Rhetoric vs. Reality: Setting the Record Straight on Medication Abortion

Excerpted from a June 2019 article from the Center for American Progress

By Nora Ellmann, Kelly Rimar and Jamila Taylor 

 

Medication abortion can be a key tool in the fight for reproductive choice: It has the potential to bring abortion access to those who need it most—particularly people of color, low-income people, people in rural areas, and others who cannot easily access providers giving individuals greater agency over their health care decisions.

Medication abortion, or abortion with pills, is safe, effective, and less invasive than a surgical procedure and gives people the option to have an abortion outside of a clinic in the comfort and privacy of their own homes. Yet despite the proven record and benefits of the medication abortion regimen, anti-choice groups continue to spew false claims about its safety.

As access to quality reproductive health care is under siege, it is crucial to recognize and correct the lies around medication abortion that anti-abortion groups have propagated in order to influence federal and state policies. Ellmann, Rimar and Taylor have detailed the truth behind myths about medication abortion.

Myth 1: Medication abortion is unsafe

Reality: The medication abortion regimen is used in the first 10 weeks of pregnancy and consists of two medications: mifepristone and misoprostol. Mifepristone is taken first, generally in a clinic or health center, followed by misoprostol one to two days later, usually at home. Mifepristone, the first of the two pills, has extremely low rates of adverse events and is safer than many medications, including Tylenol and Viagra.

In 2016, after a thorough review of medical evidence, the U.S. Food and Drug Administration (FDA) extended the eligibility period from seven weeks to 10 weeks gestation and reduced the approved dosage from 600 mg to 200 mg. In March 2018, the U.S. Government Accountability Office (GAO) issued a report affirming that the FDA acted appropriately in revising the Mifeprex label in 2016, despite anti-choice advocates’ claims to the contrary.

Mifepristone remains much more heavily regulated than other prescription drugs as a result of the politicization of abortion care. The FDA has required a Risk Evaluation and Mitigation Strategy (REMS) for mifepristone. The mifepristone REMS limits its distribution; providers must register to be permitted to distribute mifepristone, and it can only be distributed in hospitals, clinics, or medical offices. This means that under the REMS, mifepristone is not available at pharmacies and can only be prescribed by a limited number of providers, which

significantly and unnecessarily restricts access to medication abortion—particularly for people who live far from a clinic or do not have an approved provider in their area. The American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) support lifting the REMS, as they are not medically necessary!

Myth 2: Medication abortion is traumatic

Reality: Everyone experiences abortion differently, and those who have abortions are entitled to the full range of emotions about their experience. However, research and powerful personal storytelling indicate overwhelmingly that people do not regret their abortions. So-called post-abortion syndrome, which anti-choice groups often point to as evidence of the traumatic effects of abortion, is not recognized by the American Psychological Association and decades of research have disproven the claim that abortion compromises mental health.

As for the physical experience of a medication abortion, most people report bleeding, nausea, cramping, and fatigue. These symptoms resemble those of a heavy period, and over-the-counter medications such as Ibuprofen are recommended for pain management. Most people may resume normal activity within a day or two after a medication abortion.

If there is any trauma involved in abortion care, it is the struggle of having to navigate unjust restrictions on abortion access and attacks from anti-choice protesters and politicians. The landmark Turnaway Study from Advancing New Standards in Reproductive Health (ANSIRH) provides evidence of this experience. The study found that while having an abortion was not associated with mental health issues, being denied a wanted abortion was associated with anxiety and low self-esteem in the short-term. The option to end a pregnancy at home provides patients with greater access to care and prioritizes autonomy and comfort in the abortion experience.

Myth 3: Medication abortion is ineffective and reversible

Reality: Medication abortion is more than 95 percent effective and has been used safely in the United States for nearly two decades. Although the two-drug protocol is recommended, misoprostol—the second medication—is about 75 percent to 90 percent effective in terminating an unplanned pregnancy when taken alone.

The medical community overwhelmingly agrees that claims of “abortion reversal” are unsupported by medical and scientific evidence. Promoters of this myth claim that abortion may be reversed after mifepristone is taken as long as the second drug, misoprostol, is not taken and the hormone progesterone is administered throughout the first trimester. However, this simply is not true. This implies that those who choose to have abortions second-guess themselves and later regret the decision. In reality, people who have abortions take their reproductive health decisions seriously and, as previously discussed, almost universally do not regret the decision.

Conclusion

Medication abortion is a proven safe and effective method that can significantly improve the availability and experience of abortion care. It is a powerful enabler of reproductive autonomy, allowing people to choose the abortion setting that is safest and most comfortable for them. To ensure access to this crucial health care option, we must put an end to the lies that undermine the health care decisions of all people seeking abortion care.