Four must-know medical facts about abortion

A similar version of this column first appeared in the September 2021 issue of the Observer.

Overturning Roe v. Wade does not change medical facts.

Fact #1:

What does “you’re 6 weeks pregnant” mean?

Ohio has a 6-week abortion ban. You may think you have 6 weeks to plan after you miss your first period – WRONG. You have 2 weeks, at best.

Doctors date pregnancy starting the first day of your last actual period. Let’s say your periods are a perfect 28 days. The first day you miss your period – that is, the first time you’re clued in that you’re pregnant – you’re already 4 weeks pregnant.

Studies show, on average, women become aware of pregnancy when they’re 5.5 weeks pregnant (about 10 days after they miss their period). Longer if they don’t want to be pregnant (denial?). That means most women have less than 4 days to meet the Ohio abortion deadline.

Over-the-counter urine pregnancy tests work. They can pick up most pregnancy on the first day you miss your period. It helps if you use concentrated urine, like the yellow, smelly first-morning urine. If negative, repeat the test for a few days to be sure.

Fact #2:

Early abortion can be done safely and easily with pills – at home.

Medication abortion is a two-drug combo: mifepristone and misoprostol. They mimic natural miscarriage. They terminate 99.5% of pregnancies up to the 7th week, 96.6% at 10 weeks. The earlier, the better.

They’ve been legal since 2000, FDA-approved for up to 10 weeks pregnant. Millions of U.S. women have used it. The serious complication rate is less than 1%. Because of their safety, efficacy, and relatively low cost, they’re on the World Health Organization Model List of Essential Medicines – like penicillin, oxygen, ivermectin…

In the U.S., about half of abortions are done by medications: in Sweden, over 90% of abortions are.

Around here, the fees start around $500 for early pregnancy termination medically or surgically. Some insurances reimburse, but not Medicaid.

Many online sites provide medication abortion. Check the Plan C website, plancpills.org, for more information. I trust Aid Access. Founded by a Dutch physician, aidaccess.org delivers medications around the world. First, you fill out a health questionnaire. If you qualify, medications will be mailed to you. The good parts: little fuss, low cost ($110-$150).

But I get hot flashes when I think of online sites. First, some are legit; others – who knows, you need to research carefully. Second, in the rare cases of complications, I worry about finding immediate medical help. Given the abortion legal minefield, do-it-yourself abortions have potential legal implications.

Fact #3:

Emergency contraception (morning-after pills) are not abortion pills. Taken after oops sex, they dramatically reduce your chance of getting pregnant.

We don’t call them the morning-after pills because they work up to 5 days after unprotected sex. Depending on the methods, about 0.1% to 2.6% will still get pregnant. If you do become pregnant – or are pregnant and accidentally take them – they’ll not harm or interfere with an ongoing pregnancy.

We have three different kinds: levonorgestrel (Plan B, etc. $10 and up), ulipristal acetate (ella, $41-$48), and IUD ($0 to $1,300, most insurances including Medicaid cover. Financial aid available). Levonorgestrel pills are over-the-counter. Boys, girls, and Martians with $10 in cash can buy them.

Recently, people have stockpiled levonorgestrel pills. If you need them and pharmacies run out, try online stores.

Or:

1. Call your doctor for a prescription for ella. For women over 165 pounds, it works better than levonorgestrel pills.

2. IUD (Copper T, Mirena, etc) prevents accidental pregnancy over 99% of the time (you can’t get a better guarantee from doctors than this). And it can be taken up to 5 days after unprotected intercourse. You need a healthcare professional to insert it. But once it’s in, it’s in, doubling as an effective contraceptive for 6 to 12 years.

3. Last resort: Use oral contraceptive pills and create your own levonorgestrel pills. It’s called the Yuzpe Method. It’s what we used in the old days. Google it.

Fact #4:

The rate of abortion is similar between countries with the strictest abortion laws and the most liberal. The difference is safety.

In the U.S., our abortion rate has steadily declined for decades. Our teenager pregnancy rate is at an all-time low. Wherever you sit on the abortion spectrum, we all want to reduce the need for abortions. As Bill Clinton said: “Abortion should be safe, legal, and rare.” Rare happens with effective public health – sex education and contraception.