case of mifepristone, the FDA has stated that the adverse events reported to the organizations “cannot be definitively attributed to the drug.”

Are medical abortions safe?

While anti-abortion activists question the safety of medical abortions, studies have shown that medical abortions are highly effective and have a low complication rate, particularly for first-trimester pregnancies. One study found over a five-year period that more than 13,000 women who took the two-drug regimen up to day 63 of pregnancy had high success rates.

The protocol terminated pregnancy in 97.7 percent of the group.

Although medical abortions are becoming more common, there are exceptions to the use of mifepristone that are outlined by the FDA, e.g. B. when a person has an ectopic pregnancy, has bleeding problems, or has an IUD.

Rand isn’t worried about the safety of the process — she’s worried about its legality.

“I’m not concerned about whether these drugs are safe for humans,” Rand said. “I worry: will people be safe or will they be criminalized?”

Are abortion pills still legal?

The short answer – it depends on where you live and it will be a subject of litigation in the future.

The Supreme Court decision placed discretionary powers over access to abortion in the hands of states. For people living in places with withdrawal bans — laws designed to ban abortions when roe would fall – Abortion by any method is illegal, with some exceptions dependent on state law.

Since the Supreme Court ruling, 15 states have banned or mostly banned abortion, which includes medical abortions, because trigger laws largely include drugs and drugs that terminate pregnancy in their definitions of abortion.

“It’s really up to the states how they want to make abortion unacceptable,” said Khiara M. Bridges, a professor at the University of California at the Berkeley School of Law.

Laurie Sobel, the associate director for women’s health policy at the Kaiser Family Foundation, said the upset roe has raised an open question as to who will be given the authority to regulate mifepristone for abortion — the FDA or states.

“We are in a certain gray area,” said Sobel.

How Were Abortion Pills Restricted Before?

Already before roe was struck down, many states had enacted laws that made specific requirements about the process of acquiring abortion pills, such as: B. advising patients. In five states, this counseling requires patients to be told that personality begins at conception, according to the Guttmacher Institute.

More than 30 states also allow only physicians to dispense mifepristone, according to an analysis by the Kaiser Family Foundation released in April.

Before the pandemic, mifepristone had to be picked up at hospitals, clinics, or doctor’s offices.

When the FDA lifted that requirement in December 2021, it allowed mifepristone to be prescribed through telemedicine appointments and shipped to patients in states where the drug was legal.

But that didn’t affect the 19 states that had already banned receiving medical abortion drugs through telemedicine appointments, according to Elizabeth Nash, a state policy analyst at the Guttmacher Institute.

Nash said she expects lawmakers to continue restricting medical abortions.

“My expectation is that states will try to enforce abortion bans to the greatest extent possible,” she said.

Can the federal government protect access to abortion pills?

While Dobbs The decision to allow states to restrict access to abortions leaves the looming legal crisis over abortion pills centered between state and federal agencies.

Attorney General Merrick Garland vowed to “protect and preserve access to reproductive care” in a statement issued after the Supreme Court ruling, specifically mentioning mifepristone.

“Specifically, the FDA has approved the use of the drug mifepristone,” Garland said in a statement. “States may not ban mifepristone based on disagreements with the FDA’s expert judgment as to its safety and efficacy.”

But Bridges, the UC Berkeley law professor, said that despite Garland’s testimony, the issue will likely be “a long-term struggle.”

“This statement is ambitious because this is a huge legal issue that needs to be brought to justice,” she said. “And the question is whether federal law would preempt state law on this issue.”

A federal court in Mississippi is considering that question. GenBioPro – which makes mifepristone – filed a lawsuit in 2020 challenging restrictions on medical abortions.

On Thursday, the company said FDA approval of the drug should override any government ban, citing Garland’s testimony, Reuters reported.

Evan Masingill, President of GenBioPro, said in a statement that the company believes in “reproductive autonomy.”

“Medical abortion treatment is safe and effective, and the FDA has established clear guidelines for administration, whether at a health center or home delivery,” Masingill’s statement said. “These guidelines should govern how medical abortion treatment is administered in all states, and we look forward to making that argument in court.”

The Justice Department declined to comment on the case.

Even with legal issues to be resolved, the Supreme Court decision has restricted access to abortion pills in the United States, causing some patients to travel across state lines for telemedicine appointments to access the drugs where they still are are legal.

The confusion surrounding the abortion pill has also fueled concerns about emergency contraceptives like Plan B. Emergency contraceptives, however, have nothing to do with abortion—they are taken to prevent pregnancy, not drive it out.

Health experts say the Supreme Court decision will lead to a rise in telemedicine consultations for medical abortions, buying the pills online and “self-administered” medical abortions — when someone searches for the medication and performs the protocol themselves.

“It’s already happened,” Sobel said. “That’s going to be very difficult to monitor or enforce state laws because it’s in the mail and mail is private.”

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