More than half of U.S. abortions are now done with pills rather than surgery, a combination of mifepristone and misoprostol tablets, two medicines used together to induce abortion thathave achieved greater use during the pandemic with the increase in telemedicine.
In 2020, pills accounted for 54% of all U.S. abortions, up from roughly 44% in 2019.
The preliminary numbers come from the Guttmacher Institute, a research group that supports abortion rights. The group, by contacting providers, collects more comprehensive abortion data than the U.S. government.
Use of abortion pills has been rising since 2000 when the Food and Drug Administration approved mifepristone, the main drug used in medication abortions.
The new increase “is not surprising, especially during COVID,” said Dr. Marji Gold, a family physician and abortion provider in New York City. She said patients seeking abortions at her clinic have long chosen the pills over the medical procedure.
The pandemic prompted a rise in telemedicine and FDA action that allowed abortion pills to be mailed so patients could skip in-person visits to get them. Those changes could have contributed to the increase in use, said Guttmacher researcher Rachel Jones.
The FDA made the change permanent last December, meaning millions of women can get prescriptions via online consultations and receive the pills through the mail. That move led to stepped-up efforts by abortion opponents to seek additional restrictions on medication abortions through state legislatures.
Specifically, preliminary data from the Guttmacher Institute’s periodic census of all known abortion providers show that in 2020, medication abortion accounted for 54% of US abortions.
That year is the first time medication abortion crossed the threshold to become the majority of all abortions and it is a significant jump from 39% in 2017, when Guttmacher last reported these data.
The estimate is based on preliminary findings from ongoing data collection; final estimates will be released in late 2022 but the proportion for medication abortion use is not expected to fall below 50%.
How it works
The procedure includes mifepristone, which blocks a hormone needed for pregnancy to continue, followed one or two days later by misoprostol, a drug that causes cramping that empties the womb. The combination is approved for use within the first 10 weeks of pregnancy, although some health care providers offer it in the second trimester, a practice called off-label use.
This data powerfully illustrates that medication abortion has gained broad acceptance from both abortion patients and providers. It also underscores how central this method has become to US abortion provision, thanks to its track record of safe and effective use for more than two decades.
As medication abortion has become the most common method of terminating an unwanted pregnancy, there is still the potential to further increase access—which is why the method has become a main target of anti-abortion politicians and activists seeking to restrict care.
So far this year, 16 state legislatures have proposed bans or restrictions on medication abortion, according to the Guttmacher report.
It notes that in 32 states, medication abortions must be prescribed by physicians even though other health care providers including physician assistants can prescribe other medicines.
Anti-freedom groups have convinced lawmakers in Arizona, Arkansas and Texas to ban mailing abortion pills to patients as well as other laws that violate the Constitution.
Due to extremist religious views among some people, society sometimes stigmatizes women who have abortions. Many women who experienced the procedure later recounted that they were stuck deciding between whether to have an abortion or have a child outside of marriage, both of which could cause them to be ostracized from society.
The decision to have an abortion is typically motivated by multiple, diverse and interrelated reasons, including responsibility to others and resource limitations, such as financial constraints and lack of partner support.
The reasons most frequently cited were that having a child would interfere with a woman’s education, work or ability to care for dependents (74%); that she could not afford a baby now (73%); and that she did not want to be a single mother or was having relationship problems (48%).
Nearly four in 10 women said they had completed their childbearing, and almost one-third were not ready to have a child.
Fewer than 1% said their parents’ or partners’ desire for them to have an abortion was the most important reason.
Younger women often reported that they were unprepared for the transition to motherhood, while older women regularly cited their responsibility to dependents.
Regardless of why a woman chooses to terminate an unwanted pregnancy, the US Constitution implies a right to privacy, so the courts have ruled that the government should not interfere with anyone’s right to make her own decision.
According to the World Health Organization, about 73 million abortions are performed each year. About 630,000 abortions were reported to the U.S. Centers for Disease Control and Prevention in 2019, although information from some states is missing. Guttmacher’s last comprehensive abortion report dates to 2017; the data provided Thursday came from an update due out later this year.
Global numbers on the rates of medication versus surgical abortions are limited. Data from England and Wales show that medication abortions have outpaced surgical abortions for about 10 years.