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As more than a dozen states have banned abortion in the past year, women with unwanted pregnancies have increasingly turned to self-managed medical abortions.
But the arduous and time-consuming methods needed to procure the drugs create delays, which often means pregnancies are further along by the time the drugs arrive. The new study, one of the first to report on self-directed medical abortions performed after the first trimester of pregnancy, offers these women some comfort, the researchers said.
“This article adds to previous research indicating that self-directed abortion with medication is safe and effective, including after 12 weeks of pregnancy,” said Dr. Daniel Grossman, Professor of Obstetrics, Gynecology and Science of reproduction at the University of California, San Francisco. “As in-clinic 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.”
Research also suggests an alternative route to medical abortion if access to mifepristone is severely restricted. In April, the Supreme Court blocked a lower court ruling that would have stopped the distribution and sale of mifepristone across the United States while the case progresses through the legal system.
Some 44% of participants in the new study used only misoprostol, which is prescribed for many conditions and available in many countries without a prescription.
Background
About 90% of the women in the study successfully terminated a pregnancy with self-managed medical abortions, with no additional intervention needed. 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 for only 10 weeks of pregnancy, under the supervision of a healthcare provider.
But the WHO, recognizing shortages of healthcare providers in much of the developing world, approves self-managed medical abortions for pregnancies up to 12 weeks without medical supervision.
And after
The new report was a sub-analysis of a larger study that looked at 1,352 women who self-managed abortion at different stages of pregnancy, and the number with later pregnancies was relatively small.
Only three participants self-managed abortions with gestations of 17 weeks or more, and the study authors called for more research into medical abortion and subsequent 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.
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