Medication abortion is increasingly the method of choice in Maine
In 2018, Sophie, who asked that we not use her real name, unexpectedly became pregnant. Her birth control failed, and Sophie says she and her husband weren't ready for a baby.
"I was gonna start school," she says. "I got into this program that was really competitive. I just knew that it just wasn't — it wasn't going to work for us."
Sophie wanted an abortion, but a surgical procedure seemed too invasive. So, she chose a medication abortion. It requires two different drugs, and at the time, she had to take the first pill in-person at the Maine Family Planning clinic in Augusta. Several hours later at home, she took the second medication.
"I was able to do this from the comfort of my own home. And, you know, I didn't have to take a ton of time off work," Sophie says. "There was no anesthetic or anything. It was just me at home with my husband. And it was good."
Medication abortion first became available in the U.S. a little more than 20 years ago. It's now the most common method, accounting for more than 50% of all abortions. In Maine, the rate is even higher.
It's a more convenient option for a lot of people, says Mareisa Weil, spokesperson for Maine Family Planning. Maine's three abortion providers only offer surgical procedures in one location each: Portland, Augusta, and Bangor. But she says abortion medication can be dispensed from all of Maine Family Planning's 18 clinics, which extend from Fort Kent to Machias to Rumford.
"It eliminates transportation barriers," Weil says. "It eliminates childcare that you might have to obtain or time off work that you might have to take. So it just makes it a lot easier to access."
And that's why more people are choosing this method of abortion, Weil says. Especially in recent years.
"It was really a flip flop during the pandemic because we had always been much higher on procedural abortions, you know, as high as like 80 or 90% for a long time," she says.
Now, Weil says, two-thirds of abortions at Maine Family Planning are done by medication. The increase is driven, in part, by the FDA's recent decision to lift the requirement that patients take the first pill in-person at a clinic. That means the medication can now be sent through the mail. Maine Family Planning nurse practitioner Lindsey Piper calls it a "no touch" abortion.
"No touch meaning we don't do an ultrasound to date their pregnancy," Piper says. "And this has been very well studied."
A recent study that involved more than 3,700 patients from U.S. clinics, including Maine Family Planning, found what research in the UK and Canada has already revealed: that medication abortion can safely be prescribed without a physical exam. Instead, patients have a telehealth appointment. Specialists rule out risk factors and ask the patient questions to hone in on how far along the pregnancy is.
"I did not actually go into the clinic at all," Anne says, who asked that we not use her real name. "Every appointment I had with them was through my screen."
Several months into the pandemic, Anne did a medication abortion through Maine Family Planning. She says she was totally satisfied with the telehealth process.
"There were no complications. And they had a 24/7 hour line that I could call if I had any concerns. So I felt like you know there would be somebody there for me if anything went wrong," she says.
"It's an incredibly safe procedure," says Nicole Clegg, a spokesperson for Planned Parenthood of Northern New England, which operates four health clinics in southern Maine. Clegg says about 65% of abortions provided by Planned Parenthood in Maine use medication.
"The biggest risk with medication abortion is that it doesn't cause an abortion," she says.
In that case, Clegg says a patient could be prescribed more medication or have an in-office procedure. At Mabel Wadsworth Center in Bangor, Abbie Strout-Bentes says about half of their patient abortions involve medication, and the other half are performed in the clinic.
"The in-clinic procedure, when they come into our office, they leave and they know they are no longer pregnant," Bentes says. "And some people really like that security of having a provider there with them through that whole process."
Bentes says that's why it's important that both methods are available. But if the U.S. Supreme Court overturns Roe v. Wade, access will be determined by state laws. And Lindsey Piper of Maine Family Planning says she can't mail medication to a patient in a state where abortion has become illegal.
"Ya know, I would lose my license," Piper says. "And then I would help zero people in Maine if I tried to help one person in Texas."
Piper says medication abortion could help meet the potentially increased demand in states where abortion remains legal. It can be dispensed to people who travel to these states and could also free up clinic space for procedural abortions. But not everyone, she says, will have the resources or ability to travel.