What is the abortion drug Donald Trump has been talking about? How is it used in Australia?

Donald Trump suggested he was open to revoking access^[1] to the abortion pill if he won the presidential race, after being asked by a reporter last Thursday if he would “revoke access” to the drug. The following day, Trump’s campaign office said^[2] he didn’t hear the question properly.

Trump’s running mate, JD Vance, has since said^[3] abortion policy should be made by the states and the pair want to “make sure that any medicine is safe, that it is prescribed in the right way”. But it’s unclear exactly what this means for American women’s future access to abortion.

The abortion drug they’re talking about is mifepristone, otherwise known as RU486.

Mifepristone is one of the medications used in a medical abortion. It acts by blocking the effect of progesterone, one of the hormones important to the development of a pregnancy.

The second medication involved is misoprostol, which contracts and empties the uterus.

In Australia these two medicines are prescribed in a combination pack called MS-2 Step^[4] which is registered for use in women up to nine weeks of pregnancy.

What happens during a medical abortion?

When a woman undergoes a medical abortion^[5], she first swallows the mifepristone tablet. This blocks a hormone called progesterone, which is needed for the pregnancy to continue. This might result in some spotting or bleeding.

Between 36 and 48 hours later^[6], she places the misoprostol in her cheek and lets it dissolve.

Strong cramps and bleeding will start and it will feel like a very heavy period with blood clots and tissue being passed. This is the lining of the uterus and the pregnancy being shed.

Doctors often prescribe^[7] anti-nausea pills and pain relief medications to deal with these symptoms.

The whole process is like having a miscarriage and usually lasts between two and six hours.

Once the pregnancy has passed, symptoms start to settle. Women will continue to bleed like a normal period for about five days, and some lighter bleeding may continue for between ten days to a month.

Medical abortion is safe and works more than 98% of the time^[8] when carried out early on in a pregnancy. There is only a 0.4% risk of a serious complication^[9] such as an infection or haemorrhage requiring hospitalisation or transfusion.

If a woman has very heavy bleeding^[10] (passing clots bigger than a small lemon or filling or soaking through two or menstrual pads per hour for more than two hours in a row), she should go to the emergency department because of the small but serious risk of haemorrhage.

If she develops a fever over 38 degrees, she may have developed an infection and should contact her health-care provider.

Women should also do a follow up blood test seven days after^[11] taking the MS-2 Step to make sure the abortion was successful.

What are the other options?

While medical abortion is rapidly becoming the most common way to have an abortion early in the pregnancy, it is not the method of choice^[12] for all women.

And it’s not suitable for everyone, especially those without support, such as homeless women or those experiencing domestic violence.

For some women, surgical abortion might be their method of choice or a better option. It can be helpful to use a decision aid^[13], which sets out the pros and cons of each method.

When did Australians get access?

Like everywhere else in the world, having medical abortion available in Australia has enabled women to access an abortion when they previously wouldn’t have been able to.

Prior to its introduction in Australia in 2012^[14], abortions were carried out surgically, requiring a one-day stay in a hospital or surgical facility, and an anaesthetic.

Read more: Arrival of RU486 in Australia a great leap forward for women^[15]

Surgical abortions were then – and still are – difficult to access. Unlike surgical procedures such as knee replacements or having your appendix removed, surgical abortions are not always provided in public hospital settings, especially hospitals run by faith-based organisations^[16].

For women living in rural areas, this has been a big problem. Many surgical providers of abortion are located in metropolitan settings and many women have felt judged and stigmatised or had barriers put in their way^[17] by doctors who did not believe in a woman’s right to choose.

Now a woman can receive a prescription for MS-2 Step through her local doctor and undergo a medical abortion in the comfort of her own home.

If her local doctor doesn’t provide this service, she can consult a doctor who does via telehealth. Medicare provides rebates for consultations related to sexual and reproductive health issues^[18] carried out either over the phone or via online video. Unlike most other telehealth consultations, for sexual and reproductive health issues, you don’t need to have seen the GP face-to-face in the last 12 months to get a rebate.

This means a woman who is living in Western Australia, for example, can have a consultation with a doctor in Queensland and receive a prescription for MS-2 Step via text message or email.

She can then go to her local pharmacy to have the medication dispensed, undergo the medical abortion at home and then have her follow up consultation again via telehealth a couple of weeks later.

What’s the situation in America?

In America, when the Supreme Court overturned Roe Vs Wade in 2022, it removed women’s constitutional right to abortion, allowing many states to introduce bans on abortions^[19]. This meant many clinics providing surgical abortions closed down.

The availability of mifepristone has, however, meant that women have been able to bypass these state-based laws and obtain medical abortion pills via telehealth or online through services like Plan C^[20] or Women on Web^[21].

If Donald Trump wins the election and restricts access to mifepristone, American women’s options will become even more limited and they may resort to unsafe abortion methods. Restricting access to abortion never stops it^[22], it just drives it underground and makes it less safe.

References

1. ^{^} open to revoking access (www.washingtonpost.com)
2. ^{^} said (www.statnews.com)
3. ^{^} since said (www.nbcnews.com)
4. ^{^} MS-2 Step (www.healthdirect.gov.au)
5. ^{^} medical abortion (youtu.be)
6. ^{^} 36 and 48 hours later (www.healthdirect.gov.au)
7. ^{^} often prescribe (www.fpnsw.org.au)
8. ^{^} safe and works more than 98% of the time (www.contraceptionjournal.org)
9. ^{^} serious complication (www.contraceptionjournal.org)
10. ^{^} heavy bleeding (thewomens.r.worldssl.net)
11. ^{^} seven days after (www.fpnsw.org.au)
12. ^{^} it is not the method of choice (bmjopen.bmj.com)
13. ^{^} decision aid (ranzcog.edu.au)
14. ^{^} introduction in Australia in 2012 (theconversation.com)
15. ^{^} Arrival of RU486 in Australia a great leap forward for women (theconversation.com)
16. ^{^} hospitals run by faith-based organisations (www.theguardian.com)
17. ^{^} barriers put in their way (bmcmedethics.biomedcentral.com)
18. ^{^} consultations related to sexual and reproductive health issues (www.mja.com.au)
19. ^{^} introduce bans on abortions (edition.cnn.com)
20. ^{^} Plan C (www.plancpills.org)
21. ^{^} Women on Web (www.womenonweb.org)
22. ^{^} never stops it (www.who.int)