Why It Matters
Since more than a dozen states outlawed abortion last year, women with unwanted pregnancies are increasingly turning to self-administered medication abortions.
But the difficult and time-consuming procedures required to obtain the drugs create delays, often meaning pregnancies are more advanced by the time the drugs arrive. The new study, one of the first to report on self-managed medication abortions performed after the first trimester of pregnancy, offers these women some reassurance, the researchers said.
“This paper adds to previous research indicating that self-managed abortion with medications is safe and effective, including after 12 weeks of pregnancy,” said Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. “As clinic-based abortion care becomes less available in many parts of the country due to state-level bans, self-managed abortion will become more common, as we are already seeing.”
The research also suggests an alternative pathway to abortion medication if access to mifepristone is severely reduced. In April, the Supreme Court blocked a lower court ruling that would have halted the distribution and sale of mifepristone across the United States while the case works its way through the legal system.
Some 44 percent of participants in the new study used only misoprostol, which is prescribed for many conditions and is available in many countries without a prescription.
Background
About 90 percent of the women in the study succeeded in terminating pregnancies using self-managed medication abortions, without the need for further intervention. Five percent had a procedure to complete the abortion, and 5 percent had an incomplete abortion.
The two-drug regimen of mifepristone and misoprostol is approved by the Food and Drug Administration for use only within 10 weeks of pregnancy, under the supervision of a health care provider.
But the WHO, taking into account the shortages of health care providers in much of the developing world, endorses self-managed medical abortions in pregnancies up to 12 weeks without medical supervision.
what next
The new report is a sub-analysis of a larger study that looked at 1,352 women who self-managed abortions at different stages of pregnancy, and the number with more advanced pregnancies was relatively small.
Only three participants self-managed abortions with pregnancies of 17 weeks and longer, and the study’s authors called for more research on medication abortions and later pregnancies.
Access to the drugs used for these abortions, which are often ordered by mail, continues to be a flashpoint in the ongoing abortion debate in the United States.