In the United States, the abortion pill has become the new battleground between pro and anti-abortion supporters since a Supreme Court decision to authorize each state to legislate on the matter.
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Approved in the country for more than 20 years, this method is very widespread, but it is now threatened by a court decision.
– In what proportion is it used?
According to the Guttmacher Institute, more than half of abortions (53%) in the United States in 2020 were medical.
This is less than in certain European countries, such as France, where this method has been authorized since 1988 and where medical abortions represented around 70% of voluntary terminations of pregnancy (IVG) in 2020.
– How does the abortion pill work?
The abortion pill is different from the “morning following pill”. While the morning following pill is taken following risky intercourse to avoid getting pregnant, the abortion pill is taken once a pregnancy is confirmed, in order to abort.
The method authorized in the United States, as in many countries, actually uses two drugs. The first is mifepristone (or RU 486), which stops the development of pregnancy by acting on a hormone called progesterone. The second, misoprostol, is taken one to two days later and triggers contractions and bleeding.
At the time of the abortion, women are at home or in a place of their choice, and not in a health facility.
– Which framework in the United States?
In the United States, the method using mifepristone and misoprostol has been authorized by the American Medicines Agency (FDA) since 2000.
It is approved up to 10 weeks following the last menstrual period. Beyond that, women wanting an abortion must have recourse to an aspiration abortion.
– What effectiveness and what risks?
Abortions using mifepristone and misoprostol within the allowed time frame are very safe and effective, hammer all the experts.
Pregnancies are actually terminated in more than 95% of cases, studies have shown.
Complications (excessive blood flow, fever, infection, allergic reaction) requiring consultation are rare.
Important point: the pills do not work in case of ectopic pregnancy (outside the uterus, 2% of pregnancies). An ectopic pregnancy can be detected with an ultrasound and must be treated, as it can be fatal.
– Where is it currently available in the United States?
Since last summer, a dozen American states have made abortion illegal, following a Supreme Court decision authorizing them to legislate on the subject themselves. In these states, medical abortions are therefore also prohibited.
Despite this ban, organizations have stepped up to provide abortion pills to women in these states, from abroad or from other US states. The extent of these detours is difficult to assess.
Where abortion has remained legal, the FDA recently eased restrictions on mifepristone, allowing it to be mailed when prescribed, or sold directly to pharmacies like any other medication (and no longer dispensed only in specialized institutions).
But even in those states, a lawsuit threatens to challenge the FDA’s 2000 clearance. This lawsuit was strategically filed in Amarillo, Texas, where the only federal judge is known for his hostility to abortion. He must hear the positions of the parties on Wednesday and might render his decision in stride.
