Abortion access is making headlines after Politico released a leaked draft Supreme Court opinion by Justice Samuel A. Alito Jr. advising that Roe v. Wade. On May 4, 2022, SciLinean independent, nonprofit service that connects scientists and journalists, interviewed three medical experts to answer questions about medical abortions: Dr. Claire Brindis is the founding director of the Bixby Center for Global Reproductive Health and a professor at the University of California San Francisco School of Medicine. Dr Daniel Grossman is director of Advancing New Standards in Reproductive Health and professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco. Dr Lauren Owens is a Fellow of the American College of Obstetricians and Gynecologists and Assistant Professor of Obstetrics and Gynecology at the University of Michigan Medical School.
The Conversation collaborated with SciLine to bring you the highlights of the discussion, which have been edited for brevity and clarity.
How effective are medical abortions?
Claire Brindis: Research has shown us that medical abortions are as effective as surgical abortions, but we want to use medical abortion earlier in pregnancy. It is particularly effective up to 10 weeks of pregnancy.
Daniel Grosman :: The most commonly used regimen for medical abortion in the United States involves two drugs: mifepristone followed by misoprostol, which is approved by the United States Food and Drug Administration for use up to 10 weeks of pregnancy. There is evidence of its safe use up to about 11 or even 12 weeks, but overall these drugs are about 97% efficient – meaning that about 3% of people who use them will need to undergo vacuum aspiration or procedural abortion to complete the abortion.
What are the possible complications of medical abortions? Are they common?
Brinda: We found that medical abortions had a very low incidence of any kind of complications. Less than 1% – 0.4% of women – experience additional complications, such as heavier bleeding, mild fevers and additional pelvic pain that resolves over time.
Disgusting man: Medical abortion is very safe. It has been very well studied, and truly millions of patients have now used it in the United States. Serious complications are very rare; they occur in less than half a percent.
How does the safety of telehealth medical abortions compare to medical abortions performed in a clinical setting?
Owen: We know that medical abortion via telemedicine is truly equivalent to a clinical setting, as far as outcomes are concerned. We have some really good data on Iowa from Dr. Daniel Grosman, [and] from Dr. Elizabeth Raymond at Gynuity [Health Projects]. I’m doing my care in Michigan, which is a state that does medical abortion via telemedicine, which [I believe] is a great service to offer people, as people who live in rural areas may have more barriers to care than others.
Disgusting man: Telehealth has expanded into truly all areas of medicine, including providing medical abortions. And there are now several published studies, both of The United Kingdom and now from United Statesshowing that the safety and effectiveness outcomes are actually about the same with medical abortion delivered via telehealth compared to in-person delivery.
How safe are medical abortions performed at home without medical supervision?
Disgusting man: People have been self-managing their abortions for hundreds, if not thousands of years. The difference now is that people have the option of using these same drugs which they can get online or from pharmacies in certain countries or from various sources. And all of the proof That we have indicates so far that self-directed abortion using these drugs is very safe. And that people will seek care from a clinician if they have a question or concern about a complication.
Brinda: Based on previous research, I don’t anticipate there will be many more complications for women using these drugs at home to perform an early abortion. One thing that is very important to recognize is that many of these women are savvy consumers of knowledge and information. They will seek advice from friends who have already had it or other internet resources that will help them prepare for what to expect, first, before, during and after.
Owen: I really think medical abortion exists on a spectrum. So when we think of “in-clinic” medical abortion, people often take a first pill at the clinic and then take the second ones at home. So, even though it’s clinically done at first, the procedure is really done at home. There are some very good data with nearly 3,000 people showing that there are truly similar results with self-managed medical abortion compared to in-clinic abortion.
What are the physical effects of medical abortions? Are any of them durable?
Brinda: The physical effects of using these drugs are short term. They are really only around the time of abortion. And they don’t last long in women’s bodies.
Disgusting man: The drugs have the effect of causing cramping and bleeding which leads to the expulsion of the pregnancy. I will say that the side effects of the diet can be intense for some people, especially the pain. The drug can have other side effects like nausea, vomiting, diarrhea, sometimes people get fever or chills right after taking the second drug especially misoprostol. In general, these side effects are very short-lived and there are no long term risk. There are no risks for fertility in the future or risks of complications from a future pregnancy.
Owen: I see a lot of patients worrying about what abortion might mean for their future fertility, and medical abortion should have no impact on future pregnancies.
SciLine is a free service based at the nonprofit American Association for the Advancement of Science that helps journalists include scientific and expert evidence in their stories.
Lauren Owensassistant clinical professor, University of Michigan; Claire BrindisEmeritus Professor of Medicine, University of California, San Franciscoand Daniel GrosmanProfessor of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco