In 1994, a young woman, 24 years old, attempted to have a “natural” abortion by using an herbal preparation. She wanted to avoid the stigma and condescension she felt she’d receive having an abortion at a facility. She added several drops of pennyroyal extract to water and drank this several times a day for five days. She suffered abdominal pain which she interpreted as the abortion in progress.
But on the fifth day she experienced a seizure and fell unconscious. When rushed to the hospital, doctors discovered an ectopic pregnancy which they removed, but they could not reverse the liver damage or uncontrolled bleeding caused by the extract. She went into a coma, suffered brain death and was eventually withdrawn from life support by her family. Had medication abortion been available to her then, she might still be alive.
Today there are safe and effective medications to induce abortion. These drugs were first approved in France and China in 1988, in Great Britain and other European countries throughout the 1990s, and in U.S. in 2000.
The “abortion pill” is actually two different medications that are taken one to two days apart.
The first pill is mifepristone. It was developed in the 1980s and was known as RU-486 before it was approved for non-surgical abortion by the U.S. Food and Drug Administration (FDA) in 2000.
The second pill is misoprostol. This drug was developed in the 1970s to treat peptic ulcers but it was found to cause the cervix to soften and the uterus to contract. It is often used to induce uterine contractions for a woman in protracted labor.
The abortion pills, mifepristone and misoprostol, are on the WHO’s List of Essential Medicines.
Both drugs are on the World Health Organization’s List of Essential Medicines. This list comprises the drugs that are needed in every country to assure quality medications are available for their people’s health problems. Only the most safe, effective, and necessary drugs make it onto the list. Mifepristone and misoprostol together are 97% effective in inducing a first trimester abortion, side effects are manageable, and serious side effects are rare. These medications are also used to complete an early miscarriage. Misoprostol is also on the list because it saves lives by stopping post-partum hemorrhage or heavy bleeding after delivery.
How the Drugs Work
Mifepristone blocks the hormone progesterone which is at its highest levels in the second half of the menstrual cycle. It makes the lining of the uterus thick and cushiony in preparation for a fertilized egg. If no ovum appears within a week or two, the cushy lining is shed as a menstrual period. When a woman takes mifepristone, the process of shedding and bleeding begins whether or not an egg has been fertilized.
Medication abortion accounted for more than one-third (39%) of all abortions in the United States in 2017.
Misoprostol is not swallowed, it is usually placed under the tongue, against the cheek, or in the vagina where it dissolves and disperses through the bloodstream. (It is not swallowed because if it goes through the digestive tract, the stomach and liver will absorb most of it and the drug will not reach the uterus. Misoprostol attaches to the cells in the uterus and the cervix. By stimulating prostaglandin receptors located there, the cervix softens and dilates and the uterus contracts or cramps. When a woman takes misoprostol, the softening and dilating begin, ensuring that the uterus is completely emptied. The shedding and bleeding from the mifepristone and the softening and dilating from the misoprostol results in the abortion or the emptying of the uterus.
MEDICATION ABORTION vs. SURGICAL ABORTION
The term “medication abortion” is a pregnancy termination initiated by a woman who takes medications that cause her uterus to cramp and expel an early pregnancy. Other names for medication abortion are medical abortion, non-surgical abortion, self-managed abortion, or EMA for early medication abortion.
A “surgical abortion,” sometimes referred to as a “clinical abortion,” is performed by a health care provider who removes a fertilized ovum or a fetus from the uterus by using a suction instrument, or, in the case of later-term pregnancies, by dilating the cervix and evacuating its contents with instruments (a “D&E”). Other terms you might hear for either type of abortion include elective abortion, therapeutic abortion, and pregnancy termination.
In the US, the medication can only be used within 70 days (10 weeks) or less since the first day of the last menstrual period.
As of today, in the U.S., a person who is pregnant and decides to have an abortion can choose which method they would prefer. The decision will be influenced by what is available where they live, as states and countries have different laws and requirements. A visit to a clinic or a health care provider is no longer necessary in many places as telemedicine provides an efficient and effective medical evaluation which can result in a prescription for the medication. The drugs can be picked up at certain pharmacies and taken home. However, individual states and countries have different rules, often subject to political and religious pressures within the jurisdiction.
Some women like the idea of going to a clinic with their partner, friend, or family member and having the procedure completed in one day. Other women like the idea of obtaining the medication from a health care provider and then choosing the time and place to have the abortion, either by herself or with other persons of her choosing. Clinical abortions only take about 10 or 15 minutes; a medication abortion may take up to 24 hours after taking the second pills before the products of conception are passed.
Medication abortion is slightly safer than surgical abortion (which is already very safe).
Both medication abortion and surgical abortion are much, much safer than childbirth. To better understand the safety and put the risk in context, The National Academy of Sciences compared the risk of death from legal abortion to the risk of death from other common medical/surgical procedures (see Table below).
Risk of death from legal abortion, by any method, compared to other common medical/surgical procedures[i]
|Procedure||Approximate number of deaths per 100,000 procedures|
|Abortion (legal)||less than 1|
|Dental procedures||less than 2|
|Plastic surgery||less than 2|
|Tonsillectomy||about 3 to 6|
While a medication-induced abortion is a safe and effective way to end an early pregnancy, it is not without some risk. Instructions and prescriptions are required from health care providers and specifically-approved pharmacies who provide users with instructions including the signs and symptoms that might indicate complications. Users are advised to have nearby access to emergency medical facilities.
THE COST OF MEDICATION ABORTION
A first trimester medication abortion can cost almost as much as a first trimester surgical abortion depending on where you live. Either procedure may be covered if you have private insurance but many plans, including Medicaid in some states, do not cover them. The price of a medication abortion can range from about $500 to $1500, depending on a lot of factors. Low-income women may benefit from free or sliding-scale fees at some clinics or can request funding from pro-choice organizations like the National Abortion Foundation. Most abortion providers understand the financial restraints that many women have to deal with and try to keep costs as low as possible.
Efforts to end a pregnancy using unapproved methodologies are dangerous and can lead to reproductive organ damage or death. Practice abstinence or use contraceptive methods correctly and consistently to prevent an unwanted pregnancy and avoid the need for abortion. Use condoms for the prevention of sexually transmitted infections that can lead to infertility, cancer, reproductive organ damage, or death.
[i] National Academies of Sciences, Engineering, and Medicine 2018. The Safety and Quality of Abortion Care in the United States. Washington, DC: The National Academies Press. https://doi.org/10.17226/24950