that prohibit providers from examining the patient via phone or video conferencing, and instead require the patient to make an in-person visit to the provider to get the prescription. In most states, abortion drugs may be sent from a pharmacy to the patient via mail, but certain states have passed laws making that illegal, and requiring the drugs to be obtained from a pharmacy or provider in-person. Interest in abortion medications in the United States reached record highs in 2022, after the Supreme Court of the United States draft Dobbs v. Jackson Women's Health Organization ruling that would overturn Roe v. Wade was leaked online. Interest was higher in states with more restrictions on access to abortion. Pro-choice activists in the U.S. were exploring ways to make medical abortion more available, particularly in states where it is subject to limitations, with social media resources being utilized for this purpose. Contraindications Contraindications to mifepristone are inherited porphyria, chronic adrenal failure, and ectopic pregnancy. Some consider an intrauterine device in place to be a contraindication as well. A previous allergic reaction to mifepristone or misoprostol is also a contraindication. Many studies excluded women with severe medical problems such as heart and liver disease or severe anemia. Caution is required in a range of circumstances including: long-term corticosteroid use; bleeding disorder; severe anemia In some cases, it may be appropriate to refer people with preexisting medical conditions to a hospital-based abortion provider. Adverse effects Most women will have cramping and bleeding heavier than a menstrual period. Other adverse effects include nausea, vomiting, fever, chills, diarrhea, and headache. Misoprostol taken vaginally tends to have fewer gastrointestinal side effects. Nonsteroidal antiinflammatory medications such as ibuprofen reduce pain with medication abortion. Complications Symptoms that require immediate medical attention: Heavy bleeding (enough blood to soak through four sanitary pads in 2 hours) Abdominal pain, nausea, vomiting, diarrhea, fever for more than 24 hours after taking mifepristone Fever of or higher for more than 4 hours Complications under 10 weeks' pregnancy are rare; according to two large reviews, bleeding requiring a blood transfusion occurred in 0.03–0.6% of women and serious infection in 0.01–0.5%. Because infection is rare after medication abortion, the American College of Obstetricians and Gynecologists, The Society of Family Planning, and the NAF do not recommend use of routine antibiotics. A few rare cases of deaths from clostridial toxic shock syndrome have occurred following medical abortions.