Self-induced medical abortion, the use of pharmaceutical medicines without a prescription, is considered the best method of self-induced abortion, because it is relatively safe and is very effective when used in early pregnancy. Self-induced medical abortion is a popular method of abortion in countries where abortion is illegal. Latin American women who immigrate to the United States sometimes continue to use self-induced medical abortion despite the fact that medical abortion is legally available at clinics in the United States.
Menstrual extraction is based on the clinical abortion method of manual vacuum aspiration. The equipment is slightly different, but the procedure is basically the same. A vacuum and a cannula are used to empty the uterus of its contents. Menstrual extraction is usually used during the first trimester, most effectively around the seventh gestational week, to end a pregnancy.
Medical abortion
For abortions up to nine weeks, the pills can be provided through primary health care services and women can safely use the method at home or in a clinical setting, according to their own preferences and personal circumstances. Medical abortion after nine weeks and in the second trimester can be carried out in a health centre or hospital.
-International Consortium for Medical Abortion, 2004.
In medical clinics, medical abortion is an increasingly prevalent abortion technique where a series of pharmaceuticals are taken to terminate a pregnancy. In the majority of medical abortions, a woman is prescribed a pharmaceutical regime. She usually receives two medicines, mifepristone and misoprostol, to block progesterone and cause the uterus to expel the pregnancy, often within eight hours after administration.
The first medicine, mifepristone, (United States brand name Mifeprex™ or Mifegyne™) blocks the progesterone hormone required to sustain pregnancy. Mifepristone has been approved by the FDA for the termination of early pregnancy. Mifepristone is occasionally prescribed for the treatment of endometriosis and glaucoma.
The second medicine prescribed to end a pregnancy, misoprostol, has not been FDA approved to terminate pregnancy, but is FDA approved and prescribed as an ulcer medication. Misoprostol, also known by the brand name Cytotec™, is 85% effective at causing an abortion when used alone. Mifepristone and misoprostol used together are 95% effective at terminating a pregnancy. Misoprostol is more widely used by physicians for off-label application of causing uterine contractions which can induce abortion. Off-label use is the practice of prescribing drugs for a purpose outside the scope of the drug's FDA approved label, an entirely legal practice used in the United States and many other countries, whereby the regulating authority recognizes the physician's medical authority in most cases and allows physicians to practice medicine and use their best judgment.
Research suggests that, with physician oversight, women can safely administer all or part of the mifepristone/misoprostol regime safely at home.[72] When women are allowed to take the misoprostol at home they report more happiness with the medical abortion than women who have to return to the clinic for the misoprostol dose.[73] Studies have indicated that most women are able to ascertain whether or not the abortion was successful at home, by evaluating the tissue passed, any remaining symptoms, and by taking a pregnancy test three weeks after the medical abortion,[74] however how accurately a woman can self-assess the gestational age of her pregnancy has been debated.[75] Also, whether a woman can accurately evaluate her own medical history for conditions contraindicated for medical abortion, such as: evidence of underlying heart disease, respiratory disorders, liver or kidney disorders, or hypertension has also been debated, thus the prevailing thought is that this method of abortion requires physician oversight. However, if abortion is restricted or illegal, self-induced medical abortion with mifepristone and/or misoprostol is recommended as the safest and most effective abortion a woman can do at home.[76]
Financial considerations sometimes influence a woman’s choice to pursue a self-induced medical abortion, which may or may not be legal depending on the government of the area and the gestational age of the pregnancy. In 2008, the average cost for a single 200 mcg tablet of misoprostol in the United States was $2.00. In some developing countries, the cost for a single 200 mcg tablet of misoprostol can be as low as $0.50.
Based on the nominal cost of the medication, one would expect that all women could afford an abortion, however that is not the case. In the United States in 2001, the average cost for a clinical medical abortion was $487.00; and approximately 74% of American women paid for abortions with their own money.[77] In the United States, federal funding for abortions is only allowed for rape, incest, and a woman’s life being endangered by the pregnancy; and only a handful of states in the United States help poor women access free or reduced price abortion services.
To help women access medical abortion services in countries where abortion is restricted or illegal, WomenOnWeb.org, facilitates physician contact and prescription fulfillment. After a woman fills out an online questionnaire, a physician reviews the woman’s medical information and issues a medical abortion prescription, if appropriate. For a donation of 75 Euros (approximately $110.00), the prescription is sent overnight via courier to the woman in need. For women without financial means, a fund fueled by donations can sometimes help. WomenOnWeb.org also provides online support. Most countries allow prescription medicines to be imported, if the medicine is accompanied by a physician’s prescription.
WomenOnWeb.org is an offshoot of WomenOnWaves.org, a Dutch ship that provides abortion services in international waters near countries which have restrictive laws on abortion. The presence of the ship brings international media attention to the plight of women in countries where abortion is illegal or restricted.
The medicines most commonly used for medical abortion are mifepristone, misoprostol, methotrexate, and PGE1 or PGE2 pessaries:
Mifepristone \miff eh PRIH stone\
Mifepristone (RU486) is synthetic steroid antiprogesterone. Mifepristone blocks progesterone receptors causing the uterine endometrium to be unsupportive to the embryo or fetus, softens and dilates the opening of the uterus, and releases prostaglandins that can cause the uterus to contract. Mifepristone is most effective during the first 9 weeks of gestation before the placenta takes over progesterone production from the corpus luteum. Mifepristone is prescribed by doctors for abortion (FDA approved), emergency contraception, uterine fibroids, endometriosis, depression, glaucoma, cancer, and Cushing’s syndrome.
• Mifepristone Brand Names: Mifeprex™ and Mifegyne™.
Misoprostol \mye soe PROST ole\
Misoprostol is a synthetic analogue to prostaglandin E1. Misoprostol is approved as an ulcer drug in more than 85 countries, but it is commonly prescribed off-label for a variety of obstetrical and gynecological purposes. When used off-label in most countries, it is prescribed without package inserts to inform users of safe dosages, contraindications, and possible side effects. Misoprostol is prescribed off-label for abortion, incomplete abortion, and postpartum hemorrhage. Misoprostol is sometimes combined with the painkiller diclofenac and prescribed for arthritis. This combined medicine is more expensive than the misoprostol alone.
72
Victoria Blinder, Batya Elul, and Beverly Winikoff, “Mifepristone-misoprostol Medical Abortion: Who will Use it and Why?”
73
Batya Elul, et al., “Can Women in Less-Developed Countries Use a Simplified Medical Abortion Regimen?”
74
K. Coyaji, B. Elul, U. Krishna, S. Otiv, S. Ambardekar, A. Bopardikar, V. Raote, C. Elleartson, and B. Winikoff, “Mifepristone Abortion Outside the Urban Research Hospital Setting in India.”
75
C. Ellertson, B. Elul, S. Ambardekar, L. Wood, J. Carroll, K. Coyaji, “Accuracy of Assessment of Pregnancy Duration by Women Seeking Early Abortions
77
S.K. Henshaw and L.B. Finer, “The Accessibility of Abortion Services in the United States, 2001,”