Overview

Medication abortion plays a crucial role in providing access to safe, effective and acceptable abortion care.” World Health Organization. Medical Management of Abortion, Geneva, 2018, p. 54 (World Health Organization) https://www.who.int/reproductivehealth/publications/medical-management-abortion/en/.

Medication abortion also referred to as medical abortion is the use of medicines to induce an abortion. Often referred to as the “abortion pill”, the U.S. Food and Drug Administration (FDA) has approved a regimen of two medicines, mifeprex (generic version is mifepristone ) and misoprostol for medical abortion up to 70 days gestation. The first pill, mifeprex is taken orally, and then 24 to 48 hours later, misoprostol is applied buccally. If mifeprex is unavailable then misoprostol alone is dispensed. Mifeprex (mifepristone) is subject to the FDA’s Risk Evaluation and Mitigation Strategy (REMS) which imposes a series of requirements for administering the medicine to individuals seeking a medication abortion. For example, mifeprex must be “…ordered, prescribed and dispensed by or under the supervision of a healthcare provider….” U.S. Food and Drug Administration (FDA). Mifreprex (mifepristone) Information. U.S. Food and Drug Administration, https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information

On December 16, 2021, the FDA announced it will no longer require in-person dispensing of mifeprex (mifepristone) in clinics, medical offices, and hospitals. This modification to REMS allows for dispensing of medication abortion by mail under the supervision of a certified healthcare provider. This revision improves patient access to medication abortion and provides for the use of telehealth. U.S Food and Drug Administration. “Questions and Answers on Mifeprex.” https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex. But see; 19 states prohibit access to medication abortion by mail. Guttmacher Institute. Medication Abortion, State Laws and Policies. 1 December 2021, https://www.guttmacher.org/state-policy/explore/medication-abortion

Additionally, the FDA’s modification on the REMS now allows certified pharmacies to dispense medication abortion. U.S Food and Drug Administration. “Questions and Answers on Mifeprex.” https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex

U.S. Food and Drug Administration (FDA). Mifreprex (mifepristone) Information. U.S. Food and Drug Administration, https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information.

U.S Food and Drug Administration. “Questions and Answers on Mifeprex.” U.S. Food and Drug Administration,
https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex.

Medication Abortion Up to 70 Days of Gestation, ACOG Practice Bulletin, American College of Obstetricians and Gynecologists, Society for Family Planning, Number 225, Vol. 136, No. 4, October 2020 at: https://www.acog.org/-/media/project/acog/acogorg/clinical/files/practice-bulletin/articles/2020/10/medication-abortion-up-to-70-days-gestation.pdf.

World Health Organization, Self-management of medical abortion, Sexual and reproductive health, 2021, https://www.who.int/reproductivehealth/self-care-interventions/medical-abortion/en/.

Additional References

Advancing New Standards in Reproductive Health (ANSIRH). “Medication Abortion.” University of California at San Francisco (UCSF)https://www.ansirh.org/abortion/medication-abortion.

Federal and state-level regulations have effectively limited the use of mifepristone, particularly in underserved areas without a nearby clinic. Studies show providers of medication abortion are mostly concentrated where surgical abortion is already available.” The Availability and Use of Medication Abortion, Women’s Health Policy, Kaiser Family Foundation. June 2021. KFF https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion/.

Grossman, Daniel et al,. “Continuing pregnancy after mifepristone and “reversal” of first-trimester medical abortion: a systematic review.” Contraception, vol. 92, 2015, pp. 206-2011. Advancing New Standards in Reproductive Health, https://www.ansirh.org/sites/default/files/publications/files/grossman-sep15-continuing_pregnancy_after_mifepristone.pdf.

Statistics

According to The Centers for Disease Control (CDC) 2018 Surveillance Reporting for Abortions in the U.S., 38.6% of individuals had medical abortions at or before 9 weeks gestation while only 1.4% had medical abortions later than 9 weeks gestation. Kortsmit K, Jatlaoui TC, Mandel MG, et al. Abortion Surveillane—United States 2018. MMWR Sruveill Summ 2020; 69 (No. SS-7): 1-29/ DOI: http://dx.doi.org/10.15585/mmwr.ss6907a1

February 24, 2022, Guttmacher released a report on use of medication abortion

Medication Abortion Now Accounts for More Than Half of All US Abortions

Rachel K. Jones, Guttmacher Institute Elizabeth Nash, Guttmacher Institute Lauren Cross, Guttmacher Institute Jesse Philbin, Guttmacher Institute Marielle Kirstein, Guttmacher Institute

Specifically, preliminary data from the Guttmacher Institute’s periodic census of all known abortion providers show that in 2020, medication abortion accounted for 54% of US abortions.(emphasis added) That year is the first time medication abortion crossed the threshold to become the majority of all abortions and it is a significant jump from 39% in 2017, when Guttmacher last reported these data. This 54% estimate is based on preliminary findings from ongoing data collection; final estimates will be released in late 2022 and the proportion for medication abortion use is not expected to fall below 50%.”

Report available at:

https://www.guttmacher.org/article/2022/02/medication-abortion-now-accounts-more-half-all-us-abortions

2022 State Legislative Sessions: Abortion Bans and Restrictions on Medication Abortion Dominate, Policy Analysis, Guttmacher Institute, March 2002, available at; https://www.guttmacher.org/article/2022/03/2022-state-legislative-sessions-abortion-bans-and-restrictions-medication-abortion

In 2021, 108 state abortion restrictions were enacted in 19 states

  • For the period January 1-March 15, 2022, no restrictions were enacted however 519 abortion restrictions were  introducted in 41 states
  • For the period January 1- March 15, 2022, 82 abortion bans were introduced in 30 states.  Focus on Bans similar to SB8, 15-week and trigger bans
  • Abortion bans passed in one chamber in 7 states (Arizona, Florida Idaho, Kentucky, Oklahoma and W. Virginia)

Contraception, Volume 104, Issue 1:  Pages 43-48,  Erica Chong et al, sciencedirect.com/science/article/pii/S0010782421000913Pdf:Expansion of a direct-to-patient telemedicine abortion service in the United States and experience during the COVID-19 pandemic, available at; https://www.sciencedirect.com/journal/contraception 

JAMA Open Network: Research Letter Health Policy,  Abigail R. A. Aiken, MD, MPH, PhD1 et al.  February 25, 2022 Association of Texas Senate Bill 8 With Requests for Self-managed Medication Abortion

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789428

“This cross-sectional study analyzes a data set provided by Aid Access containing the date and state of origin of requests between October 1, 2020, and December 31, 2021, to assess whether requests from Texas increased after SB 8 went into effect.”

See data below;

“Between October 1, 2020, and December 31, 2021, Aid Access received 45, 908 requests for medication abortion from all 50 US states. Between October 1, 2020, and May 9, 2021, there was a mean (SD) of 10.8 (3.7) requests per day to Aid Access from Texas (Figure, panel B). A small increase occurred in mid-May, when SB 8 was returned from the House for final passage (Figure, panel A). Then, in the first week after SB 8 went into effect (September 1-8, 2021), mean (SD) daily requests increased by 1180% over baseline, from 10.8 (3.7) to 137.7 (85.7) requests per day (Figure, panel B) (95% CI, = 47.7-206.2; P = .008). During the subsequent 3 weeks (September 9-30, 2021), requests decreased from their peak, but remained 245% higher than the pre–SB 8 baseline at a mean (SD) of 37.1 (9.1) vs 10.8 (3.7) requests per day (Figure, panel B) (95% CI, = 22.4-30.27; P < .001). Overall, Aid Access received 1831 requests from Texas for self-managed abortion in September 2021. Over the following 3 months (October 1 to December 31, 2021), there was a mean (SD) of 29.5 (8.2) requests per month, 174% higher than the pre–SB 8 baseline (Figure, panel B) (95% CI, = 17.0-20.5; P < .001). During the same periods, mean daily requests from the other 49 US states showed much smaller increases (Figure, panel C), perhaps because of increased awareness of the service and other restrictive legislation.”

During COVID-19 Emergency (currently in place) the FDA will not require a qualified healthcare provider to dispense mifepristone in-person but allow clinics to distribute the medicine via mail receipt (April 12, 2021) https://www.acog.org/news/news-releases/2021/04/acog-applauds-fda-action-on-mifepristone-access-during-covid-19-pandemic

See also, ACLU, FDA Respond to ACOG April 2021, https://www.aclu.org/letter/fda-response-acog-april-2021; D’Amrosio, A. “FDA Temporarily Lifts Restriction on Abortion Pill.” MEDPAGE TODAY, April 2021, https://www.medpagetoday.com/obgyn/generalobgyn/92077

See also: The Availability and Use of Medication Abortion, Women’s Health Policy, Kaiser Family Foundation. June 2021. KFF https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion/

TelAbortion (research project)

Since 2016, Gynuity Health Project TelAbortion Study is operating in 15 states and the District of Columbia. “The TelAbortion Study is a research project that aims to evaluate the use of telemedicine for providing a medical abortion to those who prefer to receive the abortion pills in the mail.” The medications used are FDA approved.

TelAbortion. “TelAbortion: About the Project.” Gynuity Health Projects, https://telabortion.org/about.

Upadhyay, Ushma D., et al. “Adoption of no-test and telehealth medication abortion care among independent abortion providers in response to COVID-19☆.” Contraception: X, vol. 2: 100049, 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718446/.

2022 State Legislative Sessions, Abortion Bans and Restrictions on Medication Abortion Dominate, Guttmacher Institute, Policy Analysis, March 2022, available at; https://www.guttmacher.org/article/2022/03/2022-state-legislative-sessions-abortion-bans-and-restrictions-medication-abortion

Medication Abortion, State Laws and Policies, Guttmacher Institute as of April 1, 2022, available at: https://www.guttmacher.org/state-policy/explore/medication-abortion

Currently, two states ban medication abortion at a specific point during pregnancy. Texas bans medication abortion at 7 weeks, Indiana at 10 weeks. See Guttmacher Institute, Medication Abortion, as of April 1, 2022 https://www.guttmacher.org/state-policy/explore/medication-abortion

To dispense medication abortion, 32 states require health care providers to be a physician.
Guttmacher Institute. Medication Abortion, State Laws and Policies. 1 April 2021, https://www.guttmacher.org/state-policy/explore/medication-abortion

Medication abortion is prohibited from being dispensed via telemedicine in 19 states. It requires clinicians to be physically present when providing pills to patients.
Guttmacher Institute. Medication Abortion, State Laws and Policies. 1 April 2021, https://www.guttmacher.org/state-policy/explore/medication-abortion

Laws in Arkansas, Idaho, Kentucky, Nebraska, South Dakota, and Utah requiring providers to advise patients medication abortion may be reversed if given a high dose of progesterone after taking mifepristone are not based on scientific evidence. Similar bills were passed and blocked by courts in North Dakota, Oklahoma and Tennessee. Guttmacher Institute. Counseling and Waiting Periods for Abortion. 2021.

Guttmacher Institute, https://www.guttmacher.org/state-policy/explore/medication-abortion; American College of Obstetricians and Gynecologists, (ACOG). “Facts are Important: Medication Abortion Reversal is not Supported by Science.” American College of Obstetricians and Gynecologists, Advocacy, https://www.acog.org/advocacy/facts-are-important/medication-abortion-reversal-is-not-supported-by-science.

On December 16, 2021, the FDA announced it will no longer require in-person dispensing of mifeprex (mifepristone) in clinics, medical offices, and hospitals. This modification to REMS allows for dispensing of medication abortion by mail under the supervision of a certified healthcare provider. This revision improves patient access to medication abortion and provides for the use of telehealth. U.S Food and Drug Administration. “Questions and Answers on Mifeprex.” https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex. But see; 19 states prohibit access to medication abortion by mail. Guttmacher Institute. Medication Abortion, State Laws and Policies. 1 December 2021, https://www.guttmacher.org/state-policy/explore/medication-abortion

Additionally, the FDA’s modification on the REMS now allows certified pharmacies to dispense medication abortion. U.S Food and Drug Administration. “Questions and Answers on Mifeprex.” https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex

See Mifeprex (mifepristone) Information, U.S. Food and Drug Administration fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information

American College of Obstetricians and Gynecologists (ACOG). Improving Access to Mifepristone for Reproductive Health Indications, 2018, https://www.acog.org/clinical-information/policy-and-position-statements/position-statements/2018/improving-access-to-mifepristone-for-reproductive-health-indications.

American Bar Association, Resolution 107A, opposes criminal prosecution of any person having an abortion, or for experiencing a miscarriage, stillbirth, or other pregnancy outcome.
See Resolution and Report at: https://www.americanbar.org/content/dam/aba/directories/policy/midyear-2021/107a-midyear-2021.pdf

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