Last week, the Canadian government announced important changes that should go a long way to making medication abortion easier to manage for health-care providers. In Canada, mifepristone is now governed by federal regulations that are similar to, instead of more restrictive than, other prescription drugs.
If Canada can do it, why can’t we?
In the United States, mifepristone is still encumbered with unnecessary and unusually restrictive handling requirements that Canada has successfully removed. Rather than focus on the negative, let’s look at what could be a few positive developments around access to the abortion pill that could quite possibly shape the future of abortion in the United States.
But First, What Exactly Is the Abortion Pill?
The abortion pill is actually a combination of two medications (mifepristone and misoprostol) used together to safely end an early pregnancy. These medicines are most often obtained through a health-care provider and used at home within the first 70 days of pregnancy. The medicines block a hormone needed to sustain a pregnancy and cause cramping and bleeding, similar to what happens during a menstrual period, effectually ending the pregnancy. The average time for completion of a medication abortion is about 3-5 hours after taking the second medicine, misoprostol. The abortion pill is not the same thing as the morning-after pill. Emergency contraception, aka the morning-after pill, prevents a pregnancy while the abortion pill ends one.
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These medications are very safe and very effective, and 93-98 percent of people have a complete abortion with no need for additional medical treatment after their initial visit.
How Difficult Is It to Get an Abortion?
Abortion access in the United States continues to be a struggle for many people. It is not uncommon for a patient, who has an unintended pregnancy, to have to travel many miles from their home to find an abortion provider when they need one. Women in the South and Midwest are often the most affected by provider shortages where they live—primarily due to harsh and unnecessary restrictions imposed by state legislators. At the carafem location in Georgia almost 20 percent of our clients drive over 100 miles to obtain an abortion. In a report published by the medical journal Lancet last month, researchers found that one in five women travel nearly 43 miles to get an abortion in the United States.
How Do We Increase Access to the Abortion Pill in the United States?
Expand Who Can Provide Medication Abortions. carafem unequivocally supports the ability of advanced practice registered nurses (APRNs) to provide medication abortion. Not only is the process of providing the abortion pill well within the scope of their practice and training, APRNs are often the best suited to be supportive, empathetic, and to ensure the quality of care needed to help patients through abortion care. With over 200,000 licensed advanced practice nurses and physician’s assistants in the United States, they are already serving many women of reproductive age who might experience an unintended pregnancy. These clinicians know the needs of the diverse and often underserved populations that they are already caring for. It makes good sense to allow people to seek abortion care from these quality health care providers whom they may already see for their health care. We support the American Civil Liberties Union (ACLU) in a lawsuit it has brought challenging a Maine law that bars these nurses from performing abortions, and we are hopeful that by increasing access to safe abortion care through these providers, it will allow for better relationships of trust around all sexual and reproductive health care needs for underserved people.
Make the Abortion Pill Available in Pharmacies. The ACLU also launched a lawsuit in Hawaii against overly restrictive FDA guidelines regarding the provision of the abortion pill. The suit takes issue with the arbitrary and medically unnecessary guidelines that force providers to jump through a number of hoops just to be able to provide mifepristone, the first medication in a medication abortion.
Things like requiring providers to register with the drug manufacturer or agreeing to provide the medicine only through their approved medical facilities does nothing to protect clients or improve their experience. This is a very unusual and unnecessary restriction placed on an extremely safe medication. The requirement that a patient must be given the medication at a clinic, medical office, or hospital makes it difficult to get in the first place as many patients will face waiting periods to see a physician to obtain the medication. It also places additional hardship on those seeking abortion care, as they may have to search for another doctor who, hopefully, will have the medicine in stock.
While many primary care providers already have a trusted and caring relationship with their clients, and may be very willing to prescribe and help a client use the abortion pill, the cost of acquiring and storing the medicine is very high and may be too much of a barrier to keep it in stock in their office. Pharmacies are experts at ordering, storing, and providing medications to clients, and doing so with more flexible hours than those available to many medical offices. Why should this safe and relatively common medication be provided in any other way? carafem supports the ACLU in fighting to change the way mifepristone is regulated and agrees it should be treated similarly to how other medications are obtained in the United States.
Abortion Care Is Basic Health Care
It is important to remember that almost 50 percent of all pregnancies in the United States are unintended, and of those unintended pregnancies, about half end in abortion. As the future of our health-care system remains unclear, especially for those among us who make the least money and have the fewest choices, this is an issue that will continue to be very important.
Efforts to end abortion through restrictive laws only increase the shame and desperation for those seeking abortion; they do nothing to decrease the number of unintended pregnancies or the number of abortions. Empowering more providers, like APRNs, to increase the scope of the care they provide builds relationships of trust with the patients they serve. Additionally, having medication abortion available in pharmacies reduces barriers for people needing this basic health-care service by increasing the number of providers patients can reach out to when looking for an option for an early, safe, and private abortion.
In the United States, as in Canada, these are good steps toward decreasing the abortion stigma perpetuated by needless and arbitrary restrictions on a routine health care option, while assuring better health outcomes for all people.