Sounds Like a Plan
Dear Leading Ladies,
Recent conversations with friends have made it clear that many of us don’t fully understand the difference between Plan B and Plan C in pregnancy management. With the overturning of Roe v Wade and the more recent ban on medication abortion pills, we thought it was a good time to review the options.
What exactly is Plan B?
Plan B, generally called the Morning-After Pill, is used when a woman has had unprotected sex and is fearful that an unwanted pregnancy could result. The pill must be taken within five days or 120 hours after unprotected sexual intercourse. As emergency contraception, the pill prevents pregnancy by preventing ovulation and fertilization. The sooner it is taken after unprotected sex, the more effective it is – as much as 95% when taken within 24 hours. The morning-after pill is not an abortion, since it is used to prevent pregnancy, not end it. Use is recommended for emergencies and not as a regular form of contraception. The cost is $30-65, making it very accessible to most women in need.
How is it different from Plan C?
In contrast, Plan C is used for medication abortions up to 70 days after the first day of the last menstrual period. With Plan C, two drugs — mifepristone and misoprostol — are usually used in conjunction with one another to induce and complete the termination of a pregnancy by blocking the hormones necessary for maintaining a pregnancy and causing the uterus to contract and empty. More than half of all abortions done in the US are medication abortions. They are 96-99% effective, very safe, non-invasive, and do not involve anesthesia. They are also accessible for women in rural and underserved areas. Costs range from free in some instances to anywhere from $175 to $800. That includes office visits, testing, and exams. The downside is that it can take a few days for the uterus to completely empty.
reproductiverights.org
The other option, of course, is surgical abortions, which usually involve dilation and aspiration of the uterus, may or may not require anesthesia, are ideally done in a hospital or clinic setting, and may be necessary for a pregnancy of advanced gestation. While a medication abortion may take a few days to complete, a surgical abortion lasts only a few minutes and requires a few hours’ stay in a facility. Women with certain health conditions, such as bleeding disorders, may want to opt for an abortion in a hospital or clinic. Surgical abortions are effective and safe 99% of the time; they can cost up to $750, depending on one’s residency, health insurance and other factors. Recently, surgical abortions have been outlawed in many US states.
How are the laws changing?
Last month, Wyoming became the first state to ban the prescription, distribution, or use of medication abortion pills, with a penalty of up to six months’ imprisonment and a fine of up to $9,000 for anyone breaking the new law. According to the new law, which goes into effect on July 1, it is a felony “to prescribe, dispense, distribute, sell or use any drug for the purpose of procuring or performing an abortion.” There are exceptions for cases of sexual assault, incest, miscarriage, and procedures for “imminent peril that substantially endangers [a pregnant person's] life or health,” not including mental health conditions. Interestingly, the law exempts pregnant persons from prosecution for their own abortions. In other states where abortions are banned medication abortions are also illegal, but Wyoming is the first state to specifically ban Plan C. We can look forward to many more states to follow.
For instance, on April 7, a federal judge in Texas ruled that the Food and Drug Administration didn't properly approve mifepristone, which has been on the market for more than 20 years and is one of the two drugs used in medical abortions. Consequently, mifepristone could become unavailable in the US soon, though the ruling is being challenged in court. The effects could be devastating for many in some states. However, as reported by NPR, doctors and other providers may continue to advise women to undergo medication abortions with only misoprostol, which is still safe and effective. The difference is that the patient tends to experience more nausea, vomiting, and diarrhea, and a longer duration of cramping and bleeding. In both cases, pregnant women see nurses or doctors online or in person beforehand and then take the medication at home.
Is this the end of medication abortions?
The major question remains. Can pregnant women undergo medication abortions in states that ban abortions? The answer is yes…and no. Medication abortions are not legal in states where abortions are outlawed, but misoprostol is legal for other purposes such as treating ulcers or inducing labor. And then there are organizations to help work around the obstacles. Mara Gordon, a family physician writing for NPR, offers these resources:
MaydayHealth offers step-by-step instructions for setting up a mail-forwarding address, so patients can list an address in a permissive state on their intake forms for a telehealth abortion, then get the pills sent along to an additional address somewhere else.
Plan C is a website that provides up-to-date information about how to get abortion pills at home.
The Miscarriage and Abortion Hotline offers free consultations with clinicians if a patient has questions about a medication abortion, even if she had the abortion in a state where it's illegal.
Aid Access is based in the Netherlands and will mail mifepristone and misoprostol to patients in states where abortion is banned. Pills sent from abroad are not subject to FDA approval and safety regulations. The organization also employs U.S.-based health care providers, who prescribe FDA-regulated abortion pills via telehealth in states where it's allowed.
Despite all these potential resources, many pregnant women who may wish to terminate their pregnancies — for reasons personal, medical, or economical — will no longer have that choice. These restrictions will present more challenges for women who are Black or brown, who lack access to decent housing, jobs, food, and medical care, and who will struggle to make good lives for their newborns. As a retired ob/gyn from Texas recently told us, their wealthier neighbors will still get the abortions they seek or the health care they need, while the gap widens between the haves and the have nots.
And, while we’re at it, please think about where you are getting your own prescriptions filled. Walgreens has decided they will not dispense abortion pills in nearly two dozen states after receiving threats of legal action from GOP states attorneys. They just lost our business!
Hoping that we can start moving forward again soon with a woman’s right to choose,
Therese (she/her/hers)
Judy (she/her/hers)
Mackenzie (she/her/hers)
Didi (she/her/hers)