Pill-Induced Abortions on the Rise in America. Why That's a Good Thing

At Planned Parenthood clinics, 43 percent of all abortions are now drug-induced, not surgical.


Bill Greenblatt UPI Photo Service/Newscom

While the overall U.S. abortion rate continues to decline, a growing percentage of legal abortions in America are being induced via drugs, not surgery, with 43 percent of abortions at Planned Parenthood clinics relying on this method in 2014. That's up from 35 percent in 2010, according to a Reuters analysis of clinic data. And in states without strong legal restrictions on abortion pills, the rates relative to surgical abortion were even higher. In Michigan, they comprised 55 percent of all abortions and in Iowa, 64 percent.

The two medications used for drug-induced abortions in America—mifepristone and misoprostol—were approved by the U.S. Food and Drug Administration (FDA) 16 years ago. "The method was expected to quickly overtake the surgical option, as it has in much of Europe," Reuters notes. "But U.S. abortion opponents persuaded lawmakers in many states to put restrictions on their use."

Most of these state restrictions have been rooted in religion, ideology, and politics rather than good-faith concern for women's safety. Taking mifepristone and misoprostol to terminate a pregnancy—aka medical abortion (in contrast with surgical abortion)—has been found just as safe if not safer than surgical abortion, and it doesn't require a woman to be put under anesthesia or undergo an invasive procedure. Even more revolutionary, this sort of abortion doesn't require—at least not for medical reasons—a visit to a hospital or any sort of specialized abortion clinic, nor the employ of a specialized doctor. After a basic health check-up and an ultrasound to determine gestational age (the pill regimen is only recommended and approved up to 10 weeks pregnancy), the whole process involves ingesting one pill and, within the next 72 hours, ingesting another pill.

This isn't to say medical abortion is an easy process for women, who report extreme cramping, nausea, and other difficulties for a few hours to a few days after taking the pills. But it is, for many women, easier than obtaining a surgical abortion, with one of the biggest benefits being that it can cost significantly less. This, combined with its ability to take place outside a special health facility, makes it much more accessible to rural and low-income women. And increased accessibility may lead, in turn, to earlier pregnancy terminations.

Since medical abortion has been legal in the U.S., the percentage of abortions performed in the first six weeks gestation has grown significantly. According to the U.S. Centers for Disease Control and Prevention (CDC), the percentage of U.S. abortions occurring within the first six weeks of pregnancy rose 24 percent between 2003 and 2012. Meanwhile, the percentage of abortions occurring at or after 13 weeks remained relatively unchanged. This means the biggest shift was from abortions occurring between weeks six and 13 toward those occurring between weeks one and six.

This doesn't necessarily mean medical abortions drove the shift to earlier abortions, but it is one plausible (partial) explanation, given the simultaneous growth in medical abortions as a share of overall (and especially early-term) procedures. Between 2001 and 2011, medical abortions went from 6 percent of all abortions to 23 percent, according to the CDC's most recent report.

Some have worried that the increased availability of abortion drugs has or will lead to an increase in the total number of abortions that occur in America. But so far, these fears seem to be unfounded: between 2002 and 2011, the total number of U.S. abortions decreased 13 percent, according to the CDC. The abortion rate—the number of abortions per every 1,000 women ages 15- to 44-years-old—was also down, by 14 percent, to 13.9 abortions per 1,000 women. And this rate is down from nearly 30 abortions per 1,000 women in 1980.

The bottom line is that U.S. women are both getting fewer abortions and, when they do, having them earlier in their pregnancies. And a big part of the latter may be due to drug-induced abortion. But many state legislatures have passed or tried to pass laws strictly limiting where, when, and how it could be prescribed and administered, including insisting the pill must be prescribed in a building that meets the requirements for ambulatory surgical centers, banning partial-telemedicine appointments, and requiring doctors to use an outdated protocol that meant more medication and more in-person clinic visits than necessary. These are efforts that should be opposed by not just abortion-rights activists or the radically pro-choice but anyone who believes abortion should be legal in the first trimester at least, believes medical policy should be driven by science not religion, and/or wants to encourage women who do choose abortion to do so as early as possible.

There has been some good news on this front lately. Earlier in 2016, the FDA finally revised its outdated guidelines for prescribing the mifepristone and misoprostol regimen. Under the new rules, doctors can prescribe the abortion pills up to 10 weeks or pregnancy, among other things. The American Congress of Obstetricians and Gynecologists said it was "pleased that the updated F.D.A.-approved regimen for mifepristone reflects the current available scientific evidence and best practices."

Reuters suggests that drug-induced abortions likely make up a larger percentage of U.S. abortion procedures (at Planned Parenthood and elsewhere) since the FDA change, which took place after the most recent Planned Parenthood data was collected. "In three states most impacted by that change—Ohio, Texas and North Dakota—demand for medication abortions tripled in the last several months," Reuters found from talking to clinics, state health departments and Planned Parenthood affiliates in these states.