California is now the first state to force colleges to perform medical abortions but women aren’t being told the whole truth
California State Bill 24 (SB 24), was approved by Governor Gavin Newsom on October 11, making California the first state to force state colleges to become first trimester abortion providers by offering medical abortions in the form of the abortion pill (RU-486) on campus. This new law, set to take effect in 2023, coincides with a growing trend among college students who search for the abortion pill rather than a surgical abortion when they get pregnant. But women who are seeking the abortion pill often are not informed of the serious side effects involved with the abortion pill. Coupled with public confusion that the abortion pill is the same thing as the morning after pill, this growing trend can lead to dangerous health outcomes for women.
According to the American College of Obstetrics and Gynecology (ACOG), “Most women choose medical abortion because of a desire to avoid surgery, a perception that medical abortion is safer than surgical abortion, and a belief that medical abortion is more natural and private than a surgical procedure. Compared with surgical abortion, medical abortion takes longer to complete (days to weeks), requires more active patient participation, and is associated with higher reported rates of bleeding and cramping. With medical abortion, expulsion of the products of conception most likely will occur at home, but a few women will still require surgical evacuation to complete the abortion.”
Tasha Keirns, Nurse Manager at Support Circle, said, “Many women have been coming to Support Circle’s medical clinics asking about the abortion pill. It’s definitely something women have been searching for and wanting more information about.” Proponents of the new law cite the growing popularity of the abortion pill and the need for abortion to be available on campus so students don’t have to miss class time. But opponents of the bill argue the abortion pill is already available at medical clinics close to colleges. They also cite the serious side effects of taking the pill and argue that class time will most likely have to be missed anyway due to those health ramifications.
Stephen Belton, MD, FACOG, retired OB/GYN, said, “The temptation to increase availability of abortion services by making medical abortion more widely available on university campuses – even through telemedicine – ignores the very real and well-recognized risks of these medications, and seems to favor ideology over science. The FDA, through its Adverse Event Reporting System, has reported deaths (hemorrhage, sepsis) and serious morbidity (transfusion, ICU admission, emergency surgery) with the use of these medications. This Bill puts women’s health at risk by lowering the bar for the prescribing of this medication that carries with it significant risk.”
What is the Abortion Pill?
Many people confuse the abortion pill and the morning after pill because they are often not informed of the differences in promotional material, or when they are given the abortion pill at abortion clinics. These pills are designed to perform two completely different functions. The morning after pill (Plan B One Step, Ella, or a birth control pill regimen) is a form of emergency contraception designed to prevent ovulation and thus stop a pregnancy before it occurs. Plan B and Ella are each one pill taken within hours or days of unprotected intercourse. Plan B is available over the counter at pharmacies in the San Francisco Bay Area without a prescription. Ella and the birth control regimen require a prescription.
The abortion pill is taken after a pregnancy has occurred to end the pregnancy. Women with a pregnancy of less than 10 weeks who are considering an early term abortion have the option to choose the abortion pill. The abortion pill is sometimes referred to as a medical abortion because medicine, not surgery, is used to end the pregnancy. Unlike surgical abortions, medical abortions can be completed in the woman’s home.
While it sounds like just one simple pill is all that is needed, the abortion pill is actually a two-drug regimen. The combination of two prescription drugs, Mifepristone (also known as Mifeprex or RU-486) and Misopristol (also known as Cytotec) disrupt an existing pregnancy (but not if it is an ectopic pregnancy – a different procedure or medication will be needed). Pharmacies, such as Walgreens Pharmacy and CVS Pharmacy, do not dispense the abortion pill. The abortion pill requires a prescription and in California must currently be dispensed at a medical clinic or hospital. Once SB 24 takes effect, it will be dispensed at student health centers at all CSU and UC campuses. Women may begin the drug regimen with Mifepristone in the medical clinic or at home. Mifepristone starts the abortion by blocking the natural pregnancy hormone progesterone, softening the cervix and causing the uterine lining to shed. Misopristol completes the process by expunging the contents of the uterus.
San Francisco Bay Area resident Jessica S. said: “My friend said after she took the abortion pill, she had the worst cramping of her life.”
Availability of the Abortion Pill
In 2018, former Governor Jerry Brown cited the wide availability of the abortion pill and vetoed a measure similar to SB 24. In his veto, he wrote, “According to a study sponsored by supporters of this legislation, the average distance to abortion providers in campus communities varies from five to seven miles, not an unreasonable distance. Because the services required by this bill are widely available off-campus, this bill is not necessary.”
Mary Davenport, MD, FACOG, OB/GYN, said, “Student health centers at universities are not set up to be safe abortion providers. There is a learning curve to provision of medical abortion. When medical abortion was first legalized in the USA, four young women died in California within the first four years from toxic shock. I fear that this new law will cause the deaths of young pregnant women in addition to their unborn babies.” She added on, “SB 24 is misguided legislation. With 133,000 abortions in California in 2017, it does not seem logical to assert that college students lack access to abortion.”
On-campus posters supporting SB 24 at nearby UC Berkeley, posted by a group called justCARE, said, “We need abortion care – not obstacles! We’re forced to travel and take time from class, jobs and family for care that could be on campus.” However, these posters don’t mention that the abortion pill process could take several days or weeks to complete. During this time, ACOG further informs that women most commonly experience heavy bleeding and blood clots, severe pain, fever, chills, dizziness, nausea and vomiting, pelvic cramping, headaches and diarrhea. “Counseling should emphasize that the woman is likely to have bleeding that is much heavier than menses (and potentially with severe cramping) and is best described to patients as comparable with a miscarriage. The woman should understand how much bleeding is considered too much. An easy reference for the patient to use is the soaking of two maxi pads per hour for 2 consecutive hours.”
Furthermore, bleeding or spotting may last for 30 days or more and can be expected for an average of 9 to 16 days according to the drug manufacturer, Danco Laboratories, which distributes Mifespristone under the brand name Mifeprex.
Unlike a surgical abortion, women who choose a medical abortion experience their abortion over a period of days or weeks at home, usually without trained medical personnel to assist. A follow-up visit 7-14 days after Mifepristone is taken, is required to confirm the contents of the uterus was fully expunged. If it has not been expunged, additional medical intervention, including a dilation and curettage (D&C), may be required. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.
Sometimes the Abortion Pill is a Medical Necessity, and Other Times it is Elective
It is important to note that under some circumstances, the abortion pill is a medical necessity, such as when a woman has recently experienced a miscarriage. One such woman, Lauren D., while trying to get pregnant, unfortunately experienced a miscarriage and needed to take the abortion pill to avoid surgery and have a more natural way of completing the miscarriage.
Though she expected some extra pain with the abortion pill, she wished to avoid going into the operating room for a D&C. But in actuality, Lauren ended up experiencing all the side effects ACOG cautions their OB/GYNs to warn women about, as well as serious complications. Lauren recounted her ordeal: “I was advised to expect to start bleeding heavily within two to 10 hours after taking the abortion pill so I should remain at home. After about a week, without any progression, I was told that the abortion pill would ‘eventually kick in.’ It was 10 days before the bleeding began.
“When it did, I experienced a horrific menstrual cycle with severe cramping, excruciating pain and profuse bleeding. I was only prescribed the abortion pill, not any higher doses of pain medication. Because I was still losing so much blood 10 days into it, I went to the ER. The ER doctor told me what I was experiencing was normal and did not want to do a pelvic exam. I insisted and they found golf ball sized blood clots. I was sent home to wait out the completion of the process as the lining of my uterus had not shed yet. I received a $1,500 ER bill.
“At my two-week follow-up, I was given another round of the abortion pill because the lining of my uterus still had not shed. My doctor continued to monitor me over the next few months. Much like student health centers at California colleges, my doctor did not have the facility to perform a D&C and this was a factor in the extended treatment plan I received. Later that year, after surgery, I was informed that my uterus had bled profusely and formed scar tissue. Given the choice, I would never use the abortion pill again.”
Lauren’s experience mirrored the cautions by ACOG and Danco Laboratories. She is incensed that women who are considering taking the abortion pill electively are not being informed of the high incidence of serious side effects before being given the abortion pill. “The misleading of young women about the full truth of medical abortion is unconscionable and potentially dangerous to women,” she said.
Disclaimer: Support Circle provides information about the abortion pill but does not prescribe or dispense these medications.