Abortion Drugs May Be Safe Even After the First Trimester, Study Suggests
The News
An overwhelming majority of women were able to end unwanted pregnancies with abortion medications and without additional medical procedures, even if they were well beyond the first trimester, according to a report published on Thursday.
The study was based on the experiences of 264 women who were nine to 16 weeks pregnant in Argentina, Nigeria and an unnamed country in Southeast Asia where abortion is illegal. Almost half of the women took only one drug, misoprostol, instead of the standard two-drug regimen, mifepristone and misoprostol.
They were nonetheless able to terminate the pregnancies, according to the study, published in the journal Obstetrics & Gynecology. All of the participants received information from an abortion support group.
The findings align with clinical data showing the efficacy and safety of medication abortions conducted under medical supervision throughout pregnancy, said Ruvani Jayaweera, an epidemiologist and research scientist at Ibis Reproductive Health and one of the study’s authors.
Nearly one in four women sought medical care after the abortions, most frequently to confirm that the termination was complete. A smaller percentage wanted to address concerns about bleeding, pain, fever or discharge.
Women who were pregnant for 12 weeks or longer were significantly more likely to seek medical care after a medication abortion, compared with those who were nine to 11 weeks pregnant.
Why It Matters
As more than a dozen states banned abortion in the past year, women with unwanted pregnancies have turned in growing numbers to self-managed medication abortions.
But the arduous and time-consuming methods needed to procure the drugs create delays, often meaning pregnancies are more advanced by the time the drugs arrive. The new study, one of the first to report on self-managed medication abortions carried out after the first trimester of pregnancy, offers these women some reassurance, researchers said.
“This paper adds to previous research indicating that self-managed abortion with medications is safe and effective, including after 12 weeks of pregnancy,” said Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. “As clinic-based 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.”
The research also suggests an alternative path to medication abortion if access to mifepristone is severely curtailed. In April, the Supreme Court blocked a lower-court ruling that would have stopped the distribution and sale of mifepristone throughout the United States while the case wends its way through the legal system.
Some 44 percent of the 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 percent of the women in the study succeeded at ending pregnancies with self-managed medication abortions, without any 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 through only 10 weeks of pregnancy, under the supervision of a health care provider.
But the W.H.O., taking into account shortages of health care providers in much of the developing world, endorses self-managed medical abortions in pregnancies of up to 12 weeks without medical supervision.
What’s Next
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 more advanced gestations was relatively small.
Only three participants self-managed abortions with gestations of 17 weeks and longer, and the study’s authors called for more research into medication abortion and later pregnancies.
Access to drugs that are used for these abortions, which are often ordered through the mail, continues to be a flashpoint in the ongoing debate over abortion in the United States.
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