Is the Mexican abortion pill safe?

With Governor Rick Perry signing the restrictive Texas abortion bill into law many news organizations have shed light on traveling to Mexico for abortion and there has been much talk about the “Mexican abortion pill.”

The medication that people typically call the Mexican abortion pill is misoprostol, marketed under the trade name Cytotec. It is a prostaglandin analogue and is used for prevention of stomach ulcers. It also has many uses in OB/GYN such as inducing labor, preparing the cervix for a therapeutic abortion, treating a missed abortion (a miscarriage where the pregnancy ends, but the uterus fails to empty), and as part of the two drug regimen for medical termination of pregnancy (medical abortion).

With medical abortion the most effective regimen is 200 mg of oral mifepristone (RU-486) followed by 800 mcg of misoprostol given vaginally 6-24 hours later. This regimen is 95-99% effective at terminating a pregnancy up to 63 days gestational age (9 weeks) with an extremely low rate of serious complications.

Studies have also looked at misoprostol alone and it is fairly effective. When 800 mcg of misoprostol is moistened with water and used vaginal and repeated every 24 hours (up to 3 doses) the success rate is 88% for terminating pregnancies up to 56 days gestation (8 weeks). You might say, “Well, 88% isn’t bad!” but that is significantly less effective than the mifepristone-misoprostol combination.

How safe is a misoprostol only regimen? It’s not inherently unsafe or dangerous if supervised, but therein lies the issue. If a woman is driving across the border to get the tablets it isn’t a stretch to say that she is unsupervised and hasn’t been adequately screened.

If a woman is further along than she thinks and uses the misoprostol only regimen she could have catastrophically heavy bleeding and not know when to call for help. In addition, about 1% of women who use this method appropriately will bleed enough they need expert intervention. A woman who got her medications from Mexico may feel too much stigma or may be medically disadvantaged enough to get appropriate help.

Inadequate screening may also lead a woman with an undiagnosed ectopic pregnancy to use misoprostol with devastating complications. Other issues surround the failure rate. If the pregnancy fails to abort and a surgical termination isn’t possible (this will happen for at least 12% of women, but likely more because many women who resort to getting misoprostol in Mexico will likely be further along than 56 days), the pregnancies that continue may be at increased risk of birth defects.

According to the American Congress of Obstetricians and Gynecologists (ACOG) mifepristone/misoprostol 200 mg/800mcg is the preferred regimen.

Unless the law is overturned women in Texas needing abortion are likely to get a less effective regimen with no supervision and somehow this will make abortion “safer” for women.

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

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  • Trina

    “Abortions in Texas will be prohibited after 20 weeks of pregnancy. The
    law also enforces surgical center regulations on facilities that perform
    abortions”

    I’m not sure what’s so “extreme” or “restrictive” about that. You get 5 months to decide whether or not to kill your baby. And…?

    And facilities will be regulated the same way other medical facilities are. No more Kermit Gosnells slipping through the cracks. And…?

    The Mexican abortion pill is NOT for women who are more than 5 months along anyway.

    Sounds like much ado about nothing to me.

    • Guest

      The regulations on those facilities is so extreme that many have already stated they will be unable to afford all the changes required to stay open. They will close their doors, limiting access. No doubt some of these facilities are in remote locations meaning that women would have to drive hundreds of miles to get access to LEGAL abortion.

      It is interesting to me that in the context of assisted reproduction, there is no controversy regarding disposal of frozen embryos or reduction of multiples. Why don’t these topics come up in the abortion debates; I mean, we are talking about SAVING UNBORN CHILDREN. Or are we?

      Let’s face it, controlling and restricting abortion is all about controlling and restricting women who have sex.

      Go ahead and be comfortable, Trina, that Texas wants to restrict abortions after 20 weeks. In AR it’s 18 wks. In MS, there is one abortion clinic available in the state being kept open by the federal government. If you are willing to return to the dark dark ages when women were dying after back alley abortions, then I think you are a heartless woman.

      The chipping away at reproductive freedom should alarm you.

      • Sandra K.

        “It is interesting to me that in the context of assisted reproduction,
        there is no controversy regarding disposal of frozen embryos or
        reduction of multiples. Why don’t these topics come up in the abortion
        debates; I mean, we are talking about SAVING UNBORN CHILDREN.”

        No, we’re not. Frozen embryos are not five months along. Ever. We’re talking about no tearing out living, often viable babies, after 5 months. Women can decide to have a doctor kill their baby any time in the first five months of pregnancy. If five months isn’t enough for you to decide whether or not you want your baby to be born alive or not, you should probably use birth control so that you never find yourself in that position in the first place.

        The majority of Texans, including the majority of Texas WOMEN, are in favor of this law, in favor of abortion only in the first five month, and in favor of SAFE, LEGAL abortion, which means no filthy Gosnell-esque abortion suites.

        • Guest

          You’ve been duped by crafty legislation, which is not surprising. Emotion about abortion and BABIES is how government incites the masses. Read the bill. The preventing abortions after 20 weeks is just part of the bill. The other is creating restrictions so onerous that many abortion clinics in the state would have to close. The restrictions are not designed to make abortion clinics safer. They are designed to be restrictive, unaffordable, and to shut the places down so that no woman can get an abortion. It’s an attack on women’s reproductive rights.

          But you choose to focus on the 20 WEEKS which is exactly what Ricky Perry and conservatives want you to do. You’re a good little pawn.

          Oh, and mentioning Kermit Gosnell? Relying on inciting emotion to make your point? You may have a future in politics.

          “Women can decide to have a doctor kill their baby any time in the first five months of pregnancy.” Wow. Way to stand up for women everywhere. Maybe women who choose to have abortions should just be publicly stoned.

          • Guest

            “Maybe women who choose to have abortions should just be publicly stoned.”

            Wow. Straw man much?

            Because agreeing that we should try to make sure that abortions are safe for women is EXACTLY like saying we should stone women who have abortions. SMH.

          • Guest

            Let’s not even pretend that’s your agenda.

            Kindly educate me. What regulations does the bill pose to enforce that will make abortions safer than they are now?

        • Guest

          PS – in no state is viability 20 weeks. Fetuses are not viable at that age. Don’t make things up and present them as fact.

          I’m always curious how those who want to restrict abortion help out living impoverished children. Do you provide free day care? How about donating diapers to foster children? How about contributing more tax money to low income health care and education?

          Usually the most “pro life” people are really just pro-birth. Once the kid is out, it’s on its own.

  • Vladimir Ross

    But women who choose the Mexican way will be out of the control of medical “authorities”.

    Fantastic. Beyond the grasping fingers of doctors.

    Best of luck to them all

  • Bob

    Is RU-486 only available in the U.S.?
    American women have choices, a lot of them to control birth or not, all of which rely on time. 20 weeks? Really? Seems we have the most of any country, yet this seems to be only an American problem.

  • Guest

    The pro-abortion mob always sing the hymn that they want abortion to be “safe, legal and rare”, yet try to take steps that will make it more safe, or to make the killing of nearly full-term babies more rare, and watch them shriek.

    Remember, Gosnell was not caught in the end for violating any abortion safety standards. He was doing nothing wrong THERE, apparently – on the side of the angels, slaughtering babies by the hundred. He was only caught because he was prescribing too many opioid painkillers (eeeeek! now some things are just BEYOND the pale!!)

    There’s no “war on abortionist-murderers”, there’s just a “war on drugs”. If he hadn’t been pinged by the DEA, he would still be happily slaughtering babies and women, all with the tacit approval of the pro-abortion mob. SMH.

    • Guest

      Gosnell was an outlier and a criminal. Stop using his case to defend your stance. His behavior was NOT the norm.

      What about the fact that the infanticide occurred on babies who were minorities and whose mothers were poor minorities on services? Suppose they had lived? When they broke into your homes for drug money I’m sure you’d hardly be advocating for their right to life.

      • Guest

        I am mixed race myself (dad is from Mexico [luckily HIS mom didn't use the "Mexican abortion pill!] and mom is from Haiti). And Gosnell was black, and most of his victims were black. So put your race card away please, unless like the founder of planned parenthood you are a white supremacist who WANTS blacks to be exterminated? In which case YOU are the racist.

        A human life is a human life. I accept that our legal system currently allows babies to be killed (just as it once allowed black people to be bought and sold and hung by the neck from trees), but let’s at least guarantee women who have hired a doctor to kill her baby the same level of safety and cleanliness that she could expect if she were having some other “unwanted tissue”, say a tumor, surgically removed.

        • Guest

          I see. And what changes is this bill proposing? I haven’t read the bill myself; I’m just wild about baby killing.

          /sarc

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