药物流产约占美国所有流产的40%。这种越来越常见的方法依赖于药物而不是手术，这为在女性家中而不是诊所进行流产创造了可能性。在新冠肺炎大流行期间，这一选择变得非常重要。
随着共和党各州普遍限制堕胎，其中许多州也在限制药物流产。
提供者说药物流产是安全和必要的，尤其是在共和党控制的州去诊所变得更加困难的时候。
药物流产是如何工作的?
自2000年食品药品监督管理局批准使用米非司酮以来，药物流产已经在美国出现。
药物流产包括服用米非司酮，等待24-48小时，然后服用米索前列醇。米非司酮阻断孕酮激素，这是维持妊娠所必需的。米索前列醇通过引起痉挛和出血来排空子宫。
这些药物被美国食品和药物管理局批准在怀孕10周内使用。
该方法被认为是健康专业人士认为高效和安全，95%以上的病例终止妊娠，0.4%的病例出现严重并发症。
根据美国食品和药物管理局的数据，2000年至2018年期间，有370万妇女使用药物流产。在此期间，24名妇女在服用米非司酮后死亡。
这种方法的受欢迎程度稳步上升。支持堕胎权利的研究机构古特马赫研究所估计，堕胎占美国所有堕胎的40%，占怀孕10周以下堕胎的60%。
为什么重要?
堕胎权利倡导者表示，这种流行病已经证明了虚拟医疗的价值，包括在妇女家中而不是诊所进行堕胎的隐私和便利性。
更吸引人的是:在共和党通过严格法律限制就诊的几个州，诊所少之又少。密西西比州、密苏里州、北达科他州、南达科他州和西弗吉尼亚州只有一家堕胎诊所。
堕胎服务提供者说，随着去诊所变得越来越困难，药物堕胎可以让妇女在不面临旅行负担的情况下堕胎，这对低收入妇女来说尤其困难和昂贵。
各州如何限制它?
堕胎反对者担心药物堕胎变得越来越普遍，正在共和党领导的各州推动立法，限制药物的获取。
各州已经通过了几项措施来限制其可用性。这些措施包括禁止邮寄堕胎药丸，缩短允许这种方法的10周时间，以及要求妇女在诊所而不是在家里服用这些药丸。
一些州还要求医生告诉接受药物流产的妇女，这一过程可以在中途逆转，批评者称这一说法没有科学依据。
在33个州，只有医生被允许提供堕胎药丸。在17个州和哥伦比亚特区，它们可以由高级临床医生提供。
在19个州使用药物时，提供药物的临床医生必须亲自在场，这意味着堕胎患者不能在家服用药物。
阿肯色州、亚利桑那州、蒙大拿州、俄克拉荷马州和得克萨斯州的共和党州长今年签署了法律，禁止通过邮件运送堕胎药物。这些法律在很大程度上被视为对大流行期间远程医疗普及程度上升的回应。
这些法律在蒙大拿州和俄克拉荷马州面临法律挑战。在俄亥俄州，一名法官暂时阻止了一项法律，该法律本应禁止在法律挑战进行期间将远程医疗用于堕胎药丸。
一些共和党立法机构也限制了怀孕期间可以提供药物流产的时间。在印第安纳州和蒙大拿州，今年通过的法律禁止怀孕10周后服药，在德克萨斯州，一项新签署的法律禁止怀孕7周后服药。
德克萨斯州的法律将于12月生效。该法案通过之际，得克萨斯州开始根据一项更深远的法律禁止几乎所有堕胎，该法律被称为参议院第8号法案，已成为半个世纪以来美国对堕胎的最大限制。
药物流产可以逆转吗?
八个州需要咨询来宣传药物流产可以通过服用米非司酮后的大剂量黄体酮逆转的观点。美国妇产科学院不支持为这种用途开黄体酮处方，并表示逆转声明没有科学依据。
这些法律在阿肯色州、爱达荷州、肯塔基州、路易斯安那州、内布拉斯加州、南达科他州、犹他州和西弗吉尼亚州生效。印第安纳州、北达科他州、俄克拉荷马州和田纳西州的法院案件阻碍了这些咨询要求的执行。在蒙大拿州，该法律将于10月1日生效，但正在法庭上受到质疑。
联邦规则是什么?
2020年7月，根据联邦法院的命令，食品药品监督管理局放松了对堕胎药片的限制，以便它们可以通过邮件发送。此前，美国妇产科学院和其他团体提起诉讼，要求推翻一项规则，该规则要求患者在医院、诊所或诊所拿起一片米非司酮，并签署一份表格，其中包括药物潜在风险的信息。
特朗普政府领导下的美国食品和药物管理局及其母健康机构辩称，这些规则对于确保药丸安全使用是必要的。
但去年4月，美国食品和药物管理局确认，在新冠肺炎大流行期间，寻求堕胎药丸的妇女不需要去看医生。这一政策变化仅适用于没有法律禁止使用远程医疗或要求医生在服药时在场的州。
美国食品和药物管理局的政策也只适用于新冠肺炎卫生紧急情况持续的时间。一些医疗组织正在推动通过在线处方和邮购药店永久提供药物流产。
女性有哪些选择?
“援助获取”是通过邮件向妇女发送堕胎药丸的几个在线倡议之一。它由荷兰医生丽贝卡·贡珀斯博士领导。
时任特朗普政府的美国食品和药物管理局(FDA)两年多前曾致信Aid Access，要求其停止活动，但这家在线药物供应商一直在向美国的患者发送堕胎药丸
这种做法的合法性尚不明确，但旨在提高对自我管理堕胎的认识的C计划等组织提供了关于在哪里以及如何在线获得药物的信息。
这些组织表示，在堕胎诊所面临反堕胎倡导者持续攻击的地方，以及立法者和州长越来越难让诊所保持开放的地方，这种准入对妇女来说尤其重要。
自2000年以来，一个生殖权利法律援助团体If/When/How追踪了24起妇女因自我管理堕胎而被起诉的案件。
该组织的政策主管萨拉·安斯沃斯(Sara Ainsworth)表示:“即使没有法律规定这是非法的，也有可能有人成为调查、逮捕或起诉的目标。
EXPLAINER: Medication abortion becomes latest GOP target
Medication abortion accounts for about 40% of all abortions in the U.S. The increasingly common method relies on pills rather than surgery, opening the possibility for abortions to be done in a woman's home rather than a clinic. It's an option that has become important during the COVID-19 pandemic.
As Republican states move to restrict access to abortion generally, many of them also are limiting access to medication-induced abortions.
Providers say medication abortion is safe and essential, especially as access to clinics in Republican-controlled states becomes more difficult.
HOW DOES MEDICATION ABORTION WORK?
Medication abortion has been available in the U.S. since 2000, when the Food and Drug Administration approved the use of mifepristone.
A medication abortion consists of taking mifepristone, waiting 24 to 48 hours, and then taking misoprostol. Mifepristone blocks the hormone progesterone, which is essential to sustain a pregnancy. Misoprostol empties the uterus by causing cramping and bleeding.
The drugs are approved for use by the FDA up to 10 weeks of gestation.
The method is considered byhealthprofessionals to be highly effective and safe, with pregnancies terminated in more than 95% of cases and serious complications in 0.4% of cases.
According to the FDA, 3.7 million women used medication abortion between 2000 and 2018. In that period, 24 women died after taking mifepristone.
The method’s popularity has grown steadily. The Guttmacher Institute, a research organization that supports abortion rights, estimates that it accounts for about 40% of all abortions in the U.S. and 60% of those taking place up to 10 weeks’ gestation.
WHY IS IT IMPORTANT?
Abortion rights advocates say the pandemic has demonstrated the value of medical care provided virtually, including the privacy and convenience of abortion taking place in a woman’s home, instead of a clinic.
Adding to its appeal: Clinics are few and far between in several states where Republicans have passed strict laws limiting access. Mississippi, Missouri, North Dakota, South Dakota and West Virginia are states that have just a single abortion clinic.
Abortion providers say as access to clinics becomes more difficult, medication abortion can allow women to get abortions without facing the burden of traveling, which can be especially difficult and expensive for lower-income women.
WHAT ARE STATES DOING TO RESTRICT IT?
Abortion opponents, worried medication abortion is becoming increasingly prevalent, are pushing legislation in Republican-led states to limit access to the drugs.
States have passed several measures to limit its availability. These include outlawing the delivery of abortion pills by mail, shortening the 10-week window in which the method is allowed and requiring women take the pills in a clinic rather than at home.
Some states also require doctors to tell women undergoing drug-induced abortions that the process can be reversed midway through, a claim critics say is not supported by science.
In 33 states, only physicians are allowed to provide abortion pills. In 17 states and the District of Columbia, they can be provided by advanced-practice clinicians.
Clinicians providing the medication must be physically present when it is administered in 19 states, meaning abortion patients cannot take the drugs at home.
Republican governors in Arkansas, Arizona, Montana, Oklahoma and Texas signed laws this year prohibiting abortion drugs from being delivered by mail. Such laws were largely seen as a response to the rise in popularity of telemedicine during the pandemic.
The laws face legal challenges in Montana and Oklahoma. In Ohio, a judge temporarily blocked a law that would have banned the use of telemedicine for abortion pills while a legal challenge is underway.
Some Republican legislatures also put limits on the point during a pregnancy when medication abortion can be provided. In Indiana and Montana, laws passed this year ban the medication after 10 weeks' gestation, and in Texas a newly signed law bans the medication after seven weeks.
The Texas law is set to take effect in December. It passed just as Texas began banning nearly all abortions under a more far-reaching law, known as Senate Bill 8, which has become the nation’s biggest curb to abortion in a half-century.
CAN MEDICATION ABORTION BE REVERSED?
Eight states require counseling to promote the idea that medication abortion can be reversed through a high dose of progesterone after taking mifepristone. The American College of Obstetricians and Gynecologists does not support prescribing progesterone for that use and says the reversal claim is not based on scientific evidence.
Such laws are in effect in Arkansas, Idaho, Kentucky, Louisiana, Nebraska, South Dakota, Utah and West Virginia. Court cases in Indiana, North Dakota, Oklahoma and Tennessee have blocked enforcement of these counseling requirements. In Montana, the law is set to take effect Oct. 1 but is being challenged in court.
WHAT ARE THE FEDERAL RULES?
In July 2020, the Food and Drug Administration -- under federal court order -- eased restrictions on abortion pills so they could be sent by mail. That came after the American College of Obstetricians and Gynecologists and other groups sued to overturn a rule that required patients to pick up the single tablet of mifepristone at a hospital, clinic or medical office and sign a form that includes information about the medication’s potential risks.
The FDA and its parent health agency, under the Trump administration, argued the rules were necessary to ensure the pills were used safely.
But last April, the FDA affirmed that women seeking an abortion pill would not be required to visit a doctor's office during the COVID-19 pandemic. The policy change applies only in states where there are no laws banning the use of telemedicine or requiring a physician to be present when the drugs are taken.
The FDA policy also applies only as long as the COVID-19 health emergency lasts. Several medical organizations are pushing to make medication abortion permanently available through online prescribing and mail-order pharmacies.
WHAT ARE WOMEN'S OPTIONS?
Aid Access is one of several online initiatives that is offering to send women abortion pills by mail. It is led by Dr. Rebecca Gomperts, a Dutch physician.
The FDA, then under the Trump administration, sent a letter to Aid Access more than two years ago asking it to cease its activity, but the online drug provider has continued to send abortion pills to patients the U.S.
The legality of the practice is ambiguous, but groups such as Plan C, which aims to raise awareness about self-managed abortions, provide information about where and how the drugs can be obtained online.
Those groups say such access is especially important for women in places where abortion clinics face an ongoing assault by anti-abortion advocates and where lawmakers and governors are making it progressively harder for the clinics to remain open.
If/When/How, a reproductive rights legal aid group, has tracked 24 cases since 2000 when women were prosecuted for self managed abortions.
“It is possible that someone could be targeted for investigation or arrest or prosecution, even in the absence of a law that actually makes it illegal,” said Sara Ainsworth, policy director for the group.
