2nd Year Medical Student and Pro-Choice Advocate at QUB
Among the general public, there seems to be a very common misconception about what most early, first trimester abortions actually involve. Anti-choice activists would have you believe it’s a complicated and dangerous surgical procedure, which has a high rate of complications, but medical practice and the experiences of women show this to be baseless.
The general lack of knowledge around the issue, owing to a lack of unbiased education, means that the majority of people in Northern Ireland are in the dark about early abortions facilitated through the use of two pills: misoprostol and mifepristone (until a woman was recently prosecuted here for obtaining these medications online to induce her own abortion).
Misoprostol and mifepristone are a combination of pills used to induce what is known as a ‘medical abortion’. This is opposed to early surgical abortion, which uses manual uterine aspiration, another safe procedure when done by a trained professional, also with low rates of complications.
Misoprostol is commonly used to prevent the development of stomach ulcers while on non-steroidal anti-inflammatory drugs (NSAIDs), however when used during pregnancy, it can cause a miscarriage.
Misoprostol is usually used in combination with mifepristone to induce an abortion in the first 2-10 weeks of pregnancy. One dose of mifepristone is taken first; it is a synthetic steroid used to block the hormone progesterone, which is necessary for pregnancy to continue. 24 hours after taking mifepristone, multiple doses of misoprostol are taken sub-lingually (under the tongue) and held there to dissolve for 30 minutes. Finally, 4 hours after the first dose of misoprostol, 2 more tablets are dissolved under the tongue for 30 minutes. This induces the same process as a natural miscarriage. From reading the BNF, I know that tablets sometimes come in different dosages of misoprostol.
In countries where abortion is restricted, but misoprostol is readily available in pharmacies, an induced abortion with just misoprostol can be done just as well. This involves 3 separate doses, 3 hours apart of 4 tablets of misoprostol under the tongue.
One of the most common concerns about using pills to induce an abortion is: is it safe? The media has frequently warned about dangerous medications , stating that women will risk heavy bleeding when using these pills. These concerns are easily addressed, as both of these medications are safe when prescribed and used after a consultation with a medical professional, as is the case with WoW and WHW. Bleeding is to be expected, after all, the pills induce the same symptoms as a miscarriage, but the risk of an excessive amount of bleeding is less than 0.2%, and this can be easily treated in a hospital as a problematic miscarriage. If people take these pills and are concerned that they are bleeding too much, they are encouraged to seek medical advice, and do not require to give information that the miscarriage was induced my medication.
Mifepristone and misoprostol are both on the World Health Organisation’s Model List of Essential Medicine, and are prescribed by doctors all over the world to women who seek a first trimester abortion. These medications are also used to treat many women in Northern Ireland for incomplete miscarriages and postpartum complications. Anyone claiming the drugs are ‘dangerous’ is misinformed, and should be aware that this procedure has been researched and recommended for a safe first trimester abortion by the World Health Organisation.
These drugs have even been approved for home use in certain countries. In South Africa, a scheme is being trialled, where women receive a text service from their clinic or hospital to let them know how their abortion process should be going, and telling them to seek medical help if it is abnormal. This is a stark contrast to Northern Ireland, where a woman was prosecuted for using the abortion pill at home. This process is completely safe, and easily managed as an outpatient procedure worldwide, so why do governments prevent women from accessing this procedure somewhere that is potentially more comfortable and less intimidating?
In my opinion, the decriminalisation of usage of misoprostol and mifepristone would be a vital step towards best medical practice whilst providing patients with autonomy and treating them as partners in their own medical care provision, rather than the dangerous outlaw method it is described as in the media.
Here are some links to the research on the safety and effects of Early Medical Abortion, including the Women on Web research into women’s own experiences of using the medicines in this way – legal permission notwithstanding.