Doctors across Texas are helping their patients navigate reproductive health options after Roe v. Wade was overturned earlier this month. Abortions are now essentially banned in Texas, except in cases where the pregnancy could kill or physically injure the person pregnant.
Stephanie Mischell is a family physician in Dallas. The clinic she works at is no longer able to provide abortion services, so she’s spending her time connecting people to resources.
“There's just, unfortunately, so much misinformation when it comes to not just abortion, but to reproductive health in general,” said Mischell, who also is a fellow with Physicians for Reproductive Health, a national advocacy organization.
One thing she’s noticed is that people are not certain of the difference between emergency contraception, like Plan B and IUDs, and abortion medication.
Emergency contraception doesn’t cause abortions
Mischell says while emergency contraception is part of the spectrum of resources for people who can become pregnant, “it's a really separate category than abortion care.”
Emergency contraception can be used up to five days after after sexual activity to prevent pregnancy, she said. Medicines like Plan B, which is available at pharmacies, and Ella, which is a prescription pill, work by preventing ovulation.
“The egg never gets released from the ovary and can't meet the sperm and get implanted in the uterus to become a pregnancy,” Mischell said. “Once the egg and sperm meet and are sitting in the uterus, that pregnancy is growing, those pills will not have an impact on that growing pregnancy.”
IUDs work a little differently, she said. IUDs are commonly small, t-shaped, flexible plastic devices inserted into the uterus, preventing ovulation or preventing sperm from reaching an egg. IUDs can be hormonal or non-hormonal, and can last up to 10 years.
Abortion medication stops a growing pregnancy
Abortion medication, on the other hand, is a series of pills that blocks hormones from reaching the pregnancy, and then causes the uterus to pass the pregnancy tissue. Mischell isn’t allowed to offer abortion medication to patients because of Texas law after Roe v. Wade.
“When patients show up in my office, most of the interaction is apologies for the fact that even though I know they could take [abortion medication] safely, that I know it's a good option for them, this is just not something that we're able to provide,” she said.
Medical abortion “plays a crucial role in providing access to safe, effective and acceptable abortion care,” according to the World Health Organization (WHO). Mischell said that the pills often cause cramping and bleeding for patients initially, and then spotting or bleeding for the weeks that follow.
“When I talk to patients, I advise them to pick the type of abortion, whether it's medication or procedural, that feels most comfortable to them,” she said. “From a safety perspective, they're both good options.”
Confusion, emergency contraception and politics
She believes the confusion around emergency contraceptives and abortion medication isn’t a “medical conflation, it’s a political conflation.”
“I think this is the result of people making decisions about health care that are speaking not from a place of medical knowledge, but really from a place of power, control and shaming people who can become pregnant,” Mischell said. “Emergency contraception is not abortion. And abortion bans should not apply to emergency contraception.”
She’s concerned that Roe v. Wade being overturned might impact people’s ability to access reproductive healthcare, including emergency contraceptives and birth control. Her work already looks completely different than it did a few weeks ago.
“It's just so hard to see so many people who want this care, and have to tell them no,” Mischell said. “Instead, you are now stuck making these incredibly, incredibly hard choices about how to handle a pregnancy. It’s just completely heartbreaking and unfair.”
Where somebody lives can have a huge impact on what kind of healthcare they can access. Mischell said that’s mind-boggling.
“It's just a dramatic inequality and a real disservice to the people of Texas,” Mischell said.