Restrictions in case of annulment of the sentence Roe v. Wade could lead women to do without medical assistance in the event of a pregnancy termination

Antonio Regalado

If the US Supreme Court overturns the historic 1973 legal decision that enshrined abortion as a constitutional right, some parts of the country will be ready to question women’s self-determination, banning abortion even in the event of rape. , incest or fetus with genetic abnormalities.

But there is still a window open: most of these state laws ready to take effect exempt the woman who asks for an abortion from any sanction. The likely result is an increase in the number of people who will end their pregnancy at home using so-called abortion pills.

These drugs are safe and widely prescribed by doctors, and the best way to use them is under medical supervision, with before and after checkups. But with the possibility that the Roe ruling may soon be overturned, letting individual states set their own rules, women want to know how to get the pills and use them on their own to carry out a form of “self-managed” abortion..

MIT Technology Review asked some doctors and reproductive rights experts how abortion pills work, where to find them and what are the risks of using them without medical assistance.

What is drug abortion?

It means intentionally terminating a pregnancy using abortion pills, a drug that was introduced in the United States 22 years ago and has slowly but steadily replaced other abortion procedures. According to the Guttmacher Institute, over 50% of abortions in the United States are performed using pills. Typically, they are prescribed by a doctor and the patient sees a healthcare professional before and after taking them.

Are abortion pills less invasive than surgical abortion?

In early pregnancy, a surgical abortion is a procedure in which a doctor basically uses a special cannula attached to an aspirator. It ended in a day. Drug abortion takes longer – several days. But there is no public exposure and avoids walking between rows of demonstrators in front of the clinic. Furthermore, drug abortion is less expensive. There is talk of $ 200-300 versus $ 750-1,000 for a surgical abortion, depending on insurance and other factors.

What is drug abortion in telemedicine?

It is a home abortion carried out with pills under the remote supervision of a doctor. This type of intervention became popular during the covid-19 pandemic and is allowed in several US states. It usually involves an online consultation with a doctor who will help determine the genesis of the pregnancy and prescribe the pills, which either arrive in the mail or can be picked up at the pharmacy. Abortion telemedicine service providers include Carafem and Aid Access. Even if there is no transition to the clinic, telemedicine still offers medical supervision.

What is a self-managed abortion?

It means getting and using abortion pills at home without the involvement of a doctor or even a prescription. According to the definition of Doctors Without Borders, a self-managed abortion means “obtaining and taking abortion pills outside of a medical setting“, Often with the help of online guides, telephone hotlines and foreign pharmacies.

What are the drugs?

In the United States, drug abortion usually relies on two drugs, mifepristone and misoprostol, taken within a day or two of each other. Medicines are prescribed to terminate pregnancies with a gestational age of up to 70 days or 10 weeks (counted from the last menstrual cycle). Both drugs can end a pregnancy on their own more than 80% of the time. But together they work more effectively and interrupt about 95% of pregnancies of less than 10 weeks.

What do these drugs actually do?

Mifepristone (also known by the brand name Mifeprex) is a synthetic compound that blocks progesterone, also known as the ‘pregnancy hormone’. It does this by binding to the same receptor within the cells that progesterone wants to use. Without enough progesterone, the uterine lining that supports pregnancy will begin to bleed and break down.

Mifepristone, known at the time by the code name RU-486, was introduced to the market in 2000 by a non-profit health organization called the Population Council. Its approval sparked a series of battles with anti-abortion activists, as told by WebMD. The United States still imposes restrictions on doctors on the type of prescriptions.

Misoprostol (common brand name is Cytotec) is a synthetic version of the hormone prostaglandin. It is approved for the treatment of ulcers, but it has been shown that it can also be used to induce labor. The drug softens and dilates the cervix and triggers contractions, which expel the fetus. It was never approved for abortion specifically.

Overall, drug abortion is similar to a miscarriage. The drugs cause severe cramping and bleeding, like a heavy cycle, doctors say. In addition to blood or clots, it may be possible to see the conceptus which would be the size of a coin about seven weeks after fertilization.

Are abortion pills safe?

Drug abortion has been described as “safer than paracetamol” and more than 10 times less at risk of childbirth. Although medications are reliable, particularly in early pregnancy, there are ways things can go wrong. Planned Parenthood has listed a number of side effects that should not be underestimated, including some that warrant forms of medical care, such as bleeding that lasts too long or a fever, which can mean there is an infection.

Another risk is that the pills will not end an ectopic pregnancy, in which an embryo is growing outside the womb. This is in itself a medical emergency, according to the Cleveland Clinic. The surest way to determine if a pregnancy is ectopic is to undergo an ultrasound.

Do abortion pills always work?

No. And this is actually the most common risk in attempting to self-manage an abortion. About one in 20 times, the pills do not successfully stop pregnancy. Some online pill sellers recommend buying two doses in case the first one doesn’t work. If a medical abortion fails, the options are to try again with more pills, try to perform a surgical abortion, or continue the pregnancy, in which case there is an additional risk of fetal abnormalities, such as facial defects or incomplete limbs, linked to the misoprostol drug. To find out if the pregnancy has been terminated, an ultrasound check is required. Another way is to take a pregnancy test about three weeks after the abortion attempt.

Up to what point in pregnancy can we intervene with abortion pills?

The pills are currently prescribed in the United States for up to 70 days, or 10 weeks, after the last menstrual period, although abortion rights advocates say their use through the end of the first trimester is well established. In reality, the pills are capable of intervening at any time during pregnancy, but the later they are used, the closer to delivery the greater the medical, moral and legal risks.

Is self-managed abortion legal?

Yes, but many open questions remain. Reproductive rights advocates say self-managed abortion is legal almost everywhere in the United States, although laws in some states, such as Arizona, can restrict it when a pregnancy is too advanced. In general, even the new and stricter bans on abortion envisaged by some states in the event of the overturning of the Roe ruling do not provide for penalties for the person who abortions.

A law in Oklahoma, for example, provides for fines of $ 10,000 for the supply of any substance or drug that could “cause the death of an unborn child,” but does not consider penalties for the woman who has an abortion. The problem is that restrictive abortion laws will create a much more hostile environment for health care measures in general, including abortion pills.. For example, if you seek medical assistance after an abortion, health care workers or hospital staff might also notify the police, regardless of whether self-managed abortion is legal.

Attempts to prosecute people for having abortions are not common, but they do happen. Over the past 20 years, the legal organization If / When / How has counted several dozen cases in which women have been investigated or prosecuted after attempting to abort. These cases usually involve full term pregnancies. In 2021, for example, an Ohio woman and her boyfriend were found guilty of bodily outrage after using abortion pills to end a third-trimester pregnancy.

How are abortion pills obtained?

In states with liberal laws, such as New York and California, a person can request a medical abortion at a dedicated clinic or through a telemedicine consultation. In states seeking to limit abortion, both of these possibilities are limited. If the Roe ruling is overturned, doctors in these states will commit a crime if they prescribe pills.

But today it is still possible to obtain them. One way is to have a postal address in a state where abortion by telemedicine is legal. Another option is through Aid Access, which has foreign doctors who will prescribe the pills and ship them from a pharmacy in India. Because Aid Access has doctors who don’t work in the United States, they’re not subject to state laws (as long as they don’t travel to those states). Through this alternative solution, says Aid Access, it is still possible to carry out abortions in telemedicine and by sending pills in all 50 states.

A person can also order the pills directly from a pharmacy outside the United States without a prescription and thus self-manage the abortion. An organization called Plan C has a search engine that will suggest the easiest way to get abortion pills in each state and has a list of legitimate overseas pharmacies, which provide the pills at prices starting at $ 250. This path requires a credit card or other way to pay electronically.

Is it risky to order abortion pills from India?

Yes. Pharmacy websites often seem quite ambiguous and, according to the US FDA, importing pills from outside the country is generally illegal. However, the agency does not intervene directly when the drugs are for personal use. Right now, there is no great legal risk by ordering pills online, although that may change in the future.

What to do in anticipation of a review of the sentence Roe?

It is a good idea to inquire about abortion pills and how to get them. Another option is to order the pills now, while it is still possible, and keep a supply on hand, assuming they are valid for at least three years. Aid Access agrees to ship pills to people who are not pregnant. Overall, it’s always best to refer to a US pharmacy and see a doctor, but if the law changes anyone living in a state that prohibits doctors from prescribing abortion pills will not have that choice.

Will abortion pills ever be available over the counter?

It will take at least ten years of social battles before that happens.

Image by Khusen Rustamov from Pixabay

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