Yesterday, Health Canada announced important changes that should take us a long way to making Mifepristone medication abortion easier to manage for health care providers. In Canada, Mifepristone now has federal regulations that are similar to, instead of more restrictive than, other prescription drugs.
In the United States, Mifepristone is still encumbered with unnecessary and unusually restrictive handling requirements that Canada has successfully removed. Rather than focus on the negative, let’s look at what could be a few positive developments around access to the abortion pill that could quite possibly shape the future of abortion in the US.
What exactly is the abortion pill?
The abortion pill is actually a combination of 2 medications (Mifepristone and Misoprostol) used together to safely end an early pregnancy. These medicines are most often obtained through a health care provider and used at home within the first 70 days of pregnancy. The medicines block a hormone needed to sustain a pregnancy and cause cramping and bleeding, similar to what happens during a menstrual period, effectually ending the pregnancy. The abortion pill is not the same thing as the morning-after pill. This is a common misconception and something that needs to be brought to people’s attention. Emergency contraception, aka the morning-after pill, prevents a pregnancy while the abortion pill ends one.
In terms of what to expect when taking the abortion pill, women report a range of personal experiences after taking the abortion pill that vary from bleeding similar to what they see during a period to bleeding that is quite a bit heavier – although it usually lessens a lot within the first 24 hours. Some women need no medication for cramping, while others use the same medications they use for menstrual cramps, like ibuprofen, to feel more comfortable during their abortion. Some women request a stronger pain reliever and can talk with their provider about options for pain relief during their visit.
The average time for completion of a medication abortion is about 3-5 hours after taking the second medicine, Misoprostol. It is not unusual for light bleeding to continue for a few days, or even off and on lightly until a woman sees her next menstrual period. It is a good idea to follow up with a provider if at any time a person is unsure if their abortion was complete. We do know that these medications are very safe and very effective and that 93-98% of people have a complete abortion with no need for additional medical treatment after their initial visit.
How difficult is it to get an abortion?
Abortion access in the United States continues to be a struggle for many people. It is not uncommon for a woman, who has an unintended pregnancy, to have to travel many miles from her home to find an abortion provider when she needs one. Women in the South and the Midwest are often the most impacted by provider shortages where they live – often due to harsh and unnecessary restrictions imposed by state legislators. At the carafem location in Georgia almost 20% of our clients drive over 100 miles to obtain an abortion. In a report published by the Lancet last month, it was found that 1 in 5 women travel at least 43 miles to get an abortion in the United States.
Improving care by allowing advanced practice nurses to provide the abortion pill.
carafem unequivocally supports the ability of advanced practice registered nurses to provide medication abortion. Not only is the process of providing the abortion pill well within the scope of their practice and training, nurses are often the best suited to be supportive, empathetic, and ensure the quality of care needed to help patients through the abortion experience. With over 200,000 licensed advanced practice nurses and physician's assistants in the United States, they are already serving many women of reproductive age who might experience an unintended pregnancy. These clinicians know the needs of the diverse and often underserved populations that they are already caring for. It makes good sense to allow women to seek abortion care from these quality healthcare providers that they may already see for their healthcare. We support the ACLU in this lawsuit and are hopeful that by increasing access to safe abortion care through these providers, it will allow for better relationships of trust around all sexual and reproductive healthcare needs for underserved people.
Reducing barriers by making the abortion pill available in pharmacies.
The ACLU launched a lawsuit in Hawaii against overly restrictive FDA guidelines regarding the provision of the abortion pill. The suit takes issue with the arbitrary and medically unnecessary guidelines that force providers to jump through a number of hoops just to be able to provide Mifepristone, the first medication in a medication abortion. Things like requiring providers to register with the drug manufacturer or agreeing to provide the medicine only through their approved medical facilities does nothing to protect clients or improve their experience. This is a very unusual and unnecessary restriction placed on an extremely safe medication. The requirement for a physician to stock this medication in their office makes it difficult to get in the first place as many patients will face waiting periods for a physician to obtain the medication. It also places additional hardship on those seeking an abortion, as they may have to search for another doctor who, hopefully, will have the medicine in stock. While many primary care providers already have a trusted and caring relationship with their clients, and may be very willing to prescribe and help a client use the abortion pill, the cost of acquiring and storing the medicine is very high and may be too much of a barrier to keep it in stock in their office. Pharmacies are experts at ordering, storing, and providing medications to clients, and doing so with more flexible hours than those available to many medical offices. Why should this safe and relatively common medication be provided in any other way? carafem supports the ACLU in fighting to change the way Mifepristone is regulated and agrees it should be treated similarly to how other medications are obtained in the United States.
Abortion care is basic health care.
It is important to remember that almost 50% of all pregnancies in the United States are unintended, and of those unintended pregnancies, about half end in abortion. As the future of our health care system remains unclear, especially for those amongst us who make the least money and have the fewest choices, this is an issue that will continue to be very important to the health of our country. Efforts to end abortion through restrictive laws only increase the shame and desperation for those seeking abortion. They do nothing to decrease the number of unintended pregnancies or the number of abortions. Empowering more providers, like advanced practice nurses, to increase the scope of the care they provide builds relationships of trust with the patients they serve. Additionally, having medication abortion available in pharmacies reduces barriers for people needing this basic health care service by increasing the number of providers women can reach out to when looking for an option for an early, safe, and private abortion. In the United States, as in Canada, these are good steps towards decreasing the abortion stigma perpetuated by needless and arbitrary restrictions on a routine health care option, while assuring better health outcomes for all people.