Everything You Need to Know About Medication Abortion in Michigan

Containers of the medication used to end an early pregnancy sit on a table inside a Planned Parenthood clinic, Oct. 29, 2021, in Fairview Heights, Ill. (AP Photo/Jeff Roberson)

By Keya Vakil

May 17, 2022

Searches for medication abortion and prescription requests for abortion pills have skyrocketed following the May 2 Supreme Court opinion leak. We asked Michigan OB/GYN, Dr. Halley Crissman, to talk about how medication abortion works. 


UPDATE: A judge has temporarily blocked a 1931 Michigan law criminalizing abortion. The Michigan Court of Claims ruling is a preliminary injunction declaring the state’s 1931 abortion ban unconstitutional. That means that abortion access is temporarily protected in Michigan—even if the Supreme Court strikes down Roe v. Wade—while lawsuits dealing with the 1931 ban are proceeding through the courts. Anti-abortion groups are expected to appeal the injunction to the Michigan Court of Appeals, asking them to reauthorize enforcement of the 1931 ban.

Need to Know

  • Medication abortion is a two-drug regimen that you can take at home to end your pregnancy.  
  • Medication abortion is over 99% effective at ending a pregnancy and is also very safe. In fact, it’s far safer than pregnancy and childbirth, and has minimal risks and side effects.
  • It’s unclear if a 1931 ban on abortion in Michigan would apply to medication abortion.

MICHIGAN—If the Supreme Court overturns Roe v. Wade, as it indicated it will in a leaked draft opinion published by Politico, millions of women in Michigan and across the country may find themselves with access to only one kind of abortion care: medication abortion.

While the concept of abortion historically conjures up images of a doctor’s office or clinic, the use of pills at home to terminate a pregnancy has surged in recent years. In Michigan, more than half of all abortions in 2020 involved pills, rather than a surgical procedure at a clinic or hospital–a figure that mirrors the rise of medication abortions across the country during the pandemic. 

In the aftermath of the May 2 leak, searches for medication abortion and prescription requests for abortion pills have skyrocketed nationwide.

If the Supreme Court repeals Roe in the coming weeks, Michigan would once again be governed by an old 1931 law criminalizing abortion. Under that law, it would be a felony for medical providers to perform abortions–even in cases of rape and incest. The only exception provided under that law is that doctors would be allowed to perform an abortion if it was necessary to save the life of a pregnant woman—but even that’s a threshold that might vary from doctor to doctor and be affected by their religious views

The law also makes it illegal for anyone to “willfully administer” or sell drugs “designed and expressly prepared” to induce abortion, but whether that would apply to abortion pills—which are also used to treat miscarriages—remains in question. It’s also unclear whether the “administer” clause would apply to the doctor who prescribes the pill, the pharmacist who provides it, or the pregnant person taking the pill.

Gov. Gretchen Whitmer has filed a lawsuit to strike down the 1931 law and Attorney General Dana Nessel has said that if re-elected this November, she would refuse to enforce the “draconian” measure. 

But even if medication abortion were actually banned in Michigan, the pills can be purchased online and sent by mail, making any ban extremely difficult to enforce. 

Those legal battles will play out largely beyond public reach, but with more and more attention being paid to medication abortion, we want to make sure Michiganders understand what it is and how it works. 

What is medication abortion? How does it work?

Medication abortion is a two-dose regimen of pills that work together to induce an abortion. 

“The first one is called mifepristone,” said Dr. Halley Crissman, a board certified OB/GYN and the associate medical director of Planned Parenthood of Michigan.“It’s a single pill that you just swallow. It helps to stop the pregnancy from growing and helps to make the body more responsive to the next set of medication.”

Mifepristone blocks a hormone called progesterone, which is necessary for the pregnancy to continue. Mifepristone was approved in 2000 by the US Food and Drug Administration and is sold under the brand names Mifeprex and Korlym.

Within 48 hours of taking mifepristone, patients will take the second medication, called misoprostol, which is sold under the brand name Cytotec and is typically a set of four pills.

“That is the medication that helps the body to expel the pregnancy,” Crissman said. “People have bleeding and cramping after taking that medication, and pass the pregnancy.”

Patients can take the misoprostol three different ways, according to Crissman:

  1. They can let it dissolve under their tongue for 30 minutes and swallow whatever remains.
  2. They can place the pills between their cheeks and gums for 30 minutes and swallow whatever remains.
  3. They can insert the pills into their vagina. 

Patients who choose one of the first two options should wait 24 hours—but no more than 48 hours—after taking mifepristone to take the misoprostol. Patients who opt to insert the medication vaginally do not need to wait 24 hours after taking the mifepristone, but should still take the misoprostol within 48 hours of taking the mifepristone.

Some patients may be advised to take two sets of misoprostol 4 hours apart (four pills followed four hours later by four more pills). 

How do I get these medications? 

Like with most healthcare, patients seeking an abortion start by contacting a doctor. However, at least 24 hours prior to receiving abortion care, patients must read state-mandated documents that provide information about the procedure and about prenatal and parenting resources, should they change their mind. Patients can access this information online or get it from their doctor. If the patient chooses to receive a medication abortion, they must also read through a special medication guide and sign a consent form saying they understand the risks—which are minimal. 

“They can do that online or they can do that at a health center, but they do have to have printed proof that they’ve had access to state-provided materials at least 24 hours prior to being able to get their care, ” Crissman said. She recommended that patients factor this mandatory step into their timeline.

After that, the patient visits their doctor—either in person or via telemedicine—to determine how far along they are in their pregnancy. Medication abortion is only authorized for use in the first 10 weeks of pregnancy. Some women with existing medical issues or who take certain medications may not be a good fit for medication abortion. 

If their doctor determines they are clearly eligible and that it would be safe to proceed with medication abortion, they’ll prescribe the drugs, which the patient can pick up at the doctor’s office or clinic, their local pharmacy, or through the  mail. 

What happens after I take the pills?

For most people, bleeding and cramping begins 1-4 hours after taking misoprostol and it can last for several hours. Patients typically pass the pregnancy tissue in 4-5 hours, but it can take longer. 

Some patients will see blood clots or clumps of tissue when this is happening, similar to a heavy period or an early miscarriage. The cramping and bleeding will slow, but may continue to some extent for 1 or 2 more days, and some bleeding and spotting for several weeks afterwards.

Patients who don’t have any bleeding within 24 hours of taking the misoprostol should call their nurse or doctor.

A follow-up appointment within two weeks will confirm that the pregnancy ended. 

How effective is medication abortion?

Very. A 2015 study of 30,000 women found that medication abortion successfully ended pregnancy 99.6% of the time, roughly the same rate as surgical abortions (99.8%). Other studies have found similar efficacy, with the pills working more than 96% of the time.

If you’re one of the very rare cases where medication abortion doesn’t work, you may need a second dose of medication or to have surgical procedure to complete the abortion.

Is medication abortion safe?

Yes. A 2012 study of 45,000 patients who had medication abortions found that only 0.3% of patients (or 119 people) suffered serious enough side effects to require hospitalization, with 0.1% (45 patients) requiring blood transfusions.  

Dr. Crissman noted that part of the reason abortion is so safe now is that Roe v. Wade helped reduce some of its stigma, which led to increased access to healthcare providers, and allowed for the development of new medical treatments.

“Abortion, whether medication abortion or an abortion done through procedure—surgical abortion—is really safe with a low risk of complications,” Crissman said. “Both have risks of complications that are magnitudes less than that of carrying a pregnancy to full term, in terms of morbidity and mortality.”

That’s right. Abortion is so safe and America’s maternal mortality rate is so high that abortion is actually much, much safermore than 14 times safer—than pregnancy and childbirth in the United States.

“That said, from a reproductive justice perspective, I want to be really clear that we support all people in having pregnancies and building their family in the way that feels right to them, at the time it feels right to them, and to parent the children that they have as well, and so we certainly support people in the full spectrum of care,” Crissman added.

Are there any side effects or risks?

In addition to bleeding and cramping, patients might also experience some nausea, upset stomach, vomiting, diarrhea, dizziness, tiredness, and a mild fever or chills on the day they take the misoprostol. If you experience a fever or chills the day after taking the misoprostol, call your doctor or nurse.

You can take ibuprofen (like Advil or Motrin) to deal with the pain, but aspirin is not recommended because it can increase bleeding. More serious complications like infection or excess bleeding can occur, but are exceedingly rare.

What are the benefits of medication abortion? How does it compare to surgical abortion?

​​We’re going to let Dr. Crissman handle this one. 

“The differences are essentially that with medication abortion, people are taking medications and having the passage of the pregnancy happen outside of the health center at their home or a location of their choosing,” she said. “It’s a little harder to pinpoint when exactly that bleeding or cramping is going to happen, but the patient has a bit more autonomy over when they take the medication, the setting that they’re in, and the people that are around them.”

She also believes that access to medication abortion has increased choice for women and helped them feel empowered to manage their abortion care “in the way that feels safest and most aligned with their comfort or their desires.”

Crissman said medication abortion may be a particularly appealing option for women who have a history of assault or violence, or a desire to be in their own home or surrounded by people who support them when they’re going through the process.

If you seek abortion care in a clinic or health center, on the other hand, you’ll have more control over when the pregnancy is passing. 

“We can give people pain medication to help with the discomfort of the procedure and people can leave the clinic knowing that they’re no longer pregnant, that the process has been completed,” Crissman said.

What are some common misunderstandings about medication abortion?

“I think one of the big things folks may often not understand about medication abortion is the same medication that is recommended for abortion care—that combination of the mifepristone pill plus misoprostol—is the same medication regimen that we recommend for people who are having a miscarriage,” Crissman said.

If Roe v. Wade is overturned, would medication abortion be banned in Michigan?

It’s unclear. Since safe and reliable abortions didn’t exist in 1931, there will likely be legal battles over the phrasing of the 1931 Michigan abortion ban. Separately, a Republican lawmaker in the legislature, Rep. Pamela Hornberger of Chesterfield, has introduced a bill to ban telemedicine visits for medication abortion. 

Hornberger’s effort mirrors those in several Republican-led states that have already banned or reduced access to medication abortion. 

Can I just buy abortion pills myself?

Technically, no. Abortion pills require a prescription from a doctor. However, increasingly, women are turning to online companies like Aid Access, which helps patients in the states where telemedicine visits for medication abortion are illegal and/or restricted. If Michigan were to go that route, patients in the state could reach out to Aid Access, which would connect them with European doctors who would prescribe them the medication, which would be shipped to the patients from a mail-order pharmacy in India.

This practice operates in a legal gray area, but is difficult to stop and is already in use in Republican-led states that have restricted access to medication abortion.

Is there anything else I should know?

Providers like Dr. Crissman know this is a hard, emotional time, and they’re feeling it too. But if you’re facing an unplanned pregnancy, they’re not going to leave you to fend for yourself.

“We’re not going anywhere, we’re here for our patients and we’re going to stay here for our patients,” Dr. Crissman said. “The need for care is not going anywhere. Making abortion illegal is not going to stop people from needing abortion care and so we’re going to find a way to get people the care that they need.”

Author

  • Keya Vakil

    Keya Vakil is the deputy political editor at COURIER. He previously worked as a researcher in the film industry and dabbled in the political world.

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