Do you have that pill?

The abortion pill has been available the entire 6 years I have worked in abortion provision, in fact its been available for 10 years today! It seems to have become more prevelant over the past few years as the technology has aged. Personally, I don't think I would make the choice to take the pill if I needed an abortion, I like to get anything uncomfortable over with as quickly as possible. When women ask about the pill as though it might be as simple as taking ibuprofin for a headache I try to explain to them they will go through essentially what is a miscarriage at home.

I have friends who have taken the pill who have had very intense experiences and others who say its no harder than a heavy period. After taking mifeprex patients generally take cytotec or misoprostol orally or vaginally and then expel the pregnancy tissue. Patients should expect to experience intense cramping and heavy blood clots. Its an abortion that takes place in the privacy of one's home and for women in challenging or abusive relationships they are able to tell their partner or family it was a miscarriage if needed. The pill or combination of pills used to induce an abortion in the first 9 weeks of pregnancy have revolutionized access to early pregnancy termination in the United States and abroad.

Most recently, clinics in Iowa have began to revolutionize distribution of the pill through telemedicine. Women across the United States don't have access to local providers and this might be one answer to helping women access safe care early on in their pregnancy. I'm pretty amazed by this technology and I hope it can spread to other areas, particuarly rural areas. Women need access to safe abortion and if telemedicine is part of the answer to that necessity I'm all about it.

What are you doing here? Go read this Nation article!

In the past year-and-a-half-ish, there's been a lot of noise (well, relative to the usual silence, at least) about women self-medicating with misoprostol to induce an abortion. The first piece, the New York Times article "For Privacy’s Sake, Taking Risks to End Pregnancy," was short on data (which is unfortunately bound to be the case with reports of activity that is both rare and hidden) and long on extrapolation (which is unfortunately bound to be the case with NYT trend pieces). It implied that lots of Dominican women in New York are endangering themselves via illegal abortion despite easy access to cheap legal procedures. (Lots of broad brushstrokes in there, don't you think? Technically a self-induced abortion isn't even "illegal" in NYC!) The letters to the editor included some thoughtful additional information (most of it anecdotal), by the way. More to the point, there were substantive critiques (like "Side Effects: Complications at The New York Times from DIY Abortions" at RH Reality Check) of how the paper was written and that extrapolation I mentioned, including objections from the researchers involved in the study cited.

This summer, Nicholas Kristof wrote a surprisingly nice column ("Another Pill That Could Cause A Revolution") about misoprostol's revolutionary power to save women's lives in multiple ways. Considering that he's been reluctant in the past to even mention abortion, even when writing about pregnancy-related mortality, and considering that his writing tends toward simplistic reduction of complicated problems and even toward cavalier moralizing about the decision-making of the poor, well, that was a pretty nice column, considering.

And this week, Laura Tillman at the Nation brings us "Crossing the Line," which explores in a bit more depth the reasons that in many situations -- even among US residents, even among speakers of English, even among US-born women -- it might be entirely logical to obtain medication under the table and induce an abortion at home. I'll just post an excerpt here to give you an idea, but you should read the whole piece.

A single mother of two boys, Diana was unemployed and in the hospital when she began to suspect she was pregnant. It was December 2006, and she had missed her period for two months. Her doctor conducted a urine test, which came back negative, but when Diana still hadn't gotten her period in January, she started to panic. She knew it wasn't the right time for another baby. She wasn't working and had been suffering severe symptoms of brittle diabetes, a rare form of diabetes that requires frequent hospital visits and brings bouts of depression. She felt unstable and wasn't able to afford her medications. "I thought, If I am pregnant, I want to take something to not be pregnant," she says.

For most women in the United States, this would mean a trip to a doctor or abortion clinic. But where Diana lives, in Brownsville, Texas, just north of the border, Mexican pharmacies are only a few miles away. Items said to be abortifacients—including pills, teas and shots—are well-known to be cheap and accessible just across the bridge. Misoprostol, a pill that makes up half of the two-drug combination prescribed for medical abortions in the United States, is easy to purchase over the counter in Mexico because of its effectiveness in treating ulcers. When used alone and taken correctly, it will produce a miscarriage between 80 and 85 percent of the time. ...

Go read the rest! And have a good week!


PS: Lots of very interesting research has been done on misoprostol (and mifepristone too) in the past year or few -- on both clinical and psychosocial aspects of medication abortion -- and I hope to talk more about all that in a few upcoming posts. Hope that sounds good to you :)

Happy pills

The other day when I answered the phone at the clinic, a Spanish-speaker was on the other end of the line asking about "the pill that brings on your period." I've gotten used to breaking it down on the phone after chatting with clients who ask for a Pap smear, then end up incensed that the Pap didn't test for HIV because that's really what they wanted to check out, and what do you mean that "Pap smear" doesn't translate into "all things vaguely gynecological"? (But that might be another post for another day.) I asked her a series of questions about "Did you take a pregnancy test?" and "Is this the first period you've missed?" because maybe she really DID want to start birth control that would regulate her period. But no, she definitely was referring to the series of pills that would cause an early miscarriage and soothe the conscience into believing it's only a late period, not an abortion.

Women of all demographics are drawn to the RU486/Mifeprex & Misoprostol regimen because it's kind of like Abortion Lite, but women from conservative, Catholic countries where abortion is illegal and money is scarce especially like this route. And when they end up here, in a country where they don't speak the language and they don't have the time to navigate the laws of choice, they often do the familiar thing and buy the pills (usually only one type of pill--the cheaper one that doesn't really cause an entire abortion) on the street. Of course this is dangerous for a variety of reasons, and it ends up being pricey when they have to come to the clinic for a D&C, anyway. So, on the one hand, I appreciated this woman on the phone calling a clinic so that she could get the medication from a medical provider and be overseen by a doctor.

On the other hand, though, I struggled with the desire to give her accurate information and be straight with her with the lingo of "abortion," not "inducing a period" and also respecting her need for coping with this unintended and unwanted pregnancy in a way that she knew how, and especially, not scaring her off an into the streets where she would acquire the tablets from someone who would fully go along with her "bring on the period" plan. Women aren't dumb, and they know full well that a period of this type comes along with a fetus, but where does that leave as as providers and as advocates for women? Readers or co-bloggers, have you ever been faced with this situation? Do you fully disabuse the woman of this notion of the innocuous pill since eventually, they will end up having an ultrasound that clearly diagnoses a presence in the uterus? (That's what I ended up doing.) Or do you go along with the plan a little bit, allowing the woman to see the experience as she wants to see it?