With the fall of Roe v. Wade, anti-abortion activists in the United States have now set their sights on outlawing abortion with pills—and for the moment, their legal battle to prevent the use of mifepristone, one of two key abortion medications, has made the abortion landscape in the United States even more uncertain.
But as two Ipas clinical experts explain below, an important pathway to safe, effective abortion with pills remains open: “misoprostol-only” abortion, which has been a vital option for decades in countries around the world where abortion is legally restricted.
In this Q & A, Guillermo Ortiz, an OB-GYN and Ipas senior medical advisor, and Bill Powell, a nurse practitioner and Ipas senior medical scientist, discuss the ruling’s impact and highlight some of the important clinical resources on misoprostol-only abortion that Ipas has developed over the years.
First off, how do these legal challenges to mifepristone potentially affect abortion care in the United States?
Guillermo Ortiz: If successful, they have the potential to roll abortion rights back even further—and human rights as well—because it means that people would no longer have access to the full spectrum of abortion care. Abortion is health care, and everyone should have the ability to choose the method which works best for them, whether it’s a self-managed abortion with pills or a procedure done in a clinic.
Abortions using mifepristone combined with misoprostol is a method that millions of people have used in the U.S. since the FDA approved mifepristone more than 20 years ago. But despite whatever the courts ultimately rule on the use of mifepristone, medical abortion using misoprostol only is still available in the U.S. and is an important part of the abortion care continuum.
Are misoprostol-only abortions safe and effective?
Bill Powell: Very much so. Although abortion using mifepristone in combination with misoprostol is regarded as the “gold standard” for medical abortion, recent studies have shown that abortions using misoprostol only are nearly as effective. More doses are required, side effects are increased, and it takes longer to complete a successful abortion. But the efficacy of misoprostol-only abortion is nearly the same as when misoprostol is used in combination with mifepristone.
Ortiz: It’s also important to note that misoprostol is more widely available and less expensive than mifepristone. At Ipas, we know from our work with abortion providers and health-care systems in countries where abortion is legally restricted that misoprostol-only is likely the most common method of medical abortion used worldwide.
In some Latin American countries, for instance, misoprostol is widely available in pharmacies. A box of pills can be bought for around $20, without any restrictions, and some pharmacists have been trained on how to provide information on how to safely use the pills. In Africa and Asia, misoprostol is often available in pharmacies, too, but usually only by prescription.
Based on decades of work in legally restrictive settings, Ipas clinical experts have developed guidance and clinical resources that are specific to misoprostol-only medical abortion. Can you highlight some of the key resources?
Powell: One of the most important resources is our Clinical Updates in Reproductive Health. This guidance is updated often and covers a wide range of abortion topics, including protocols for misoprostol-only medical abortionand data on the safety and effectiveness of medical abortion.
Our resources also include a tool for assessing gestational age for misoprostol-only medical abortion and a collection of informational videos that are designed to help health-care providers improve their abortion care and to help people safely self-manage their abortion using pills. The videos were filmed in facilities in Africa and Asia and are consistent with the latest WHO and Ipas clinical guidance. One video, in particular, reviews the key things people need to know about how to have an abortion with pills using misoprostol only.
What drives our recommendations is our experience working on the ground in settings around the world—and our guidance is often ahead of the World Health Organization’s.
One last question: Abortion with pills is often called “revolutionary.” What makes it such a game-changer?
Ortiz: It’s revolutionary because it puts abortion literally in the hands of pregnant people. Misoprostol was originally used to treat stomach burning and ulcers. But in the 1990s, women in Latin and Central America, where abortion was and still is highly restricted, discovered that it could induce abortion.
Over the years, abortion with pills has greatly expanded access to abortion and gives people the choice of having an abortion at home or another place of their choosing. Research has shown that medical abortion also has reduced the number of pregnancy-related deaths and illnesses because, even in legally restricted settings, it provides a safe option for people who otherwise might have had to use riskier, unsafe methods. All of that adds up to abortion with pills being a true game-changer.