More than half of U.S. abortions are now done with pills, surpassing surgery for the first time — here's why
The way most abortions are performed is changing: More than half in the U.S. are now done with pills — known as a medical abortion — rather than surgery, according to a new report by the Guttmacher Institute.
This is the first time medication abortion “crossed the threshold to become the majority of all abortions, and it is a significant jump from 39 percent in 2017” to 54 percent in 2020, according to the report.
One of the primary reasons medical abortions have become more common comes down to access. “Medication abortion is more accessible than a procedural [surgical] abortion in many cases, because medication abortion can be completed outside of a medical setting, either by providing pills at a clinic that a patient later takes at home, or having them mailed directly to a patient,” Marielle Kirstein, senior research assistant at the Guttmacher Institute, tells Yahoo Life.
For patients in rural and underserved areas, using medication abortion provided via telehealth can help save hundreds of miles of travel, Jesse Philbin, senior research associate at the Guttmacher Institute, tells Yahoo Life.
In many communities in the U.S., “self-managed abortion is the only option available to some people seeking care,” says Philbin. “A self-managed abortion is an abortion — including via pills — obtained outside of the formal health care system.”
Additionally, “providing the pills for a safe and effective abortion requires less equipment and training than procedural abortions,” notes Kirstein.
How the pandemic may have contributed to the increase
It’s also likely the COVID-19 pandemic played a role in the rise of medical abortions. “When the modern medication abortion regimen was approved in the United States in 2000, the Food and Drug Administration placed significant restrictions on who could prescribe and where one could acquire these medications,” Dr. Andrea Henkel, an ob-gyn at Stanford Children’s Health and fellow in complex family planning at Stanford University, tells Yahoo Life.
However, aided by the “abundance of research supporting the safety and efficacy of this regimen even outside of these FDA guidelines,” says Henkel, the restrictions were temporarily lifted in April 2020, with the FDA allowing abortion pills to be mailed to patients for the duration of the pandemic. This allowed patients “to obtain an abortion without making one (or several) trips to a health care facility and risking unnecessary exposure to COVID-19 if they used this method,” Kirstein explains.
In December 2021, the FDA made the allowance permanent while also expanding access to abortion medication through pharmacies, according to Kirstein. However, “guidance to pharmacies for dispensing abortion medication has not yet been developed,” she says.
There has also been an increase in clinics that provide only medication abortion and not surgical abortion, “meaning that obtaining abortion pills in a clinical setting may be more available to some patients than going to a clinic for a procedural abortion,” Kirstein says.
Despite that, not everyone has access to a medical abortion. “Notably, a number of states prohibit the mailing of abortion pills and require in-person visits to obtain the drugs,” says Kirstein. “The FDA decision does not override these laws.” Mailing abortion medications to patients is banned in three states: Texas, Arizona and Arkansas. Other states may be joining them: On March 1, the Georgia Senate passed a bill that bans abortion pills by mail.
What exactly are medical abortions?
Medical abortions use prescription drugs to end a pregnancy. The process involves taking two medications — mifepristone and misoprostol — typically within a 48-hour period. “Mifepristone blocks the effects of the pregnancy hormone progesterone, and misoprostol induces uterine cramping to expel the pregnancy,” says Henkel.
The medications cause cramping and bleeding that can last for several hours, according to Planned Parenthood. Patients may also be given antibiotics to prevent infection.
How safe are medical abortions?
“Medication abortion is incredibly safe,” says Henkel. “Serious complications requiring hospitalization for treatment of infection or transfusion occur in less than four per 1,000 patients.”
Philbin agrees, noting: “Throughout the more than 20 years that it has been used in the United States, medication abortion has been proven to be overwhelmingly safe and effective. The FDA has approved medication abortion for use up to 10 weeks of pregnancy; however, research has shown that use beyond 10 weeks is safe and effective.”
Research also shows that complications from medical abortions are “very rare.” Henkel notes, however, that medical abortion carries a risk of heavy bleeding that may require a procedure to stop the bleeding or even a blood transfusion. “There is a risk of pregnancy tissue remaining in the uterus and needing a procedure to remove the tissue or even this tissue getting infected,” she says.
There is also a low risk that the abortion pills don’t work. “In this case, a repeat dose of medication or procedure is needed to complete the abortion,” Henkel explains. “This occurs in 2 to 10 percent of medication abortions — more frequently for those at later gestational ages in the first trimester.”
Who isn’t a candidate for medical abortion?
Medication abortion is routinely offered through 10 weeks of pregnancy, according to Henkel. “Though there is data for later,” she says. “Each facility will have their own comfort level with the upper gestational age limit.”
But not everyone is a candidate for medication abortion. Henkel says it is not recommended for pregnant people with any of the following: confirmed or suspected ectopic pregnancy, intrauterine device (IUD) in place, current long-term systemic corticosteroid therapy, chronic adrenal failure, known coagulopathy or anticoagulant therapy, inherited porphyria, or allergy to mifepristone or misoprostol.
Why medical abortions may continue to climb
Henkel anticipates that “as abortion restrictions increase, there will be an increased reliance on medication abortion as this method may become the more accessible option,” she says.
She adds: “What is available and what is practically accessible can differ depending on location,” noting that 89 percent of U.S. counties do not currently have an abortion clinic “even though one in four reproductive-capable people need abortion care at some point in their life,” Henkel says. “Medication abortion is often more accessible, so some people may choose this method for convenience.”
Kirstein also anticipates that the rise of medical abortions “will be a pattern for states with fewer restrictions on abortion care because practices like mailing abortion medication and obtaining it directly from online pharmacies will be more accessible for many patients. In states with highly restricted access to abortion care, medication abortions may be patients’ only option.”
Take, for example, S.B.8 — an abortion restriction law that “outlaws abortions after six weeks of pregnancy” and “deputizes everyday citizens to sue anyone who ‘aids or abets’ an unlawful abortion,” according to ABC News. When the law went into effect in September 2021, Kirstein points out that procedural abortions decreased by almost three-quarters as compared with August 2021, according to the Texas Health and Human Services website. “While the number of medication abortions also decreased as a result of this legislation,” notes Kirstein, “they increased from accounting for roughly half of all abortions in Texas in August 2021 to two-thirds in September 2021.”
But as Philbin puts it: “While abortion pills are an important option, they are not the solution to abortion bans.”
Philbin adds: “Patients deserve all options for their abortion care and should not have to rely on medication abortions due to logistical or financial constraints if it is not the best option for them.”
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