FORT LAUDERDALE, Fla. — A generation ago, women desperate for abortion might have used a coat hanger, but in contemporary Florida, they are likely to turn to pills.
Pills that induce cramping and bleeding to empty the uterus — known as medication abortion — are legal in the state up until the 11th week of pregnancy.
But now that Florida has banned abortion after 15 weeks, women who want to end a pregnancy in their second trimester and don’t have the resources to travel may turn to these medications long past the time they are considered safe.
“There are a lot of risks in taking the pills when you are far along,” said Dr. Daniel Sacks, an OB-GYN in West Palm Beach. “Women could run into all kinds of complications from a pregnancy that fails to abort completely.”
Whether through medication or surgical abortion, about 2,700 women this year have legally terminated their pregnancies in Florida during the second trimester. That option no longer exists in the state as of July 1. Florida’s new abortion law bans abortion after 15 weeks with exceptions only to save a woman’s life or if an abnormality of a fetus is fatal.
Sacks said women in the second trimester easily can become desperate for options. That’s when they learn of serious genetic or physical abnormalities in the fetus — diagnoses such as spina bifida, Down syndrome, cardiac defects or missing body parts. “These are abnormalities that are not deadly but they are devastating.”
Using medication to induce an abortion has become an increasingly popular option in early pregnancy. In 2020, 54% of abortions in the U.S. were done with pills and less than 1% of women reported having significant complications, according to the Guttmacher Institute, a research group that supports abortion rights.
In Florida, only licensed physicians can prescribe the two-part treatment: The first pill — mifepristone — has to be taken in person in a clinic or hospital, and the second medication — misoprostol — can be taken at home. Most clinics require that patients schedule a follow-up appointment two weeks later to ensure the abortion is complete.
During the pandemic, the FDA changed some of its regulations to allow abortion pills to be prescribed via telehealth appointments and sent in the mail. So now, women can access them privately from home, with a credit card and their smartphones.
Regardless of that ease, Floridians are not able to get the pills that way. Florida law doesn’t ban telehealth prescriptions outright, however, the requirement of a face-to-face meeting with a doctor to get a prescription means that method isn’t an option.
But there is concern that women will find a way.
Among the services in the news: Aid Access, a telemedicine service in Europe, refers patients to an Austrian physician outside U.S. legal jurisdiction, who prescribes them. The medications are then packaged by an India-based pharmacy and delivered to the patient within one to two weeks.
In addition, some women already are having friends mail abortion pills across state lines, according to numerous news reports.
Dr. Sacks points out that medication abortion is considered safer than some techniques desperate women resorted to decades ago. However, in the second trimester, the fetus and placenta are bigger and the odds of complications from the pills forcing a miscarriage at home rise. The risk could be worse if women are too afraid to go to the hospital for complications or if doctors refuse to treat them.
“The pills could work or they could lead to hemorrhaging or infection or even death,” Sacks said. “Not everyone is going to go and get care when something goes wrong. They will be worried about prosecution and being judged.”
The Atlantic reported that since 2000, more than 60 women have been prosecuted for self-managed abortions or induced miscarriage, but the charges were eventually dropped, lessened, or overturned by a judge on appeal.
Orlando perinatologist Dr. Cole Greves, chair-elect for his district for the American College of Obstetricians and Gynecologists, said he is genuinely concerned about Florida women resorting to unsupervised medication abortions in the later stages of pregnancy — and ending up in the emergency room.
“When you restrict access to reproductive care, it opens the potential for people to find alternative methods that are illegal or less safe,” he said.
Greves, who specializes in treating complex prenatal disorders, said 90% of his patients are more than 15 weeks pregnant when they get a diagnosis. They want to know all their options, he said.
“Some will have the means to travel for an abortion, some won’t.”
With Florida’s new law, he believes pregnant women will become more proactive about doing genetic testing earlier, and doctors such as him will try to accommodate patients before they reach 15 weeks, even on short notice. Yet, he suspects there will be some patients who are too late and will try to self-manage their abortion with pills. “I hope that won’t be the case.”
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