Pharmacological abortion has become the most popular choice for those who do not feel like carrying on a pregnancy and consists of taking two prescription drugs days apart, at home or in a clinic. The procedures of abortion they are an invasive medical technique that empties the uterus.
They are sometimes called surgical abortions, although they do not involve surgery. Drug abortion, on the other hand, involves the drugs mifepristone and misoprostol. As more states seek limits on abortion, the demand for pills is expected to grow.
Drug abortion: here’s what you need to know
Mifepristone is given first, ingested orally. The drug dilates the cervix and blocks the effects of the hormone progesterone, which is needed to support a pregnancy. Misoprostol, a drug also used to treat stomach ulcers, is taken 24 to 48 hours later. The pill is designed to dissolve when placed between the gums and teeth or in the vagina. It causes cramps and contraction of the uterus, causing bleeding and expelling the pregnancy tissue.
Studies and trials on real use show that when taken together, the pills are safe and up to 99% effective. Side effects can include nausea, vomiting, and diarrhea.
Bleeding is normal. Very heavy bleeding – soaking more than two sanitary pads per hour for more than two hours – is rare but requires medical attention.
The doctor Stephanie Randspecialist in gynecology and abortion of New York with the advocacy group of doctors for reproductive health, states that pregnancy tests should not be used immediately to determine if a drug abortion was successful because the pregnancy hormone may be held in the body for many weeks. Bleeding, with blood clots that include lighter colored tissues, are signs of success.
Serious complications are very rare. The Food and Drug Administration says more than 3.7 million US women have used mifepristone since it was approved more than 20 years ago. The agency has received 26 reports of deaths in women using the drug, including two involving ectopic pregnancies, which grow outside the womb.
The drugs are not recommended for some patients, including those with suspected ectopic pregnancies or with implanted IUD contraceptive devices.
Costs vary by location but are similar to abortion procedures and can amount to more than $ 500. Health insurance coverage varies, with some plans making the pills free or low-cost and others not covering them at all. Mifepristone is sold under the brand name Mifeprex and misoprostol under the brand name Cytotec, but both pills are available as generics.
The FDA approved mifepristone to terminate pregnancy in 2000 when used with misoprostol. At the time, it imposed several limits on how the drug was prescribed and administered.
In December, the agency ditched the biggest restriction: requiring patients to take the drug in person. The FDA said a scientific review of the drug’s use, including during the COVID-19 pandemic, showed that women could safely receive the pills in the mail after an online consultation, with no increase in side effects or complications. .
The decision allowed for the pills to be mailed nationwide, a change long sought by groups of medical professionals and abortion rights advocates. However, millions of women will have difficulty accessing the pills due to a patchwork of state laws targeting abortion in general and consequently also drug abortion in particular.. About half of the states in the United States are expected to significantly prohibit or restrict abortion.
Legal experts predict years of judicial battles over access to drug abortion, as abortion rights advocates bring trial cases to challenge state restrictions. There are strong arguments and precedents on both sides, experts said, though little certainty about which side might prevail.
The Biden administration’s Justice Department has already flagged plans to challenge state restrictions on drug abortion. And federal lawyers are likely to be joined by outside parties, including abortion rights groups like Planned Parenthood and even the companies that make the pills.
The main argument against drug abortion restrictions is likely to be the longstanding principle that federal laws, including FDA decisions, preclude state laws. In fact, few states have ever attempted to completely ban an FDA-approved drug due to previous rulings in favor of the agency. However, states with general abortion bans are likely to interpret them as a ban on abortion pills. Many of the laws do not distinguish between abortion and drug abortion procedures.
“In the short term, those states that ban abortion will assume that their bans also include drug abortion and that it will be banned.“, he has declared Greer Donley, Specialist Professor in Reproductive Health Care at theUniversity of Pittsburgh Law School.
While general bans are successfully challenged, more than 30 states have laws that specifically restrict access to abortion pills. For example, 19 states require doctors to be physically present when the drug is administered. Those laws could stand up to judicial challenges. States have long had authority over how doctors, pharmacists, and other providers practice medicine.
States also establish rules for telemedicine consultations used to prescribe drugs. In general, this means that health care workers in states with restrictions on drug abortion could be subject to penalties, such as fines or license suspension, for attempting to send abortion pills in the mail. Women have already traveled across state lines to places where access to the abortion pill is easier. This trend is expected to increase.
Meanwhile, some women will continue to receive drugs through online pharmacies in Canada and abroad, often with telemedicine consultations from foreign doctors. The practice is technically illegal but essentially not enforced, and advocates believe women will increasingly choose this method as more states move to ban abortion.
“The states opposed to abortion will do everything possible to limit pharmacological abortion, but in practice people have been and will continue to access it through the mail of international pharmacies”, said Donley, who expects cases based on various legal theories to unfold for a few years before clear decisions emerge.
A key question is how the nation’s supreme court might rule if and when it takes those court cases. While the Supreme Court has rejected a constitutional right to abortion, conservative judges have also generally deferred to the FDA’s primacy over drug decisions.
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