Abortion Pills Now Account for the Majority of All Terminated Pregnancies in the U.S.

COVID-19 prompted a "sea change" in health care delivery, including driving an increase in medication abortions.

Abortion Pills Now Account for More Than Half of All Terminated Pregnancies
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Far more patients are turning to medication abortions—more commonly known as the "abortion pill"—than procedural abortions, according to preliminary research released last week. The trend, according to experts, has been at least partially fueled by the COVID-19 pandemic and abortion restrictions.

The new data comes from the Guttmacher Institute, a U.S. organization that supports sexual and reproductive health rights. The research shows that medication abortion—specifically abortion pills prescribed and taken under the care of a doctor—accounted for 54 percent of all abortions in 2020, up from 39 percent in 2017.

"The COVID-19 pandemic brought about a sea change in health care delivery, including providers' and patients' increased use of telehealth for contraceptive and abortion care," Jesse Philbin, senior research associate at the Guttmacher Institute and co-author of the report, told Health.

In April 2020, the U.S. Food and Drug Administration (FDA) announced it would allow abortion pills to be mailed to patients for the duration of the pandemic—a decision that was made permanent in December 2021. "This action meant patients could obtain an abortion without making one—or several—in-person visits to a health care facility and risking unnecessary exposure to COVID-19. The change also allowed online-only abortion providers to mail pills to patients in more states," said Philbin.

The landscape of abortion rights across the country has also been shifting significantly over the past year or more, which may also be contributing to the uptick in use of the abortion pill. From Mississippi to Texas (where near total abortion bans have been put in place) and beyond, a record number of states moved to restrict access to abortions in 2021.

In total 106 abortion restrictions were enacted across 19 states in 2021, according to Guttmacher Institute data. In a December media interview Guttmacher Institute's principal policy associate of state issues, Elizabeth Nash, described 2021 as the worst legislative year for U.S. abortion rights since Roe v. Wade. Last year also saw the U.S. Supreme Court, which now has a 6-3 conservative majority, take up two separate cases that could uphold restrictions on abortion rights. It is amid this backdrop that an increasing number of patients are turning to the abortion pill.

"The availability, efficacy, and safety of medication abortion has expanded abortion care in the United States," Marielle Kirstein co-author of the Guttmacher Institute, told Health. "In rural areas, and areas that are underserved by providers, medication abortion can save a patient hundreds of miles of travel and decrease logistical costs associated with accessing care. In states with fewer restrictions on abortion care, online pharmacies and the ability to have a provider mail medications directly to patients may make medication abortion more accessible for many patients."

Still, experts caution against viewing the abortion pill as a solution to abortion bans. Furthermore, the crackdown on abortion rights in this country is merely one of many considerations that may be triggering increased use the abortion pill.

Why More People Are Using the Abortion Pill

The Guttmacher Institute says there are several reasons why the abortion pill is growing in popularity. In addition to minimizing exposure to COVID from attending in-person appointments, the following factors have contributed to the uptick in medication abortions, said Philbin:

  • Provision of procedural abortions (also known as surgical abortions) was temporarily restricted in some states, due to concerns around the pandemic.
  • Medication abortion can be completed outside of a medical setting, and in the comfort and privacy of one's home.
  • Pills can be provided at a clinic or delivered directly to a patient through the mail.
  • In rural or underserved communities, medication abortion can save a patient hundreds of miles of travel.

However both Philbin and Kirstein pointed out that medication abortions are not an option for significant numbers of patients.

To begin with, medication abortions are only available to those seeking care in their first trimester. In addition, abortion restrictions continue to hamper the delivery of medication abortion. In 19 states, telemedicine visits for medication abortion are still banned "despite the preponderance of evidence, such as the recent FDA guidance, that this method is highly safe and effective. State policies play a huge role in determining the accessibility of abortion care, including for medication abortions," Philbin said.

Kirstein added that while expanding access to abortion pills is important, medication abortion will not provide a solution to abortion bans.

How Safe Is the Abortion Pill?

Nisha Verma, MD, Darney-Landy fellow at the American College of Obstetricians and Gynecologists, said that decades of data demonstrate that medication abortion—which involves a two-pill dosage—is safe and effective.

For instance, a UC Davis systematic review found that outpatient medical abortion regimens with mifepristone followed in 24 to 48 hours by buccal misoprostol are highly effective for pregnancy termination through 63 days of gestation.

"Abortion is one of the safest medical interventions, and medication abortion is highly safe and effective," Dr. Verma told Health. "Increasingly, we are seeing that patients are familiar with medication abortion and its potential advantages."

While the Guttmacher Institute's research illustrates that medication abortion has gained broad acceptance from both abortion patients and providers, Verma noted it has been a preferred option for many people for quite a while.

She also stressed that medication abortion is increasingly subject to burdensome legislation and restrictions, from state in-person dispensing requirements to bans after a certain gestational age.

"These restrictions are not based on science and do nothing to enhance the safety of my patients. Medication abortion is safe and effective and the new data show that it's the right choice for many people," said Dr. Verma.

How Does the Abortion Pill Work—and When Can It be Used?

While procedural abortion is provided in a clinical setting via vacuum aspiration or another method, medication abortion can be taken at home.

As directed by a provider or the manufacturer's instructions, medication abortion is initiated by taking the first pill, mifepristone, which blocks the hormone progesterone. Progesterone is needed for pregnancy, and therefore mifepristone stops the pregnancy from growing.

One or two days after taking mifepristone, misoprostol is taken. This medication is intended to empty your uterus, and will cause cramping and bleeding.

It is important that patients understand their options for abortion, said Dr. Verma. While some people value the experience of getting an abortion procedure and knowing that their abortion is complete when they leave the exam room, she said others value the experience of having an abortion in the comfort and privacy of their own home.

"Some may have additional barriers or concerns that may impact their choice, like needing to arrange childcare for a visit to a clinician or traveling long distances. Because both options are safe and effective, people should be able to choose what is right for them," she said.

Currently, medication abortion is approved for use up to 10 weeks of pregnancy. The FDA approved that limit based on research the agency reviewed at the time. However, the Guttmacher Institute points out that additional research shows provision beyond 10 weeks is safe and effective and some providers administer medication abortion "off label" after that point in pregnancy.

The FDA states that a woman should not take Mifeprex or its generic brand if it has been more than 70 days since the first day of her last menstrual period, or if any of the following apply:

  • Previous ectopic pregnancy
  • Problems with the adrenal glands
  • Being treated with long-term corticosteroid therapy
  • Has had an allergic reaction to mifepristone, misoprostol or similar drugs
  • Has bleeding problems or is taking blood thinners
  • Inherited porphyria
  • Intrauterine device (IUD) in place

How (and Where) to Get the Abortion Pill

In general, pills can be obtained from licensed health providers or clinics that offer the service, as well as delivered via the mail, depending on where you live. However, obtaining the abortion pill is not that straightforward for everyone. The laws surrounding use, and prescription, of the abortion pill vary from state to state.

"Although the [FDA] has finally lifted the burdensome, needless in-person dispensing requirement for mifepristone...19 states still require that patients be physically handed the pill by their prescribing clinician," said Dr. Verma.

Those who are unsure of the local laws and policies surrounding medication abortion can visit the Guttmacher Institute website where there's a state-by-state guide. You can also talk to a doctor about the options available. If you don't have access to a health care provider, Marielle Kirstein, co-author of the Guttmacher Institute report suggested visiting ineedana.com or abortionfinder.org, both of which offer resources for finding abortion care.

Cost of the abortion pill may also be a challenge or barrier for some patients. A medication abortion can cost up to $750, according to Planned Parenthood. However, here too, things may vary depending on where you live as the cost may be less in many places.

You can also try calling your insurance provider to find out whether they cover abortions, but it's important to know that some do not, according to Planned Parenthood.

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