Abortion pills are medicines that can be used to end an early pregnancy by medical abortion. Many women prefer to terminate pregnancy through medical abortion for various reasons that it can be started early in pregnancy, can be done from the comfort of home, is more natural than a surgical abortion or is less expensive and less invasive. Abortion pills are very effective when used appropriately giving more than 90% success rates in medical abortions. However, it is still possible for a medical abortion to fail in terminating a pregnancy. There may be quite a number of reasons that the abortion pills are ineffective in terminating a pregnancy.
Possible risk factors for certain failed or incomplete abortions following medical abortions are self-administration or prescription of abortion pills by unregistered practitioners, lack of examination, incorrect dosage and drugs, pre-existing conditions and lack of post procedure follow-up. Four main reasons for continued pregnancy even after taking abortion pills are:-
- Unauthorised or self-administration of abortion pills – The MTP act of India permits only registered medical practitioners and not any alternative medicine doctors, nurses or pharmacists to prescribe abortion pills. WHO insists that the doctors prescribing abortion pills should refer an emergency health care facility in case of failed or incomplete abortion.
As per WHO and FOGSI guidelines, the use of abortion pills indicates the necessity of pre abortion assessment for women requesting for abortion. A qualified doctor needs to confirm pregnancy, estimate the correct gestational age and locate the site of pregnancy as either intra or extra uterine before prescribing medical abortion pills. It also emphasizes the need to obtain a detailed medical history to rule out certain medical conditions such as bleeding disorders, uncontrolled seizure disorder, anaemia, chronic adrenal failure etc that can be contraindication for medical abortion. There is utmost importance for physical examination specially in younger pregnant girls to assess fitness before administering abortion pills.
Significant details of the medical abortion procedure like correct administration of the drug, dosage strength, duration and knowing the symptoms of a possible failure are vital to ensure completion of safe abortion process. There could be inadequate dosage of medicine due to vomiting and diarrhoea immediately following intake of the abortion pills. A follow up examination with the doctor on day 14 is recommended in order to confirm that the pregnancy does not continue demanding for a surgical abortion.
The medication, dosage and administration impact the effectiveness of abortion pills. Unsupervised medical abortion which is perceived as a socially safe and secure method of spacing can fail to terminate pregnancy. Self-administration of abortion pills are rampant where abortion pills are available as over the counter drugs at the chemist. Failed abortions and complications could become common due to this malpractice. To meet with assurance of pregnancy termination, it is utmost essential to follow good practices of abortion pills.
- Pregnancy beyond 9 weeks – There is need for a doctor to check and confirm that the pregnancy is not more than 9 weeks on the day of taking abortion pills. On confirmation that the pregnancy is within 9 weeks, that is 63 days from the first day of the last period, abortion pills can be collected for medical abortion from a:
- Hospital that provides abortion services
- Family planning centre with abortion services
- women’s health clinic that specialises in abortion services
The effectiveness of medical abortion varies depending on when and where the abortion pills are taken. Taking abortion pills is a three step process where the first step initiates the medication and the second step on a later date, completes the medication leading to the third step where pregnancy leaves the body. Women are given abortion pills to be taken at specific times from the comfort of home only if the pregnancy is not exceeding 9 weeks. Termination of pregnancy beyond 9 weeks is advised under the supervision of a doctor in an abortion center or a hospital.
Abortion pills have to be taken in an orderly and timely manner for the termination to be successful. If the growth of the foetus is beyond 9 weeks, there is a risk of incomplete abortion and accompanied complications. The chances of being pregnant after taking abortion pills within 9 weeks of pregnancy is 1 in 100 and the chances increase to 3 in 100 for pregnancy within 10 weeks. Every hour of delaying pregnancy termination increases the chances of leaving the woman still being pregnant.
- Ectopic/tubular pregnancy – Though ectopic pregnancies are rare at the rate of 1.5 to 2%, there is a possibility that it will impact the efficacy of abortion pills. Abortion pills cannot end an ectopic pregnancy where the fertilized egg attaches somewhere other than the uterus usually the fallopian tube or at times, the ovary. Taking abortion pills with an ectopic pregnancy may lead to bleeding but the fertilized egg growing elsewhere will not be expelled as clots that would otherwise happen while terminating a normal pregnancy growing in the uterus. If there is no bleeding along with expulsion of the uterine lining, after taking abortion pills, an ectopic pregnancy might be one of the reasons. Hence it becomes mandatory for a doctor to confirm a uterine pregnancy before taking abortion pills.
- Pre-existing pelvic infection – Pelvic infections can be sexually transmitted or happen during menstruation, after childbirth, miscarriage or abortion. It is also possible that infection enters the reproductive tract due to an improper intrauterine device (IUD) which is a form of long-term birth control or any unsafe procedure that involves inserting instruments into the uterus. Existing infections due to previous untreated conditions or complications can affect the effectiveness of abortion pills taken to terminate a following pregnancy. It is recommended to plan medical abortion ahead of time to make sure of needed care in the unlikely event of having a complication from an incomplete termination of pregnancy.
Abortion pills are safe and reliable when they are taken with a method that is recommended by WHO and that is appropriate to the pregnancy duration and when the person prescribing abortion pills is qualified and has the necessary skills to assess and administer.