A Shift in Abortion: from Surgical to Medicinal

Since the Supreme Court’s decision in 1973 to legalize abortion in all 50 states in the case of Roe v. Wade (410 U.S. 113), millions of abortions have been performed, most through surgical methods. Recent studies show that medication abortions are starting to rival surgical abortions in the United States, a phenomenon that has been occurring in Europe for some time. The FDA has developed a new evidence-based regime for the drugs used in medication abortion, but regulations in some states keep the rate of medication abortions around 43%, while states like Iowa and Michigan with no restrictions have higher rates, around 55-65%. Before discussing these state restrictions, it is important to know what exactly medication abortion is, as well as any issues surrounding it.

Mifepristone and Misoprostol

 The two drugs used to perform medically induced abortions are Mifepristone and Misoprostol. Mifepristone (approved in 2000 by the FDA) is given at the clinic where the patient choses to have their abortion. The drug, according to Planned Parenthood, “works by blocking the hormone progesterone. Without progesterone, the lining of the uterus breaks down, and pregnancy cannot continue.” Next, the patient takes Misoprostol at home, where they may be alone or with a loved one. Misoprostol causes the uterus to empty and complete the abortion.

Anti-abortion groups have labeled the medicinal abortion option as dangerous. They especially disagree with the new FDA regulations that make the drug easier to acquire. The President of “Operation Rescue,” an anti-abortion group in Kansas, said that “pharmaceutical companies will use the FDA’s decision to persuade more ‘vulnerable pregnant women’ to use the ‘unpredictable’ drug.”

The facts disagree with this “unpredictable” label. A study by the University of Illinois at Chicago regarding the effects of medication abortion on university students showed that the medication is safe and reliable. The researchers found very few difficulties with the procedure and concluded, “Medication abortion services in a student health care clinic are safe and feasible. However, additional treatment may be required with some patients.”

Side by side with the surgical abortion option, medical abortion is just as safe as surgery with some minor tradeoffs. With the medication option, there is less chance for cervical or uterine injury due to the lack of medical instruments in proximity to the reproductive area. There are some minor downsides including more office visits, more bleeding for the patient (although the surgical option will cause bleeding as well), and 1-3% more women will have to redo the procedure as compared to surgical abortion. However, a major advantage of the medication is that the procedure can be done in the privacy of the woman’s own home with a loved one if she so chooses.

The State of the States

As previously stated, the prevalence of medication abortions as a method varies across the states due to differing regulations. The new FDA regulations have helped surpass some of these regulations. Specifically, the regulations allow the medication to be taken for 70 days after the start of the woman’s most recent menstrual period, up from 49 days under previous regulations. The prescription process was also simplified. So, following these new regulations, what is the current condition of the states’ laws surrounding the medication abortion process?

There are three broad categories of regulations, and some states overlap containing more than one type. Three states (Texas, Ohio, and North Dakota) reject the new FDA regulations and follow the old, outdated, and more rigid regulations. Nineteen states require the clinician to be present when the medication is taken, taking away the home privacy aspect of the procedure. Lastly, 37 states require clinicians who “perform medication abortion procedures to be licensed physicians.” This last category severely restricts the supply of medication abortions. These regulations are a primary reason why the U.S. is not on par with Europe on the overall percentage of abortions completed with medication as opposed to surgery.

Implications and Future Trends

The public opinion on abortion has remained relatively the same (within 1-9 percentage points) since 1998. The majority has fluctuated between pro-life and pro-choice about 5 times since that date, with the pro-choice camp at roughly 47% and the pro-life camp at roughly 46% in 2016. This is a unique case for a social issue, given that many other social issues such as gun control, healthcare, same-sex marriage, and the death penalty have shifted left since the 1990’s.

I offer a suggestion as to why medication abortions may possibly shift public opinion towards the pro-choice camp. The main factor for my reasoning is the private aspect of the medication route. Allowing women to perform the abortion at home takes the procedure out of the public view. This means that the concerns over graphic images of late term abortions and unsafe procedures are minimized. If this more private form of abortion does not shift public opinion, it may still allow women to avoid the scrutinizing eyes of the pro-life camp just enough to mitigate further regulations and restrictions.


About Jeremy Clement

Jeremy Clement is a staff writer for the Government column of the World Mind. He is an International Studies major at American University with an interest in International Development and Conflict Resolution. Jeremy has a professional background involving internships and jobs with the U.S. Committee for Refugees and Immigrants, the Center for Israel Studies at American University, the New York State Senate, the SUNY Center for International Development, the New York State Unified Court System, and volunteer experience abroad in Israel and Palestine. Lastly, he hopes to study law after undergraduate study.