A new study on an alternative to the abortion pill mifepristone was reported on by many news outlets this week. Last year, the Supreme Court preserved the Food and Drug Administration’s previous existing approval of mifepristone. As the drug faces greater legal challenges, and after the fall of Roe v. Wade, abortion advocates are looking to find other abortifacients — and the study suggests that a viable option is already on the market, as the key ingredient in the morning-after pill.
The new study, published Thursday in the journal NEJM Evidence, involved a drug called ulipristal acetate, the active ingredient in the prescription contraceptive Ella, one of two types of morning-after pills approved in the United States. (The other, Plan B One-Step, which does not require a prescription, contains a different drug and does not work in a way that would terminate a pregnancy, according to scientific evidence.)
In the study, 133 women who were up to nine weeks’ pregnant took twice the dose of the ulipristal acetate contained in Ella, followed by misoprostol, the second drug used in the typical medication abortion regimen. All but four of the women completed the termination of their pregnancies without further intervention, a 97 percent completion rate that is similar to the regimen using mifepristone. (The others finished the process with additional medication or a procedure.)
Participants in the study were required to be Mexico City residents at least 18 years old (“or emancipated minors”) who were “seeking an abortion for a viable pregnancy that is 63 days or less.” The 97 percent abortion success rate is comparable to mifepristone’s success rate — typically anywhere between 95 and 98 percent. The botched cases of “the others” who “finished the process with additional medication or a procedure,” as the Times wrote, similarly mirror mifepristone’s failure rate.
One woman was admitted to the emergency department three days after she was administered the chemical abortive “with heavy bleeding.” She “underwent a sharp curettage to manage an incomplete abortion,” the study noted. Sharp curettage is the procedure by which a doctor dilates a mother’s cervix, manually removes the baby from her uterus, and uses a surgical instrument with a hook at its tip to scrape away remaining fetal tissue.
The abortive failed to kill two of the participants’ babies. Both received two follow-up misoprostol doses to terminate the pregnancies. Misoprostol worked for one of the women. The other woman “underwent an MVA 8 days later,” according to the study. A manual vacuum aspiration (MVA) procedure is a common suction method used to dismember and discard first-trimester babies. A fourth participant “also had an ongoing pregnancy at the follow-up visit and underwent an MVA at that visit.”
Along with the four women who needed further intervention to end their pregnancies, three women reported “adverse” events: One “reported that she almost fainted from pain after taking misoprostol and was prescribed analgesics”; another “had a mild maculopapular rash after misoprostol administration”; a third had “a urinary tract infection that was addressed with antibiotics.” One hundred and three women out of the 133 had chills, 89 had diarrhea, 64 had nausea, 51 had a fever, and 36 were vomiting after being administered the dose. Eight women found the procedure “unacceptable or very unacceptable.”
Such anecdotes about chemical abortions are familiar. Women administered at-home chemical abortifacients risk an experience similar to that of the first woman mentioned above. Some women may take the pill at home, only to experience cramping, bleeding, pain, without medical aid. Some women may take the pill at home, only to days later have a doctor scrape her child’s remains from her uterus.
Yet, “there were no serious complications, and the study concluded that using ulipristal acetate in the two-drug medication abortion regimen was safe,” the Times reported.