Medication abortion, or taking a combination of the drugs mifepristone and misoprostol, is becoming more common method of terminating pregnancies in the United States. The reasons vary and overlap: some women do not have access to personal abortion clinics; others prefer to terminate a pregnancy in the comfort of their own home. Others seek the pills because they costs much less than surgical abortion.
with more personal clinics formwork and a Supreme Court that threatens to overthrow roe v. wadinga small but growing number of reproductive experts have encouraged discussion of an idea called “advancements” — or, more informally, stocking up on abortion pills in case you need them later.
It’s an idea that has merit: Mifepristone has a shelf life of about five yearsmisoprostol about twoand both drugs work better the earlier you take them in a pregnancy. In states that are ramping up abortion restrictions, there is often a race against time to access care. In Texas, for example, if you don’t realize you’re pregnant until eight weeks – which can be just a few weeks after a missed period — you would have passed already the state’s new legal deadline for getting abortion pills. But if you already kept them in your house, or had your friend or neighbor, you could take them with you.
In a National Representative Survey 2018 of women aged 18 to 49, 44 percent expressed support for advances and 22 percent said they were personally interested in it. Those who had previously undergone drug abortion and those who reported facing greater barriers to reproductive health care were more likely to support the idea.
Data on these types of abortions — often referred to as “self-managed” or “self-managed” — are harder to track down. Research published in 2020 estimated that 7 percent of women will have an abortion during their lifetime, although this was calculated on the assumption that: roe was still in place. New Guttmacher data published last week on US abortion incidence found there were 8 percent more abortions in 2020 than in 2017, but self-directed abortions do not count.
“We know there are thousands of self-managed abortions that we don’t record,” Rachel Jones, a Guttmacher researcher, told cafemadrid. “If Supreme Court Overthrows Roe and Becomes Abortion” illegal in 26 states and people cannot travel to another state, then self-management will be the only other option they have for an abortion.”
Talking more honestly about self-selected abortion goes against long-standing American cultural norms. For years, American reproductive rights groups emphasized that the decision to terminate a pregnancy “was made between a woman and her doctor.” Internationally, where abortion is more heavily criminalized, there is less pressure to involve medical professionals. It was in the legally restrictive context of Brazil late 80s that women first pioneered the use of misoprostol to self-manage their abortions.
Rebecca Gomperts, the Dutch physician who founded Aid Access in 2018 to provide abortion pills to American patients, was one of the most vocal advocates for early delivery and began offering it as an option. to people in all 50 states last fall† The cost for the pills ranges from $110 to $150, with a sliding scale for those who don’t have the cash. Recently, in PoliticoGomperts encouraged doctors to prescribe mifepristone and misoprostol to those who are not pregnant so that they have the medication on hand if they need it later.
“Abortion pills are something you can’t actually die from,” she said. “You can never overdose on it. And what we know from research is that you don’t have to do an ultrasound for a medical abortion.”
The idea of getting medicine before it’s needed isn’t new. Doctors also often prescribed emergency contraception for women before it was available without a prescription.
Right now, major mainstream abortion rights groups tend to be: remain silent on pre-provision, which means that lesser-known organizations such as Aid Access and Plan C to try to get out of the word† (NARAL and Guttmacher declined to comment, and Planned Parenthood did not return requests for comment.)
Access to help and forward obstetrics are among the few groups currently offering American patients the option of pre-ordering pills, although Elisa Wells, co-director of Plan C, said she knows others are considering it. “I just had a conversation with a provider in Montana,” she told me. “We think it will happen more often. Sometimes we call it the ‘just in case’ plan, because unplanned pregnancy is so ordinary†
It is a safe option for most patients
When it comes to the safe termination of pregnancies, drug abortion is more than 95 percent successfulGuttmacher said. Less than 0.4 percent of patients require hospitalization. The National Academies of Science, Engineering and Medicine also confirmed drug abortion as a safe method of termination of pregnancy, one with a very low risk of complications.
Research published earlier this year in the medical journal Lancet specifically found self-managed abortions to be highly effective, and with a high degree of patient satisfaction.
Gomperts also argues for more attention for misoprostol only abortions, which are common internationally. The drug may be more easily accessible to women because misoprostol is less tightly regulated; it is used for other conditions, including stomach ulcers and to treat miscarriages, and is: sold over the counter in many countries.
While drug abortion is a safe option for almost everyone in early pregnancy, the pills are not recommended for people who are taking blood thinners, have bleeding disorders, or who: at high risk of ectopic pregnancies† (Echos are recommended for those in this latter category.)
Still, one benefit of pre-dispensing — and abortion in general — is the greater number of people who could potentially dispense the pills, including primary care physicians. Another benefit is that it can be easier to share pills with those who need the medication quickly, but don’t have access to it. Research suggests that the drugs are best taken within the first 10 to 12 weeks of pregnancy.
Attention to legal risks and criminalization
Outside of groups that exploit international law, such as Aid Access, advance delivery is unlikely to be a legal option in every state. For example, some states need patients to get echoes before a health care provider can give them abortion pills. Other states are tackling abortion pills themselves.
While few states currently completely ban self-managed abortion, many states have existing laws that could use overzealous prosecutors to go after women, such as the fetal murder statutes. “I’m concerned that if people stockpile without knowing the legal risks or how to hide their digital footprints, they could become victims of criminalization,” said Renee Bracey Sherman, founder of the abortion story group. We testify†
The National Right to Life Foundation also released model legislation in mid-June encouraging states to criminalize those who “help or encourage” illegal abortions, including those who instruct over the phone or the Internet about self-managed methods.
Even in states with fewer legal concerns, advance determination will not be the right option for everyone. “It’s a potentially high cost to a patient that probably won’t be covered by insurance,” said Daniel Grossman, a physician and professor of obstetrics and gynecology at the University of California at San Francisco. Not everyone can afford to spend $150 to have a backup method available, and some people will still require or prefer personal clinic care.
It hasn’t gone mainstream yet
In the days following the leaked draft of the Supreme Court’s quash decision Roe v. Wadetelehealth abortion providers reported spikes in internet searches and pill orders† Yet, most Americans lack of fame not only with abortion drugs, but also with the few groups that currently pre-provide the pills. Some activists say leaders and organizations with more resources should do more to promote self-imposed abortion as an option.
In December 2021, three UCSF Reproductive Health Researchersincluding Grossman, published an article call prepayment “an untapped model of care that we believe holds promise and deserves further investigation.”
Grossman told cafemadrid that he believes more people should ask their primary care and reproductive health providers if they are open to prescribing or giving abortion pills to save them for later use. “Even if the doctor doesn’t want to, I think it’s worth just having a conversation with them and getting their healthcare provider to think about it,” he said. Dirty man earlier Jezebel told he found it a challenge to get other researchers and healthcare providers to give advances the attention they deserve.
“We have ibuprofen for a headache, cough syrup for a cold and plan B for a broken condom,” says Bracey Sherman of We Testify. “It’s already normal for other health care and we should normalize it for abortion.”
Wells, of Plan C, said the historical restrictions placed on abortion have likely made some groups and individuals more reluctant to talk about advance provisions. “I think there’s probably a lot of fear of not wanting to break any rules,” she said.
Another factor hindering discussion, Wells suggested, is the way abortion is heavily medicalized in the US, to the point where people believe the drugs should or are best administered by a medical professional. The attitude is different internationally, she said.
“We’re so invested in saying we need to have safe abortions and that doctors and clinicians and the clinics can provide that,” Wells said. “Doctors have done a great job and we need to have all these different types of care options available, but [self-managed abortions] can be a bit of a threatening message to that whole system.”