Medication abortion and mifepristone access

Mifepristone is a very safe drug, used exclusively for the initiation of medication abortions. In about 5% of the medication abortions through this two drug procedure, the abortion has to be completed through another process like dilatation and evacuation. For the 95% of abortions that are complete, there are extremely, extremely rare complications, mainly hemorrhage that needs to be treated. (Posted March 14, 2023 | Download Video)

Carol Hogue, Ph.D., M.P.H.
Professor emerita of maternal and child health; professor emerita of epidemiology, Rollins School of Public Health, Emory University Grab This Quote

There are decades of strong data supporting the safety of mifepristone. So it was first FDA approved in the United States in the year 2000. And it actually was approved in France back in 1988. So we have even decades more data on top of that. The regimen is extremely safe and got improved based off of evidence in 2016. There was a 2013 review of over 45,000 medication abortions that showed about a 1.1% rate of ongoing pregnancy and less than 0.4% risk of hospitalization or transfusion. (Posted March 14, 2023 | Download Video)

Lauren Owens, M.D., M.P.H.
Associate professor of obstetrics and gynecology, University of Washington Medical Center Grab This Quote

Medication abortion with mifepristone and misoprostol has been extensively studied in the U.S. and has a really excellent safety profile. So what we define as serious adverse events from using the medications—that would include things like a blood transfusion, surgery, or hospital admission—those things are really rare, with studies showing that these happen in one half of a one percent—or 0.5%—of medication abortions in the U.S. So this means medication abortion with mifepristone and misoprostol has a better safety profile than other commonly used medications like Tylenol or Viagra. (Posted March 14, 2023 | Download Video)

Lauren Ralph, Ph.D., M.P.H.
Associate professor, department of obstetrics, gynecology and reproductive sciences, University of California, San Francisco Grab This Quote

It is as safe, but it is not as effective. So the safety record is virtually identical. But instead of having 95% complete, it’s more like 93%. And for this kind of medication abortion, women do need to be aware that there are some possible contraindications, things that they should really not use this type of abortion. That includes if there’s a concern about ectopic pregnancy, or a uterine mass, or some kind of blood disorder that would possibly increase the risk of hemorrhage. Those things would suggest that the woman should use a different procedure. (Posted March 14, 2023 | Download Video)

Carol Hogue, Ph.D., M.P.H.
Professor emerita of maternal and child health; professor emerita of epidemiology, Rollins School of Public Health, Emory University Grab This Quote

They’re both very safe and effective, and the World Health Organization released some guidance last year recommending either the regimen that we talk about here in the U.S.—with 200 milligrams of mifepristone and 800 micrograms of misoprostol, or 800 micrograms of misoprostol. We do know that the mifepristone and misoprostol is more effective together than the misoprostol 800 micrograms alone. Since some of the concern about the lawsuit around mifepristone, the American College of Obstetricians and Gynecologists has recommended doing misoprostol alone 800 micrograms every three hours for up to three doses if somebody is in a setting where they can’t access mifepristone. (Posted March 14, 2023 | Download Video)

Lauren Owens, M.D., M.P.H.
Associate professor of obstetrics and gynecology, University of Washington Medical Center Grab This Quote

Both regimens—mifepristone and misoprostol, or misoprostol alone—have excellent safety profiles. Mifepristone and misoprostol results in serious adverse events in just one half of one percent—or 0.5%—of cases. And that figure is quite similar for misoprostol alone, where it’s 0.7%. So across both regimens in less than 1% of cases a pregnant person would have an adverse event like hospitalization, blood transfusion or surgery. Both regimens are also effective in ending the pregnancy. So medication abortion with mifepristone and misoprostol has effectiveness of 97% through 10 weeks of pregnancy, and about 95% at 10 to 12 weeks of pregnancy. Medication abortion with misoprostol alone has a somewhat lower effectiveness. However, it’s really still quite effective, with studies showing effectiveness ranging from 87 – 93%, depending on factors such as the number of misoprostol doses taken and the route of administration of the medication. (Posted March 14, 2023 | Download Video)

Lauren Ralph, Ph.D., M.P.H.
Associate professor, department of obstetrics, gynecology and reproductive sciences, University of California, San Francisco Grab This Quote

Limiting access to abortion itself is a major public health problem for women. Right now, maternal mortality is the sixth leading cause of death for women aged 15 to 34. The fact is, it’s not listed as one of the top ten causes of death because it it happens only to women—and only women of reproductive age. Nevertheless, it is the sixth leading cause of death for women right now. It will increase with increasing restriction to abortion. And the research is pretty clear on this. Beginning in about 1995 when the abortion restrictions started to proliferate across the country, there was a distinct difference in maternal mortality rate for the states that restricted abortions and those that did not. And it’s gotten worse and worse and worse as the restrictions have occurred. The fact is that women who are otherwise perfectly healthy at six weeks or 12 weeks of pregnancy can have preeclampsia can have postpartum hemorrhage. Most of the deaths occur at the time of delivery or after delivery. And women are exposed to those risks, irrespective of whether they want to have the pregnancy or not. (Posted March 14, 2023 | Download Video)

Carol Hogue, Ph.D., M.P.H.
Professor emerita of maternal and child health; professor emerita of epidemiology, Rollins School of Public Health, Emory University Grab This Quote

There’s been a lot of restrictions around medication abortion and access to the medications. I’ve even known, where I used to live in Michigan, people that might not be able to access medications for pregnancy loss because they had a pretty spontaneous abortion. So, we know that one in four people with the uterus has an abortion by the time they’re 45. We know that one in five pregnancies end in miscarriage and mifepristone improves the efficacy of misoprostol for miscarriage management, too. So limiting people’s access decreases their access to evidence-based health care, whether for miscarriage or for abortion care. (Posted March 14, 2023 | Download Video)

Lauren Owens, M.D., M.P.H.
Associate professor of obstetrics and gynecology, University of Washington Medical Center Grab This Quote

Medication abortion accounts for more than half of all abortions in the U.S. today. So the impact of banning mifepristone would be devastating, especially for people who are already facing barriers to abortion like having to travel hundreds of miles to the nearest clinic and navigate longer wait times at these clinics. And broadly speaking, offering pregnant people options when it comes to their abortion-related health care is beneficial. Some people prefer a medication abortion specifically because of the potential privacy and flexibility it offers, and because it allows them to minimize interactions with the health care system. So for example, during the COVID-19 pandemic, we saw many abortion providers offering medication abortion using telehealth, and this allowed us to study these models of care and learn that they’re safe, effective and well liked by patients. So removing or limiting options for abortion isn’t in the patient’s best interest or supported by research evidence. (Posted March 14, 2023 | Download Video)

Lauren Ralph, Ph.D., M.P.H.
Associate professor, department of obstetrics, gynecology and reproductive sciences, University of California, San Francisco Grab This Quote

We know that mifepristone improves misoprostol’s effectiveness when we use it for management for early pregnancy loss. Mifepristone and misoprostol also get used together for induction termination of pregnancy or management of a second trimester pregnancy, loss of labor induction. And then we also know for folks who are having a surgical evacuation of the uterus in the second or third trimester—dilation and evacuation—that mifepristone works together with osmotic dilators that help the cervix open, to make that dilation easier and safer. So there are many uses that could potentially be impacted if there would be a ban on mifepristone. (Posted March 14, 2023 | Download Video)

Lauren Owens, M.D., M.P.H.
Associate professor of obstetrics and gynecology, University of Washington Medical Center Grab This Quote

In short, yes. Mifepristone is used to treat a wide variety of medical conditions. Within obstetric and gynecologic care, mifepristone is also used for management of early pregnancy loss for patients experiencing miscarriage. It is also used for other specialties—for example, for treatment of patients with Cushing syndrome. To ban mifepristone, if that is what the judge in this case does decide, would not be a decision based on science or research or evidence. The FDA followed its rigorous process based on evidence when it initially approved the medication over 20 years ago, and since then, we’ve accumulated an even larger body of research demonstrating its safety and effectiveness after use by millions of pregnant people. (Posted March 14, 2023 | Download Video)

Lauren Ralph, Ph.D., M.P.H.
Associate professor, department of obstetrics, gynecology and reproductive sciences, University of California, San Francisco Grab This Quote

“Research has shown us that medical abortions are as effective as surgical abortions, but we need to consider that we want to use medical abortion earlier in the pregnancy. So it’s effective, especially effective, up to ten weeks of pregnancy.” (Posted May 4, 2022 | Download Video)

Claire Brindis, Dr.P.H.
Founding director of the Bixby Center for Global Reproductive Health, University of California, San Francisco Grab This Quote

“The most commonly used regimen for medication abortion in the United States involves two medications, mifepristone followed by misoprostol, which is approved by the U.S. Food and Drug Administration for use up through ten weeks of pregnancy. There is evidence about its safe use up until about eleven or even twelve weeks, but overall these medications are about 97 percent effective—meaning that about 3 percent of people who use them will need to have a vacuum aspiration or a procedural abortion to complete the abortion.” (Posted May 4, 2022 | Download Video)

Daniel Grossman, M.D.
Director, Advancing New Standards in Reproductive Health; professor, department of obstetrics, gynecology and reproductive sciences, University of California, San Francisco Grab This Quote

“Medication abortions are highly effective. The best data we have—and how I counsel my patients—is  that medication abortions are 95 plus percent effective.” (Posted May 4, 2022 | Download Video)

Lauren Elizabeth Owens, M.D., M.P.H.
Associate professor of obstetrics and gynecology, University of Washington Medical Center Grab This Quote

“We have found that medical abortions have had a very low incidence of any type of complications. Less than one percent—0.4 percent of women—experience any kinds of additional complications, such as heavier bleeding, low-grade fevers, and some additional pelvic pain that over time is eliminated.” (Posted May 4, 2022 | Download Video)

Claire Brindis, Dr.P.H.
Founding director of the Bixby Center for Global Reproductive Health, University of California, San Francisco Grab This Quote

“Abortion using medications is very safe. This has been very well studied, and really millions of patients have now used it in the U.S. Serious complications are very rare, occur in less than half a percent. These include things like heavy bleeding, possibly requiring a blood transfusion—the risk of blood transfusion is less than one out of a thousand people who use the regimen. Infection similarly is very rare.” (Posted May 4, 2022 | Download Video)

Daniel Grossman, M.D.
Director, Advancing New Standards in Reproductive Health; professor, department of obstetrics, gynecology and reproductive sciences, University of California, San Francisco Grab This Quote

“Like any procedure in medicine, there are complications with medication abortion. I would say they’re extremely rare. So, it’s very unusual to have excessive bleeding that would require a transfusion, to have a medication abortion not be complete and to require another procedure, or to have infection that would require antibiotics. Those are probably the most common things that could happen with a medication abortion, but to call them common is really an overstatement. They’re extremely unusual.” (Posted May 4, 2022 | Download Video)

Lauren Elizabeth Owens, M.D., M.P.H.
Associate professor of obstetrics and gynecology, University of Washington Medical Center Grab This Quote

“Medical abortions have been shown to be extremely safe and effective, as comparable to surgical abortion, particularly early in the woman’s pregnancy. What is important to note is that an ironic outcome of COVID has been the pivoting to the use of telemedicine, which has been shown to be extremely effective in being able to provide these types of services to women in a very cost-effective and also patient-centered approach. So counseling can take place, other types of advice, following the procedure, and a lot of attention that women in the past might not have received when they were just going to their doctors’ offices for their medications or for the surgical abortion.” (Posted May 4, 2022 | Download Video)

Claire Brindis, Dr.P.H.
Founding director of the Bixby Center for Global Reproductive Health, University of California, San Francisco Grab This Quote

“You know we’ve learned so much about telehealth during the COVID pandemic. Telehealth has expanded in really every area of medicine, including for providing medication abortion. And there are now several published studies, both from the United Kingdom and now from the United States, showing that safety and effectiveness outcomes are really pretty much identical with medication abortion provided by telehealth compared to in-person provision. So all of the evidence really points to this being safe and effective. So much so, in fact, that the FDA has endorsed the practice and says that this is an evidence-based practice.” (Posted May 4, 2022 | Download Video)

Daniel Grossman, M.D.
Director, Advancing New Standards in Reproductive Health; professor, department of obstetrics, gynecology and reproductive sciences, University of California, San Francisco Grab This Quote

“We know that telemedicine medication abortion is really equivalent to a clinical setting, as far as outcomes. We have really great data out of Iowa around that; we have great data from Dr. [Daniel] Grossman, [and] from Gynuity [Health Projects]. And I perform my care in Michigan, which is a state that does have telemedicine medication abortion, which is a great service to offer people, as folks who live rurally may have more barriers to care than other people.” (Posted May 4, 2022 | Download Video)

Lauren Elizabeth Owens, M.D., M.P.H.
Associate professor of obstetrics and gynecology, University of Washington Medical Center Grab This Quote

“Based upon previous research, I don’t anticipate that there are many more complications for women using these medications 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 out advice either from friends who’ve already had one or from other internet resources that help them prepare for what to expect, first, before, during, and after.” (Posted May 4, 2022 | Download Video)

Claire Brindis, Dr.P.H.
Founding director of the Bixby Center for Global Reproductive Health, University of California, San Francisco Grab This Quote

“People have been self-managing their abortions for hundreds, if not thousands, of years. The difference now, over the past few decades, is that people have the option of using these same medications—either mifepristone together with misoprostol or misoprostol used alone—which they may obtain online or from pharmacies in some countries or from a variety of sources, and all of the evidence that we have so far, particularly from other countries, indicates that self-managed abortion using these medications is very safe. And that people will seek care from a clinician if they have a question or concern about a complication. So as a physician I don’t have concerns really about the medical risks so much from self-managed abortion using these medications. I do have concerns about the legal risks that patients may take. We know that a number of people, more than twenty, have been arrested or prosecuted or even imprisoned for allegedly attempting to self-manage their abortion or for helping someone else self-manage their abortion.” (Posted May 4, 2022 | Download Video)

Daniel Grossman, M.D.
Director, Advancing New Standards in Reproductive Health; professor, department of obstetrics, gynecology and reproductive sciences, University of California, San Francisco Grab This Quote

“I really think medication abortion exists on a spectrum. So when we think about an—in quote—in-clinic medication abortion, folks are frequently getting a first pill in clinic and then taking the second pills at home. So even though that’s clinically done at the start, really the procedure is completed at home. When folks are self-sourcing medication abortion, there are many ways to do that, but there are some really great data with almost 3,000 folks showing that there are really similar outcomes with success as far as completion of medication abortion. And so like one percent or less than one percent rate of any serious adverse event occurring. And that’s really comparable with—quote—clinic-administered medication. An asterisk there is even with a clinic-administered initial medication, folks are taking the misoprostol, the other pills for medication abortion, at home.” (Posted May 4, 2022 | Download Video)

Lauren Elizabeth Owens, M.D., M.P.H.
Associate professor of obstetrics and gynecology, University of Washington Medical Center Grab This Quote

“The physical effects of using these medications are short-term. They really are only around the time of the abortion. And they’re not long-lasting in the women’s body. The physical ailments may be additional bleeding, cramping, but no further and long-term consequences of using these medications.” (Posted May 4, 2022 | Download Video)

Claire Brindis, Dr.P.H.
Founding director of the Bixby Center for Global Reproductive Health, University of California, San Francisco Grab This Quote

“With medication abortion, the medications have the effect of causing cramping and bleeding that leads to expulsion of the pregnancy. I will say that the side effects of the regimen can be intense for some people, particularly the pain. In studies that have looked at this, the maximum pain level that people report on a scale from zero to ten can be seven to eight. And of course some people even have higher levels of pain. And I think that there’s more that we can do, there is more recent evidence about ways that we can address the pain. But it is something that’s really important to inform patients about. The medication can have other side effects like nausea, vomiting, diarrhea, sometimes people have fevers or chills right after taking particularly the second medication, misoprostol. In general these side effects are very short-lived, and there are no long-term risks. There are no risks to fertility in the future or risks of complications of a future pregnancy. These medications are very safe, and we have a great deal of experience with them now.” (Posted May 4, 2022 | Download Video)

Daniel Grossman, M.D.
Director, Advancing New Standards in Reproductive Health; professor, department of obstetrics, gynecology and reproductive sciences, University of California, San Francisco Grab This Quote

“So, medication abortion involves two medications. The first pill that folks can either take in clinic or have mailed to them is mifepristone. And I usually tell my patients they shouldn’t feel too different after taking that. They may have a little bit of nausea, but so many folks are already having nausea with their pregnancies. Then misoprostol, the second pills that folks can take at home, either in their cheek or vaginally or under their tongue, those medications’ job is to cause cramping and to help the uterus empty. That’s what they do during inductions of labor, that’s what they do for post-partum hemorrhage, and that’s what they do with medication abortion care, as well. So with that, patients can expect having cramping and bleeding, likely within four hours of taking those pills. Sometimes folks can get a little bit of a fever with them. But there really shouldn’t be long-lasting impacts for folks. I see a lot of patients who are worried about what having an abortion could mean for their future fertility, and medication abortion should not have any impact on future pregnancies.” (Posted May 4, 2022 | Download Video)

Lauren Elizabeth Owens, M.D., M.P.H.
Associate professor of obstetrics and gynecology, University of Washington Medical Center Grab This Quote