What is the abortion drug Donald Trump talked about? How is it used in Australia?

Donald Trump suggested he would be willing to block access to the abortion pill if he won the presidential election. Last Thursday, he was asked by a reporter if he would “block” access to the drug. The following day, Trump's campaign office said he had misunderstood the question.

Trump's running mate JD Vance has since said abortion policy should be determined by states and the pair want to “make sure every drug is safe and properly prescribed.” However, it is unclear exactly what that means for American women's future access to abortion.

The abortion drug they are talking about is mifepristone, also known as RU486.

Mifepristone is one of the drugs used in medical abortion. It works by blocking the action of progesterone, one of the hormones important for the development of pregnancy.

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

In Australia, these two medicines are prescribed in a combination pack called MS-2 Step, which is approved for use in women up to ninth week of pregnancy.

What happens during a medical abortion?

When a woman has a medical abortion, she first takes a mifepristone tablet. This blocks a hormone called progesterone, which is needed to continue the pregnancy. This may cause spotting or bleeding.

Between 36 and 48 hours later, she puts the misoprostol in her cheek and lets it dissolve.

There will be severe cramping and bleeding and it will feel like a very heavy period, with blood clots and tissue being passed out, shedding the lining of the uterus and the pregnancy.

To treat these symptoms, doctors often prescribe anti-nausea tablets and painkillers.

The entire process is similar to a miscarriage and usually lasts between two and six hours.

Once the pregnancy is over, symptoms subside. Bleeding is normal for about five days, and light bleeding may occur between ten days and a month.

Medical abortion is safe and works in over 98% of cases when performed early in pregnancy. The risk of a serious complication such as infection or bleeding requiring hospitalization or a blood transfusion is only 0.4%.

If a woman experiences very heavy bleeding (blood clots larger than a small lemon appear or two pads become saturated or soaked per hour for more than two hours in a row), she should go to the emergency room because of the small but serious risk of bleeding.

If the temperature rises above 38 degrees, there may be an infection and she should contact her doctor.

To ensure that the abortion was successful, women should also have a blood test seven days after performing the MS-2 step.

What other options are there?

Although medical abortion is rapidly becoming the most common method in early pregnancy, it is not the method of choice for all women.

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

For some women, surgical abortion is the method of choice or even the better option. A decision aid that shows the advantages and disadvantages of each method can be helpful.

When did Australians get access?

As elsewhere in the world, the availability of medical abortion has enabled women in Australia to have abortions that would not have been possible before.

Before the introduction of this method in Australia in 2012, abortions were performed surgically, requiring a one-day stay in a hospital or surgical facility and anesthesia.

Read more: Arrival of RU486 in Australia a major step forward for women

Surgical abortions were – and still are – difficult to access. Unlike surgical procedures such as knee replacements or appendectomies, surgical abortions are not always performed in public hospitals, especially those run by religious organizations.

This is a major problem for women in rural areas. Many surgical abortion clinics are located in large cities and many women feel judged and stigmatized or face barriers from doctors who do not believe in women's right to self-determination.

Now a woman can get a prescription for MS-2 Step from her local doctor and have a medical abortion in the comfort of her own home.

If her primary care doctor doesn't offer this service, she can consult a doctor who does via telemedicine. Medicare provides reimbursement for consultations for sexual and reproductive health issues that are done either by phone or online video. Unlike most other telemedicine consultations, for sexual and reproductive health issues, you don't have to have seen the primary care doctor in person in the past 12 months to qualify for reimbursement.

This means that a woman 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 administered, have the medical abortion at home, and have a follow-up visit via telemedicine a few weeks later.

What is the situation in America?

When the Supreme Court in America overturned Roe vs. Wade in 2022, it stripped women of their constitutional right to abortion, allowing many states to introduce abortion bans. This led to the closure of many clinics that performed surgical abortions.

However, the availability of mifepristone has allowed women to circumvent these state laws and obtain medication abortion pills via telemedicine or online through services such as Plan C or Women on Web.

If Donald Trump wins the election and restricts access to mifepristone, American women's options will be further limited and they may resort to unsafe abortion methods. Restricting access to abortion will not stop it; it will only drive it underground and make it less safe.