Medication abortion, also known as medical abortion, is one way to terminate an early pregnancy using pills. Medication abortion should not be confused with emergency contraception (i.e.the “morning after pill”). Emergency contraceptive pills (ECPs) are the most common method of preventing pregnancy after unprotected sexual intercourse. The use of ECPs does not cause an abortion. If a woman wants to prevent pregnancy after sex, she can use ECPs. If a woman wants to terminate an established pregnancy at an early stage of gestation, she can use medication abortion.
The drugs most commonly prescribed for medication abortion are mifepristone (brand name Mifeprex®,previously known as “RU-486”) in combination with misoprostol (brand name Cytotec®). Mifepristone blocks the hormone progesterone, which is needed to maintain a pregnancy, and misoprostol causes the uterus to contract and expel the pregnancy. This regimen is extremely safe and 95-98 percent effective in ending a pregnancy without clinical intervention. Furthermore, studies show that patients who use medication abortion find it to be acceptable and choose this option because they consider it to be less clinical and invasive than other options.
According to the Guttmacher Institute, in 2011 an estimated 36 percent of those who fit the criteria for medication abortion decided to use this method. The baseline mifepristone plus misoprostol protocol for pregnancy termination was originally approved by the US Food and Drug Administration (FDA) in 2000. Following that approval, clinical practice evolved, as it does across all health care fields, to incorporate evidence-based improvements to the regimen outlined in the FDA label.
The FDA revisits drugs’ original labels only occasionally, relying upon evidence-based medical practice to ensure that providers administer drugs a drug’s original label. However, in March 2016 the FDA completed its first update of the mifepristone label in 15 years. Among other things, the new label indicates medication abortion is approved from the time a woman confirms she is pregnant up through 10 weeks LMP; that non-physician providers can administer medication abortion; and that pregnancy termination can be confirmed without a patient having to return for a follow up examination. Although the FDA’s approval of an updated label better approaches evidence-based practice of medicine, a number of unnecessary FDA restrictions remain which, especially in combination with politically motivated state laws further restricting medication abortion, still limit access to medication abortion.
RHTP worked tirelessly first to bring medication abortion to the United States and later to bringing policy in line with research and practice and, in doing so, expanding access to abortion care. Telemedicine (i.e. medical care provided via video conference or other communications technology) has increasingly been used to improve access to medication abortion, as well as other types of reproductive health care, especially for patients in rural communities. Unfortunately, abortion opponents have pursued a number of strategies to limit women’s access to medication abortion. Such restrictions generally focus on limiting how medication abortion can be prescribed and/or provided. These efforts single out this safe and effective way to end a pregnancy in the first trimester and treat it differently than other types of health care despite having no scientific or clinical basis for such measures.