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Alabama Can’t Prosecute Those Who Help With Out-of-State Abortions, Judge Rules
Alabama cannot prosecute doctors and reproductive health organizations for helping patients travel out of the state to obtain abortions, a federal judge ruled on Monday.
Alabama has one of the strictest abortion bans in the country, and in 2022 its attorney general, Steve Marshall, a Republican, raised the possibility of charging doctors with criminal conspiracy for recommending abortion care out of state.
Multiple clinics and doctors challenged Mr. Marshall’s comments in court, accusing him of threatening their First Amendment rights, as well as the constitutional right to travel. The Justice Department under the Biden administration had also weighed in with support for the clinics, arguing that “threatened criminal prosecutions violate a bedrock principle of American constitutional law.”
On Monday, the judge, Myron H. Thompson of the Middle District of Alabama, in Montgomery, ruled that Mr. Marshall would be violating both the First Amendment and the right to travel if he sought prosecution.
“It is one thing for Alabama to outlaw by statute what happens in its own backyard,” Judge Thompson, who was named to the court by President Jimmy Carter, wrote in his 131-page opinion.
“It is another thing,” he added, “for the state to enforce its values and laws, as chosen by the attorney general, outside its boundaries by punishing its citizens and others who help individuals travel to another state to engage in conduct that is lawful there but the attorney general finds to be contrary to Alabama’s values and laws.”
Judge Thompson described a hypothetical scenario in which a bachelor party from Alabama could be prosecuted for casino-style gambling in Las Vegas, which is illegal in Alabama.
“As the adage goes, be careful what you pray for,” he wrote.
Travel to other states to obtain an abortion, or abortion pills, has significantly increased since the Supreme Court overturned Roe v. Wade. More than 171,000 patients traveled for an abortion in 2023, compared with 73,100 in 2019, according to the research organization Guttmacher Institute.
Mr. Marshall repeatedly defended his position in court, arguing that he retained the ability to prosecute a conspiracy that took place in Alabama and that the legality of abortion laws in other states did not matter. (He does not appear to have charged anyone in such a case.)
“The right to travel, to the extent that it is even implicated, does not grant plaintiffs the right to carry out a criminal conspiracy simply because they propose to do so by purchasing bus passes or driving cars,” Mr. Marshall wrote in one filing.
Republican-led states, like Alabama, generally have the most restrictive abortion laws in the country. Some of those states are now taking legal steps to stop out-of-state efforts to help residents obtain abortions.
Louisiana, which passed a law last year designating abortion pills as dangerous controlled substances, has charged both a Louisiana mother and a New York doctor with violating the state’s abortion ban. (New York has declined to extradite the doctor.)
And this month, a New York county clerk blocked Texas from filing legal action against the same doctor. New York has an abortion shield law that prevents penalties against abortion providers who use telemedicine to send medications to other states.
The Alabama ruling could be appealed, as the judicial system continues to grapple with the fallout from Roe. In June, the Supreme Court temporarily allowed for emergency abortions in Idaho, though it did not weigh in directly on the state’s abortion ban.
Alabama, where voters approved a constitutional amendment in 2018 aimed at protecting the rights of unborn children, has been at the center of the debate over reproductive medicine and abortion access. It has one of the strictest abortion bans in the nation, with an exception only if the life of a pregnant woman is at risk. It also allows for doctors to be charged with felonies that carry sentences of up to 99 years in prison.
And its anti-abortion amendment was at the heart of a State Supreme Court decision last year that found that embryos could be considered children, a decision that briefly paralyzed fertility treatments in the state and thrust the issue of in vitro fertilization into the national spotlight.
The clinics that first challenged Mr. Marshall’s comments, in 2023, included the Yellowhammer Fund, an organization founded in Tuscaloosa that helps fund and support abortion access in the Deep South, and the West Alabama Women’s Center in Tuscaloosa, now known as WAWC Healthcare. The plaintiffs also included Dr. Yashica Robinson, an obstetrician-gynecologist in Huntsville.
In court filings, they said they either had stopped operating an abortion fund or had begun declining to answer questions about how patients could seek care out of state. Collectively, the plaintiffs still receive several calls a week asking for help; the court ruling on Monday put the figure at as many as 95 a week.
“Every day was agonizing,” said Kelsea McLain, the health care access director for the Yellowhammer Fund. The ruling, she said, brought “just an overwhelming sense of relief.”
“We are free to do exactly what we feel called to do, in ways that we are experts in,” she added. “People won’t be alone.”
Mr. Marshall’s office did not immediately respond to a request for comment.
Notably, in a 2022 opinion concurring with the decision to overturn Roe, Justice Brett Kavanaugh wrote that he did not believe a state could constitutionally bar a resident from traveling for an abortion. Judge Thompson noted this in his ruling on Monday.
Abbie VanSickle contributed reporting.
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Hotels have a big World Cup problem: Bookings are running far below projections
General view of Arrowhead Stadium, in Kansas City, Missouri, which will be hosting some of the World Cup matches this summer.
Jamie Squire/Getty Images North America
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Jamie Squire/Getty Images North America
With only six weeks to go before the start of the World Cup, hotels at most of the cities hosting the tournament are facing a major problem: Bookings are running far below what they had expected.

For some metro areas such as Kansas City, bookings are running even below what a typical June or July would bring, according to an industry survey released on Monday by the American Hotel and Lodging Association. The report was conducted last month and a spokesperson said it’s based on 205 respondents “representing hotel operators and owners, many of whom own multiple hotel portfolios across the country and across multiple World Cup markets.”
AHLA said the disappointing bookings stem from fewer than expected international travelers and large cancellations by FIFA — the organizer of the World Cup — leaving hotels with an unexpectedly large number of empty rooms.
“Despite more than 5 million tickets sold (for World Cup matches), this demand has not yet translated into strong hotel bookings,” the AHLA said in the report.
The disappointment comes after the hotel industry was bracing for a strong summer in 2026. The World Cup is taking place across the U.S., Canada and Mexico — with 11 U.S. cities hosting games. In addition, the U.S. is celebrating the 250th anniversary of the signing of the Declaration of Independence, which was also expected to bring an influx of foreign visitors.

Overseas visitors are critical to the hotel industry, the AHLA says, because they tend to spend more — and stay longer.
But the AHLA warned nearly 80% of hotel bookings across host cities are running below initial forecasts, according to its survey. In Kansas City, 85% to 90% of hotels reported bookings below projections.
World Cup organizers in Kansas City pushed back to the survey, telling The Athletic that embassy staff in countries such as the Netherlands are deploying additional staff to the city in anticipation of a high number of visitors. An tournament organizers in the city still stand by their ambitious projection to attract 650,000 visitors over the course of the World Cup, CEO of Visit KC and the Kansas City Sports Commission, Kathy Nelson, told KCUR in an interview.
KC26, the host committee, did not immediately reply to a request for comment from NPR.
There were bright spots, however, for host cities Miami and Atlanta. About half of survey respondents in the capital of Georgia reported bookings in line or ahead of projections, while about 55% of respondents in Florida’s biggest metro city reporting stronger-than-expected projections.
Japan supporters celebrate after their team beat Spain at a 2022 World Cup game held at the Khalifa International Stadium in Doha, Qatar, on Dec. 1, 2022.
Adrian Dennis/AFP via Getty Images
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Not coming to America
The survey results appear to be another sign that overseas travelers are not planning to come to the U.S. in the numbers once expected as a result of a slew of factors including tighter immigration policies by the U.S. administration.
“Even with global anticipation building, the path to the U.S. for many World Cup travelers feels increasingly less like a red-carpet welcome,” the AHLA said in its survey. “There is a perception that international travelers may face lengthy visa wait times, increased visa fees, and lingering uncertainty around entry processing.”

The AHLA also cited other factors such as the strong U.S. dollar and concerns about airport screening as “contributing to a growing sense that visiting the U.S. for the World Cup may be more complicated and costly.”
FIFA has continued to tout the “unprecedented” demand for the tournament, and has said it expects the World Cup to break attendance records.
Meanwhile, White House spokesman Davis Ingle told NPR last week for a story on World Cup demand that the tournament “will no doubt be one of the greatest and most spectacular events in the history of mankind,” and that “President Trump is focused on ensuring that this is not only an incredible experience for all fans and visitors, but also the safest and most secure in history.”
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The U.S. Army’s ‘Big Experiment’ in the Arctic Cold
The soldiers heaved the 300-pound plastic sleds down the hallway of their headquarters building. Packed inside were the things they would need to survive when the temperature at their Alaska training area plunged to 40 below or colder.
Each sled carried a tent with enough room for 10 soldiers if they curled their legs. There were gasoline containers to fuel a small metal stove that would keep them warm. There were shovels to clear the snow and hammers, stakes and rope to keep their tents standing when the winds howled.
There were fire extinguishers in case the whole thing caught ablaze.
“Make room!” the soldiers screamed.
The white sleds screeched across the linoleum floor.
In Washington and other world capitals, the Arctic is cast as a new frontier for military competition, a region where rising temperatures are opening new sea lanes and creating new access to valuable rare earth minerals. Pentagon strategy papers have repeatedly called for closer cooperation with Arctic allies and the construction of new bases to ward off rivals like Russia and China. President Trump has expressed his interest in more atavistic terms, vowing to buy or, if necessary, conquer Greenland by force.
“I would like to make a deal the easy way,” Mr. Trump said earlier this year of his ambitions for the semiautonomous Danish territory. “But if we don’t do it the easy way, we’re going to do it the hard way.”
Absent from all of the strategy documents and Oval Office threats is any sense of how U.S. troops might fight in the brutal conditions.
In February, the Iran war was looming and tens of thousands of U.S. troops were gathering in the Middle East, the region that has been the Pentagon’s focus for the last 25 years. But in Alaska, the Army was preparing for a new kind of war.
The setting was the Yukon Training Center, a 400-mile expanse of snow and ice near Fairbanks and the Arctic Circle.
At minus 40 degrees and below, weapons fail, batteries quickly lose their charge, and fuel turns into a viscous jelly. Army officials wanted to learn how their equipment would perform in the extreme cold.
But their biggest questions were about the soldiers who came from places like Alabama, Texas, Florida and California. How far could these troops go before exhaustion set in and they started to lose focus, make mistakes or simply quit?
About 4,000 soldiers from the Army’s 11th Airborne Division, including 107 from the division’s Able Company, were taking part in the training battle, which pitted two similarly sized forces against each other.
In this fight, the ammunition was fake; blanks and lasers replaced bullets and artillery shells. But the cold was unsparingly real.
Capt. Trung Duon Vo had been in command of Able Company for almost a year, enough time to understand the dangers his soldiers faced from frostbite. The coldest nights, he knew, could take fingers and toes. If soldiers got sloppy, it could cost them their lives.
Captain Vo called the company’s leaders together inside their small headquarters building to update them on the latest intelligence on the enemy, which consisted of about 1,000 paratroopers positioned along two ridgelines.
Outside, it was a relatively balmy minus 3 degrees. A light snow was falling.
Captain Vo’s most immediate worry was the company’s movement across a frozen river into the training area and the possibility that someone might break through the ice. He stressed the importance of quickly alerting him and other leaders to “real world issues” like frostbite or hypothermia.
Heads nodded.
“The Arctic always puts a little fear into me as a leader,” Captain Vo confessed. “If you don’t do the right things, you will die.”
The troops’ eagerness to get moving mixed with dread at the prospect of 10 days in the bitter cold. A few minutes later they were streaming onto buses that would drop them off in the icy, dark wilderness.
Into the Fight
The Able Company soldiers said they often felt as if they were participants in a “big experiment.”
Some of the soldiers had volunteered to serve in Alaska, in search of adventure or because the Army had offered them a cash bonus. Others were there purely by chance; someone in the Pentagon’s vast bureaucracy needed to fill an open spot in an infantry platoon.
The troops climbed off the buses and spent the next several hours searching for their rucksacks and other equipment in the dark. The soldiers knew they were at higher risk for frostbite and other weather-related injuries when they were not moving. So, they flapped their arms and stomped their feet to keep their blood flowing.
“If you’re cold, put on your Level 7s,” a sergeant screamed, referring to their heaviest jackets.
Captain Vo expected that his company’s lead element — about two dozen troops from its first platoon — would push across the frozen river and march about three miles through knee-deep snow with their tents and equipment.
Around 2 a.m. Captain Vo’s lieutenant and first sergeant quietly approached. The 10-day exercise had barely begun and some of the troops already looked miserable. The snowfall was growing heavier.
The lieutenant and first sergeant suggested that they modify the plan and cut the first platoon’s movement that night down to one mile.
Captain Vo’s normally upbeat demeanor shifted quickly to disgust. “I’m so sick of whiny infantrymen!” he yelled.
He was a relative newcomer to Alaska and still learning how to fight and survive in the extreme cold. His uncertainty about his new environment, though, was balanced against a powerful belief in “the human capacity to endure difficult things,” he said.
As a child, he had endured six years in a Malaysian refugee camp. Hundreds of displaced Vietnamese families, including his own, were packed into a space not much larger than a football field.
A chain-link fence surrounded the facility, with armed men at every gate.
Eventually, his family was granted political asylum and a new chance at life in the Atlanta suburbs, where they opened a nail salon.
Now, he was a 35-year-old Army officer who needed to get his infantry company motivated and moving.
“It’s Day 1 and you already sound like you’re tired,” he shouted. A string of profanities followed, along with a shared understanding that the first platoon soldiers were going to march the full three miles as planned through the snow before they broke for the night and set up their tents.
By 2:24 a.m. the soldiers had strapped their snowshoes to their boots. Bent under the weight of their 60-pound rucksacks, they made their way across the frozen river and disappeared into the darkness.
They arrived at their objective as the sun was rising and started digging out a clearing in the snow to put up their tents. After about 30 minutes of shoveling in search of solid permafrost, they realized that they were digging in frozen muskeg, a deep bog common in the Alaska wilderness.
Instead of looking for a better spot, they decided to temporarily lay out their sleeping bags in the open snow. They squeezed each other’s fingertips and earlobes, a regular check to ensure that blood was still flowing through their capillaries and they were not at risk for frostbite.
They boiled water, using portable gas heaters, and poured it into plastic bottles that they stuffed into their sleeping bags for extra warmth.
After a couple of hours in their cold bags, they resumed their search for solid ground. Captain Vo arrived just as they were scraping the permafrost and staking their tents.
“You look demoralized,” he told First Lt. Jordan Lofgren, the platoon leader.
“That was an ass kick,” replied Lieutenant Lofgren, 26. “Without some rest we can’t move the way we just did.”
The platoon had about six hours before they would have to head out again.
They climbed inside their dark, cramped tents. As the heat from small metal stoves spread, the soldiers sprang back to life. They talked about the parties they were going to throw when they got back to the base and the high cost of plane tickets home. They showed affection in the macabre ways of the infantry. Specialist Zooey Adams, a 20-year-old from Texas, told Lieutenant Lofgren that she had seen him running on post and debated hitting him with her car.
“Like a light nudge or a real hit?” he asked.
“In my mind, I’m taking you out, sir,” she replied.
Soon the only sounds in the tent were snoring and the occasional rustle of a soldier rising to do a shift as fireguard.
The Endless March
Senior leaders knew that their frontline troops cared about two things more than anything else. “They want to know when they are going to get warm, and they want to know when they are going to eat their next hot meal,” said Col. Christopher Brawley, who oversaw about 2,700 troops, including Captain Vo’s Able Company.
Colonel Brawley built his strategy around this harsh reality. If he could cut off the enemy’s access to food and fuel, Colonel Brawley believed that he could rapidly break their will to fight.
The Able Company troops were part of a big force moving to cut off the enemy’s northern supply routes. A smaller force, made up of several hundred Canadian soldiers, was pushing across more than 10 miles of heavy snow and muskeg — a multiday slog — to close off the harder-to-reach southern routes.
“The Canadians have a horrifying task,” Colonel Brawley said.
But they also had some advantages. They had three times as many snowmobiles as the U.S. battalions in the Arctic. Their soldiers were accustomed to operating in the extreme cold.
As the Canadians drove south, Captain Vo and his troops trudged toward their objectives in the north.
The days blurred together. The troops longed for the moment when they would sneak up on the enemy and test their soldier skills in a simulated firefight with lasers, smoke and the loud pop of blank rounds. But the actual gun battles were few and far between.
Most days they simply marched.
The lower the temperatures fell, the louder the snow crunched under their boots. “The worst sound you can hear,” Sgt. First Class Stephen Bowers said.
When the temperature plunged below minus 30, the soldiers said they could feel a cold ache in their lungs. Exposed skin prickled and turned red in a matter of seconds. At minus 40 and below, the soldiers retreated to their tents and shifted into survival mode. Sergeants had to force their reluctant troops to keep drinking water. No one wanted to leave their tent to pee.
On Day 5, heavy snows forced a six-hour pause so that the Army could plow the roads leading into and out of the training area. It was a relatively warm morning, with temperatures hovering around 10 degrees.
A dozen of the Able Company soldiers grabbed their weapons and strapped on their skis so they could practice being pulled by a snowmobile. The tactic, known as skijoring, was supposed to help them move faster while carrying a heavy load. But many of the troops were still wobbly on the snow.
The snowmobile made a big circle, pulling five soldiers who clung to a rope. On one of the passes, Specialist Zaurion Caldwell’s M240 machine-gun barrel caught in the snow, sending him flying and taking out several soldiers behind him. Everyone was laughing and smiling.
“Anyone wanna do it one more time?” the platoon sergeant asked.
“Yeah, me!” someone yelled.
The skijoring soldiers did another loop, hitting 22 miles per hour before letting go and gliding to a gentle stop.
“The Arctic is a hell of a place,” said Sgt. John Wolf, 26, of Selma, Ala.
An hour later, the pause was lifted. And with that, Able Company returned to the endless march.
A big question that hung over the entire Arctic training exercise, now in its fifth year, was whether the U.S. Army could really fight a war this way.
One problem was the warm tents, which stood out in the extreme cold and could be easily spotted by drones carrying thermal sensors. “They glow like Christmas trees,” said Sgt. Marcus Soto-Simmons, one of the Able Company drone operators.
A few days into the training center battle, Captain Vo launched a surveillance drone and, using its thermal sensor, quickly found an enemy platoon in its tents.
He then sent out a second killer drone carrying a mock explosive. The opposition soldiers heard its whirring engine as it sped toward them at 80 miles per hour and tried to scramble out of their tents to safety. But it was too late.
The judges overseeing the exercise concluded that Captain Vo had killed most of the enemy platoon. “What would happen if drones took out a string of American tents?” Captain Vo wondered. How would the American people react? How would he?
The Army had been using the same heavy canvas tents for decades. Senior Army leaders were looking for tent fabrics that radiated less heat.
The Army was realizing it needed more Arctic vehicles, like snowmobiles or big, tracked troop carriers. The Swedish-made machines cost $1 million each, carry a dozen soldiers and can move swiftly through deep snow.
The exercise also showed the value of Arctic expertise. The Canadians had weighed every piece of equipment that they brought to Alaska and meticulously planned how far their troops would be able to move each day. “The American technique is go, go, go until you can’t anymore,” Colonel Brawley said. The Canadian approach, he concluded, was more effective.
By the ninth day of the exercise, the American and Canadian troops under Colonel Brawley’s command had cut the opposition’s supply lines. They were running low on fuel. “You have the enemy in checkmate,” one of the Army officers overseeing the exercise texted him.
For the Able Company soldiers, though, the combat never felt as real as the cold.
A handful of soldiers were forced out of the exercise by cold weather injuries, twisted knees, broken ribs or wrenched backs. But the vast majority endured and were now taking turns digging out spots for their tents. Most preferred shoveling, which got their blood pumping and warmed their bodies, to standing around.
They struggled to hammer tent stakes into the permafrost. The smell of smoke, from metal pounding metal, hung in the air.
Two hours passed before they had raised the tent.
Specialist Abdul Mare, 25, who emigrated from the Ivory Coast, threaded the Yukon stove’s metal chimney through a hole in the canvas.
“I don’t like the cold,” he said. “But, here I am.”
Everyone was moving slower than normal. Everyone’s muscles ached. In the morning, they would head home and finally escape the cold.
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Here’s how medication abortion works with just one drug that’s still fully available
Misoprostol is typically used as part of a two-drug protocol for a medication abortion. But it is also safe and effective when used alone, doctors say.
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Misoprostol is typically used as part of a two-drug protocol for a medication abortion. But it is also safe and effective when used alone, doctors say.
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A version of this story was originally published on April 10, 2023. It has been updated to reflect news that mifepristone must be prescribed in person as of Friday, May 1, 2026.
On Friday, a panel of federal appeals court judges changed rules for a medicine called mifepristone. For more than two decades, mifepristone has been used with another drug, misoprostol, for most medication abortions in the U.S.

The Food and Drug Administration, under President Joe Biden, relaxed prescribing rules for mifepristone. That allowed doctors to prescribe the two-drug regimen over the phone or online. The medicines could be mailed or picked up at pharmacies and taken at home to end pregnancy up to 10 weeks of gestation.
Friday’s court order said that the FDA has to go back to its earlier in-person prescribing rules for mifepristone. The order immediately applies to the whole country.
The makers of mifepristone have appealed to the Supreme Court asking for a quick change back to the Biden-era rules, as the case continues. In an earlier case involving mifepristone, the high court did just that. Something similar may happen again — or not.
In the meantime, the standard two-drug medication regimen is still available for in-person patients in states that allow abortion. And telemedicine abortions may continue in those states using only the other drug, misoprostol.
Misoprostol has been on the market longer and was first approved to treat gastric ulcers. It is also used for IUD insertion and to treat hemorrhage.
Here’s what to know about how misoprostol-only abortions work, how safe they are and how patients may be able to access them.
How does the single-drug protocol differ from the standard of care which uses two drugs?
Most medication abortions in the U.S. have used both mifepristone and misoprostol because patients experience fewer side effects when the medications are combined. A regimen involving both medications is also used for miscarriages.
But misoprostol alone can be used effectively for abortions — and is commonly prescribed in some countries. A grassroots effort among women in Brazil, Argentina and other South American countries in the late 1980s and early 1990s spread word that the medicine originally on the market as an ulcer treatment could be used to end unwanted pregnancies.

“This regimen is still incredibly safe and effective,” says Dr. Kristyn Brandi, a New Jersey family planning specialist and spokesperson for the American College of Obstetricians and Gynecologists.
With the two-drug regimen, patients first take mifepristone — which blocks the hormone progesterone — to end the pregnancy. Patients then take misoprostol 24-48 hours later, which causes the uterus to expel the pregnancy tissue. Patients experience bleeding and cramping, and usually pass the pregnancy within 4-6 hours after taking the misoprostol.
In a misoprostol-alone abortion, patients start the process with misoprostol, using the same amount as is used in the two-drug regimen. Three hours later, they take misoprostol again, causing the uterus to contract. They repeat this for three to four doses until the pregnancy passes, which usually takes between 9-12 hours.
Is the misoprostol-alone regime safe? What can patients expect to experience?
There’s lots of research that shows the misoprostol-only protocol is as safe as the two-medication protocol – but it does tend to cause more side effects.
Even though the two-drug protocol is still preferred when possible, there’s ample evidence that misoprostol alone is a very effective alternative, according to the Society of Family Planning, an abortion research organization.
Multiple organizations, like the American College of Obstetricians and Gynecologists and the World Health Organization, say the one-medication protocol is an acceptable choice, particularly when mifepristone isn’t available.
Patients using misoprostol alone, however, tend to experience more nausea, vomiting, and diarrhea, and a longer duration of cramping and bleeding. That’s why it’s usually the second choice regimen.
The misoprostol-only protocol is actually faster than the two-medication protocol, which takes about 30 hours total since patients take the second drug at least 24-hours after the first. In the misoprostol-alone regimen, the process usually only takes 9-12 hours, but patients typically experience cramping and bleeding for longer.
When might a patient need to seek further medical help for a medication abortion?
With either regimen, the reasons to seek follow up care are the same.
If patients experience heavy or prolonged bleeding — spotting that persists for over 2 weeks, for example, or bleeding so heavy they soak through more than two pads an hour for over two hours — they might need a procedure to complete the abortion.
A prolonged fever above 100.4 degrees Fahrenheit is also a reason to seek medical care. While low-grade fevers and chills are an expected side effect of misoprostol and aren’t life threatening, if a fever persists for more than 24 hours after taking misoprostol, it could be a sign of infection.
Also, if a patient does not experience any bleeding or cramping, the medication may not have worked to end the pregnancy, and she might need more misoprostol or a procedure to have a complete abortion.
How far along into the pregnancy does medication abortion work?
The Food and Drug Administration has approved the two-drug regimen to end pregnancies up to 10 weeks gestational age; the World Health Organization endorses it up to 12 weeks. After that, they’re less likely to be effective and may cause more bleeding and cramping.
For misoprostol-only abortion, it’s less clear cut. There’s some data showing that the regimen can be effective in ending pregnancies up to 22 weeks. That’s according to one study that looked at patients having self-managed abortions, without the direct involvement of a doctor in countries that have had restrictive abortion laws.
But in U.S. states where second trimester abortion is allowed, Brandi says, doctors will typically recommend a procedural abortion in a hospital rather than a medication-based abortion to end pregnancies after 12 weeks. That’s because second trimester misoprostol-only abortions can involve more bleeding and prolonged cramping. Doctors would probably only recommend misoprostol-alone in the second trimester in states where patients don’t have other legal options.
How do patients get prescriptions for medication abortions? Would they be able to get them for the one-drug regimen?
In states where abortion is legal in the first trimester, patients can speak to a health care provider and get a prescription for medication abortion via telehealth abortion companies, in-person at clinics that provide abortion like Planned Parenthood, and at many general OB/GYN and family medicine clinics.
When mifepristone’s legality was in question before, many providers indicated they would start prescribing misoprostol alone.
Dr. Jamie Phifer, the medical director of Abortion on Demand, said at that time that her team would continue to provide mifepristone and misoprostol combination abortions to their patients unless it becomes illegal.
“But we’re ready,” she added. “We can make the switch [to misoprostol-only protocols] within hours.”
In fact, misoprostol is easier to access than mifepristone because of its additional uses, so it’s stocked in almost all pharmacies and hospitals.
Are patients able to get the medication in states where abortion is banned?
Patients in states that have banned or heavily restricted abortion have been able to access telehealth medication abortion, and this is at the heart of the case Louisiana brought against the FDA.
No medication abortions are available legally in states that have banned abortion. But some organizations have been helping women in those states access pills. Abortionfinder.org keeps an up-to-date list of services that help people access abortion, and includes state-by-state legal information.
The Miscarriage and Abortion Hotline offers free consultations with clinicians if a patient has follow-up questions about a medication abortion, even if she had the abortion in a state where it’s illegal.
Some organizations have flouted the law openly to provide abortion medications in all 50 states.
Aid Access, for example, is based in the Netherlands and will mail mifepristone and misoprostol to patients in states where abortion is banned. Pills sent from abroad are not subject to FDA approval and safety regulations.
Mara Gordon is a family physician in Camden, New Jersey, and NPR’s Real Talk With A Doc columnist. She’s on Instagram at @MaraGordonMD.
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