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Abortion pills are used for most U.S. abortions. What are they?

Demonstrators, including Elizabeth Lasey (left), gathered Tuesday at the Connecticut state Capitol in response to a leaked draft opinion from the U.S. Supreme Court that suggests it could overturn Roe v. Wade.
Mark Mirko
Connecticut Public
Demonstrators, including Elizabeth Lasey (left), gathered at the Connecticut state Capitol in May in response to a leaked draft opinion from the U.S. Supreme Court that suggested it could overturn Roe v. Wade.

This story was prepared by Science Friday:

The draft Supreme Court decision overturning Roe v. Wade means abortion access is once again in jeopardy. Nearly half of U.S. states will immediately ban abortion upon a Roe v. Wade overturn.

Medication abortion, or abortion by pill, is the most common method of abortion in the United States. In 2020, 54% of abortions in the United States were medication abortions, according to research from the Guttmacher Institute.

If the Supreme Court decision is overturned, it’s expected that the ease and convenience of an abortion pill may make medication abortion an even larger share of all abortions nationwide.

Science Friday’s Ira Flatow talked with Ushma Upadhyay, associate professor of obstetrics, gynecology and reproductive sciences at Advancing New Standards in Reproductive Health at UC San Francisco. Upadhyay explained how medication abortion works, how its regulated and its role in a possible post-Roe v. Wade era.

What is medication abortion?
Medication abortion is the combination of two medications that induce abortion. The first is mifepristone (Mifiprex), a pill that blocks the hormone that allows a pregnancy to grow, and the second is misoprostol (Cytotec), which are tablets that cause the cervix to dilate and the uterus to contract. The pregnancy is expelled from the vagina.

What’s the difference between medication abortion and Plan B?
Plan B, or emergency contraception, is taken within the first 72 hours after unprotected sexual intercourse. Medication abortion is a set of medications that someone takes to end a pregnancy after they’ve determined that they’re already pregnant.

The FDA has approved its use in pregnancies up to 10 weeks, but research shows that medication abortion is effective at up to 12 weeks of pregnancy, “and actually, it’s even effective beyond that,” said Upadhyay, but more doses of the misoprostol is needed further along in the pregnancy for it to be most effective.

Is medication abortion available via telehealth? 
Yes, although 19 states have outlawed telemedicine abortions.

What is the process like to get prescribed a medication abortion through a telehealth appointment?
The patient can go to a virtual clinic website to begin the process. Some providers offer secure messaging, so the patient doesn’t have to communicate over video or phone. From there, the clinician will determine if the patient is eligible, and if they are, they will be sent a packet of abortion medications by mail.

After one week, the provider will follow up with the patient to check on expected symptoms, like bleeding and cramping. At four weeks, the patient will take an over-the-counter pregnancy test to ensure the abortion was successful (the pregnancy hormone remains in the urine for a few weeks after termination).

If someone is living in a state where medical abortion isn’t legal, can they go to a state where it is legal and receive the prescription that way?
Upadhyay leads a research study called the CHAT (California Home Abortion by Telehealth) Study. Patients in her study have traveled across state borders to receive consultations, and receive abortion pills at a post office box or other place where they could receive mail.

She notes that one patient in Texas had medications mailed to a friend in a state where abortion pills are legal, and then the friend mailed the medications to her in Texas.

“Patients are starting to get creative about getting these medications,” she said.

What about websites that ship abortion pills from overseas?
It is technically illegal for Americans to order prescription drugs from abroad. However, the ability of the federal government to restrict mail-order prescriptions is limited, and exists in somewhat of a legal gray area.

However, some states are looking to crack down on the shipment of abortion pillsfrom abroad.

Aid Access is a telehealth provider of medication abortion based in Europe, which makes their services available where abortion is limited by law, including in the United States. Aid Access provides the same abortion medications available in the United States, just shipped from India, which takes longer to arrive by mail.

“It is highly trustworthy,” said Upadhyay, though she adds “the legal risks are much greater than any type of safety concern.”

A recently passed Connecticut law protects providers who prescribe medication abortions. What protections does the bill offer?
“I was very excited to see that Connecticut law passed,” Upadhyay said.

The law protects abortion patient’s records from discovery by other states who are trying to prosecute people seeking abortion. And besides protecting providers who are caring for patients in other states, it also protects those providers from being extradited to other states for prosecution. “I would really love to see states that care about protecting abortion access implementing similar laws,” she said.

How would an overturn of Roe v. Wade affect access to medication abortion?
When Texas banned abortion after six weeks of pregnancy in September of 2021, there was a spike in those seeking medication abortions. Daily requests increased by 1,180% in the week after the bill was passed.

Upadhyay views medication abortion as primary care. “Special equipment and tests are no longer needed, and any primary care provider could offer medication abortion to their patients,” Upadhyay said.

This story was prepared by Science Friday's Shoshannah Buxbaum and D Peterschmidt.

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