Where to get abortion pills and how to use them

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If the US Supreme Court overturns Roe v. Wade, the 1973 legal decision that enshrined abortion as a constitutional right, parts of the country will be ready to plunge into a reproductive-rights dark age in which doctors are forbidden from providing any abortions, in some states even in cases of rape, incest, or a fetus with genetic abnormalities.

But there is still one loophole: Most of these pending state laws exempt anyone seeking an abortion from any penalties. This could lead to an increase in home abortions.

Abortion pills are safe and widely prescribed by doctors, and the best way to use them is under medical supervision, with checkups before and after. With the possibility that Roe could be overturned, leaving each state to make its own rules, people are eager to learn how to obtain the pills and how to use them on their terms, also known as a “self managed” abortion.

MIT Technology Review interviewed medical professionals and lawyers about the abortion pill’s operation, as well as the risks associated with using them without a doctor’s supervision.

What is medication abortion?

It means intentionally ending a pregnancy using abortion pills.

Abortion pills were introduced in the US 22 years ago and have slowly, but steadily, replaced other abortion procedures. Over 50% of the abortions in the US are carried out using pills, according to the Guttmacher Institute. They are usually prescribed by a doctor or nurse and the patient sees a healthcare professional before and after they take them.

Are abortion pills better than surgical?

Early in pregnancy, a surgical abortion is a procedure in which a doctor uses an aspirator–basically a plastic tube–to suck out the contents of the uterus. It takes less than a day.

Medication abortion can take longer, sometimes even several days. However, it is more private and allows people to avoid being harassed by clinic protestors. Medication abortion is also cheaper. It usually costs about $200 to $300, versus $750 to $1,000 for a surgical abortion, depending on insurance and other factors.

What is telemedicine abortion?

Telemedicine abortion is an at-home abortion carried out with pills under remote supervision of a doctor.

Telemedicine abortion became popular during the covid-19 pandemic and is permitted in several US states. It involves an online consultation with a doctor, who will determine the pregnancy’s progress and prescribe the pills. The pills can be picked up at a pharmacy or sent by mail. Telemedicine abortion providers include Carafem and Aid Access.

Although telemedicine does not require you to visit a clinic, it still provides medical oversight.

What is a self-managed abortion?

It’s obtaining and using abortion pills at home without a doctor’s involvement or even a prescription. Doctors without Borders defines self-managed abortion as “obtaining and using abortion pills outside of a medical setting.” This can be done with the help of online guides and telephone hotlines, or overseas pharmacies.

What are the drugs?

In the US, medication abortion usually involves two drugs–mifepristone and misoprostol–taken one or two days apart. The drugs are prescribed to end pregnancies with a gestational age of up to 70 days, or 10 weeks (counted since the last period).

Either drug can end a pregnancy on its own more than 80% of the time. But together they work more effectively and will end about 95% of pregnancies that are fewer than 10 weeks along.

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 that by binding to the same receptor inside cells that progesterone wants to use. The uterine lining that sustains the pregnancy will begin to bleed and fall apart if there is not enough progesterone.

Mifepristone, known at the time by the code name RU-486, was brought to market in 2000 by a health nonprofit called the Population Council. Its approval led to a series of battles against anti-abortion activists, as chronicled by WebMD .. The USA still places restrictions on the ability of doctors to prescribe and dispense the drug.

Misoprostol, also known as Cytotec, is a synthetic form of the hormone prostaglandin. Although it is approved for treating ulcers, doctors discovered that it can also be used to induce labor. The drug causes the cervix soften, dilate, and triggers contractions that expel the pregnancy. It has not been approved for abortion.

In general, medication abortion is very similar to a miscarriage. Doctors say that medication abortion can cause severe cramping and bleeding similar to a heavy period. It may also be possible to see the conceptus. This is at seven weeks after fertilization.

Are abortion pills safe?

Medication abortion has been described as “safer than Tylenol” and more than 10 times safer than giving birth.

While the drugs are safe, particularly earlier in pregnancy, there are ways things can go wrong. Planned Parenthood has a list of side effects , to be aware of, including bleeding that is too severe or fever that could indicate an infection.

Another risk is that the pills will not end an ectopic pregnancies, which are those in which the embryo is growing outside of the uterus. According to the Cleveland Clinic, this is a medical emergency in itself. An ultrasound is the best way to determine if a pregnant woman is ectopic.

Do abortion pills work everytime?

No. This is the biggest risk when self-managing an abortion. Roughly one time in 20, the pills don’t successfully stop the pregnancy. Online pill sellers recommend buying two doses to ensure that the first doesn’t work.

If a medical abortion fails, the options are to try again with more pills, seek out a surgical abortion, or continue the pregnancy–in which case there is an extra risk of fetal abnormalities, like facial defects or incomplete limbs, that is linked to the drug misoprostol.

To determine if the pregnancy has ended, a doctor can use ultrasound to confirm. A home pregnancy test can also be done three weeks after an attempted abortion.

Do abortion pills work later in pregnancy.

The pills are currently prescribed in the US up to 70 days, or 10 weeks, after the last period, although abortion rights advocates say their use through the end of the first trimester is well established.

In reality, the pills will work at any time during pregnancy, but the later they are used, the closer the process will be to giving birth, and the higher the medical, moral, and legal risks will be.

Is self-managed abortion legal.

Yes, but it’s a bit of a gray zone and likely to get grayer.

Reproductive-rights lawyers say self-managed abortion is legal pretty nearly everywhere in the US, although laws in a few states, like Arizona, may restrict it when a pregnancy is too far advanced.

In general, even stricter abortion bans in some states, if is rescinded, don’t envisage penalties for the person who performed the abortion. For instance, a law in Oklahoma provides fines of $10,000 for providing any substance or drug that would “cause the death of an unborn child” but exempts the person having the abortion from the fine. The problem is that restrictive abortion laws can make it more difficult for women to access reproductive health care, including abortion pills. For example, if someone seeks medical attention after having an abortion inducing, they might consider notifying police, regardless of whether self-managed abortion is legal. Although attempts to prosecute someone for having an abortion are not common, they do occur. Over the last 20 years, the legal organization If/When/How has counted several dozen cases in which women were investigated or prosecuted after inducing an abortion. These cases often involve pregnancies later in life. In 2021, for instance, an Ohio woman and her boyfriend pleaded guilty to child endangerment and abuse of a corpse after using abortion pills to end a pregnancy in the third trimester.

How can a person obtain abortion pills?

In states with liberal laws, such as New York and California, a person can obtain a medical abortion at a reproductive clinic, and in many of those states it’s also possible to do everything remotely, via a telemedicine consultation.

In states that have tried to restrict abortion, it is difficult to find a clinic. Some even ban telemedicine abortion. If Roe is repealed, doctors in these states will be guilty of prescribing pills.

But it is still possible to obtain them. You can arrange for a postal address in a state that allows telemedicine abortion. Aid Access has an option. It has doctors overseas who can prescribe the pills and send them to you from an Indian pharmacy. Aid Access doctors don’t have to be US citizens, so they are not subject to US laws. Through this workaround, Aid Access says, it is still doing telemedicine abortion and sending pills to all 50 states. A person can also order pills from a pharmacy in another country without a prescription. Then, they can manage the abortion themselves.

An organization called Plan C has a search engine that will suggest the easiest way to get abortion pills in every state. It maintains a list of overseas pharmacies it thinks are legitimate, which deliver the pills for prices starting around $250. This method requires a credit card, or another way to pay electronically.

Is it safe to order abortion pills in India?

Yes. Many pharmacy websites look suspicious. According to the US FDA, it is illegal to import pills from outside the country. However, the agency has a policy of looking the other way when the drugs are for personal use.

At the moment, ordering pills online does not seem to pose a legal risk. However, this could change if states make it a crime.

How should people prepare for the end of Roe?

It’s a good idea to read up on abortion pills and how to get them. You can also order the pills while you still have them and keep enough stock.

AidAccess is currently willing to mail the pills to women who aren’t pregnant. The shelf life of the pills is at least three years. In general, it is better to visit a US pharmacy than to see a doctor. However, if Roe is rewritten, then anyone who lives in a state that prohibits doctors from prescribing pregnancy pills will not have the option.

Will abortion pills come under more legal pressure?

That’s the big question going forward. There will likely be efforts to limit access to abortion pills and even criminalize their possession if people resort to self-medication in order to circumvent laws.

Will abortion pills ever be available over the counter?

Don’t hold your breath. There are many advantages to abortion pills that can be purchased over-the-counter, such as being safe and easy to use. However, it will take a decade before this happens.

We thank the following people for explaining medical and legal facts around abortion pills: Jill Abrams, If/When/How; Greer Donley, University of Pittsburgh Law School; Daniel Grossman, UCSF; Aishat Olatunde, Physicians for Reproductive Health; Mary Owens, Susan B. Anthony List; Robin Tucker, Metro Area Advanced Practice Healthcare and AidAccess

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