More people could turn to the use of medically prescribed abortion pills in the United States as restrictions to abortion access continue to kick in across the country.
While the use of the medication has steadily increased since it was first approved by the U.S. Food and Drug Administration in 2000, surgical abortions have remained more popular in part because medication abortions are typically more expensive and can only be performed during the first few months of pregnancy.
But an onslaught of new regulations and shuttered abortion clinics could leave people looking to terminate a pregnancy with no other option.
In September, Texas banned abortions after cardiac activity can be detected in the embryo, usually around six weeks of pregnancy. Another Texas state law that began Dec. 1 makes it illegal for anyone to prescribe abortion medication via telehealth or postal mail. Mississippi's law barring most abortions after 15 weeks of pregnancy was debated this week at the U.S. Supreme Court, with a majority of the high court's justices signaling they might uphold the law. The move would weaken the landmark 1973 Roe v. Wade decision, which made it unconstitutional to limit a pregnant person's right to seek an abortion in the first trimester.
Experts predict any decision that rolls back abortion protections would give individual states power to regulate, restrict and abolish abortion altogether. According to a report by Planned Parenthood, 20 states have said they would enact an abortion ban if Roe v. Wade is overturned, leaving 25 million menstruating people of reproductive age without access.
"Medication abortions are likely to comprise a larger fraction of all abortions as early gestational age abortion bans are passed and enforced," said Amanda Stevenson, an assistant professor of sociology at the University of Colorado Boulder specializing in family planning policies.
Medical abortions can only be performed up to 11 weeks after the pregnant person's last period. A study by researchers of the New York-based Guttmacher Institute found the average cost of a medical abortion was upwards of $535 compared to $508 for a surgical procedure under anesthesia.
The U.S. Centers for Disease Control and Prevention, which tracks abortions nationwide, found 42.3% of 629,898 legally induced abortions were through the use of medication in 2019, up from 39% in 2017.
But what is a medical abortion? How do they work? Are they safe? How do people get prescriptions in different states?
What is a medical abortion and how do they work?
Medical abortion is the technical term for terminations that are induced through the use of prescription medication, more commonly referred to as "medication abortions."
The FDA approved the use of two pills to end a pregnancy, mifepristone and misoprostol, as a safe way to provide people with an alternative to medical procedures at a clinic. Most often, people will take the medication prescribed by a physician at home.
This is not to be confused with unsafe abortions, which include self-induced abortions, abortions in unhygienic conditions or those performed by someone that cannot provide adequate medical attention before, during and after the procedure.
When a person has been prescribed a medication abortion, they will first take the mifepristone, which blocks the body's ability to absorb its own progesterone, a necessary hormone for a pregnancy to grow. Then the person will take the misoprostol up to 48 hours later that will cause cramping and bleeding emptying the uterus. Medical providers have said the process is similar to a miscarriage.
Are abortion pills safe?
"Medical abortion is a safe and effective option that can help increase access to abortion for many patients that might otherwise have trouble accessing medical services," said Dr. Megan Evans, an OB/GYN and assistant professor at Tufts University School of Medicine in Boston.
On the other hand, experts said abortion restrictions make pregnancy dangerous for all people as unanticipated medical complications can occur in any pregnancy: hemorrhage, elevated blood pressure, ectopic pregnancies among others.
An analysis by the University of Colorado Boulder found pregnancy-related deaths would increase by an estimated 21% overall among all pregnant persons and 33% among Black women if abortion was banned.
These statistics are compounded by the fact that what is considered medically necessary or life-threatening has increasingly come under scrutiny.
"When you make a medical team fearful of intervention by threatening litigation, this will inevitably lead to horrible outcomes," said Dr. Danielle Jones, an obstetrician-gynecologist from Texas now based in New Zealand and known online as Mama Doctor Jones.
Which states have restrictions on medication abortions?
Although medication abortions are legal, nearly all states have placed some form of restriction.
An analysis by the Kaiser Family Foundation, a nonprofit research institute focused on health care, found that only licensed physicians can prescribe abortion medication in 33 states as opposed to advanced practice clinicians such as nurse practitioners, physician assistants or nurse-midwives.
Arkansas, Idaho, Kentucky, Nebraska, Oklahoma, South Dakota and Utah have laws requiring providers to tell patients a medication abortion is reversible if they take a high dose of progesterone after taking mifeprestone, despite lacking medical evidence to support this claim. Similar laws were passed in Arizona and North Dakota but were blocked by the courts.
Many state laws regulating abortion providers apply to all types of abortion procedures. Therefore, the availability of abortion medication could be limited in states that have anti-abortion "trigger laws" or constitutional amendments already in place to take effect if Roe v. Wade is overturned.
"Over the past several decades, politicians have steadily pushed harsher restrictions on abortion and abortion providers, defunded essential community health centers and programs, and stacked the federal courts to ensure these policies stay in place," said Danika Severino Wynn, vice president of abortion access at Planned Parenthood Federation of America. "Let’s be clear: while we're at a crisis point for access to abortion in this country, for too many people, abortion is already a right in name only because of barriers to access."
What if I live in a state with abortion restrictions? Is it illegal to get prescriptions from a different state?
The agency first temporarily allowed the medication to be available in such methods in the wake of the COVID-19 health emergency last year.
However, many states continue to chip away and regulate abortion access at the state level.
As of this month, writing a prescription or providing someone with abortion medication after seven weeks or sending pills through the mail is a felony in Texas.
Penalties include jail time and a fine of up to $10,000 for anyone who prescribes abortion pills.
Texas and South Dakota also have made it illegal to obtain a prescription from a telehealth visit, a practice that became increasingly common in the wake of the COVID-19 pandemic.
That means people in these states most take on oftentimes costly travel costs to see a doctor in another state to obtain a medical or surgical abortion.
Some clinicians and advocates work around state bans, including flying physicians in and out of different cities to provide abortions. However, the ability to circumvent state laws could be upended if Roe v. Wade is repealed.
Contributing: Christal Hayes, USA TODAY
Follow USA TODAY national correspondent @RominaAdi on Twitter.
This article originally appeared on USA TODAY: Why abortion pill use may increase if Roe v. Wade overturned