Medication Abortion

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.

In many places around the world where abortion is legally restricted or prohibited and clinical access is unavailable, women often obtain and use misoprostol alone to safely and successfully end an unintended pregnancy without talking to or seeing a healthcare provider. Use of misoprostol alone has been found to have a range of 75-90% effectiveness for induced abortion. Anecdotal evidence and a recent study suggest that some women in the United States have used misoprostol to self-induce an abortion as well, and perhaps even more so in the face of numerous abortion clinics recently being shut down by politicized overregulation. Prosecutors and legislatures have begun targeting people who self-induce abortion, using a wide variety of laws. In response to this increased criminalization of self-induced abortion, RHTP joined with a consortium of organizations to form the Self-Induced Abortion (SIA) Legal Team. The SIA Legal Team is committed to working to ensure that people who choose, for whatever reason, to end their pregnancies outside the medical system can do so without fear of punishment or denial of follow up health care should they need it. Although misoprostol was approved by the Food and Drug Administration to reduce the risk of gastric ulcers, it is also commonly used off-label for a variety of other reproductive health purposes, such as inducing labor, softening the cervix prior to a medical procedure like an IUD insertion, conducting an endometrial biopsy, and reducing postpartum hemorrhage.