Demand for the abortion pill may increase as news unfolds about the future of abortion in the United States — multiple outlets confirmed the authenticity of a leaked draft of a forthcoming U.S. Supreme Court opinion that appears to overturn the legal precedence set in Roe v. Wade. Demand for the prescription but self-administered abortion pill first peaked in early 2021 after legislators effectively banned abortions in Texas, leading some to consider this non-invasive treatment in places where clinics may be hard to reach — or where abortions have become dangerous to attain.
As of this writing, people are Constitutionally protected to have an abortion. But given the leaked draft majority opinion by conservative Justice Samuel Alito, Americans are wondering if the forthcoming Supreme Court ruling will uphold a controversial Mississippi law that bans abortion after 15 weeks. If so, that would either dramatically weaken or overrule the Federal abortion rights outlined in Roe v. Wade, which gives the right to seek an abortion up to 24 weeks of pregnancy.
The question would then be up to individual state legislatures to decide; 24 states are likely to take action to prohibit abortion outright, and 11 have “triggers laws” that go into effect the moment the Mississippi law is ruled upon, according to the Center for Reproductive Rights (the official ruling is expected in June). Ultimately, the forthcoming decision from the Supreme Court will indicate if individual states can determine when and how abortions take place — and if they’re available at all. They will also decide whether any restrictions include medication abortions; Republican states have reportedly already been moving against access to the pills.
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With all of this going on, understanding what safe and effective abortion care looks like continues to be important, and this includes “the abortion pill,” or medication abortion. Medication abortions have been around for two decades, in which pills are prescribed and dispensed by in-person or telemedicine providers for patients to take at home. They now account for about 40% of abortions in the U.S. In December 2021, the U.S. government made permanent its COVID-era rule change that allows a pregnant person to obtain the drugs by mail, in states where this is legal.
But many Americans still may not know what an abortion pill is, or if it’s even available to them should they need it. “To many patients, the ability to self-administer the pills in the comfort and privacy of their homes is appealing,” says Nisha Verma, M.D., a complex family planning specialist and Darney-Landy Fellow at the American College of Obstetricians and Gynecologists. Though medication-based abortion is common and safe, others prefer having the procedure performed by a clinician. “That’s why it’s important for patients to be able to choose the option that is best for their lives, bodies and needs,” she says.
“Medication abortions are extremely effective and extremely safe, and they could potentially solve really important abortion access issues in the country,” adds Lisa Harris, M.D., an obstetrician-gynecologist at the University of Michigan Health. Abortion laws vary across the country, and about half of those seeking to end a pregnancy live below the poverty line — and millions of people live in an area without an abortion clinic. Abortion pills are a readily available and relatively low-cost option.
Editor’s Note 05/03/2022: While a medication-based abortion may be a safe alternative for those unable to receive treatment at a clinic, it needs to be prescribed by a certified healthcare provider. Patients are advised to discuss what to expect with their doctors.
We’ll continue to update this story with new information as it becomes available, with deference to official announcements shared by the U.S. Supreme Court.
What exactly is the “abortion pill”?
The abortion pill is actually a combination of two medications — mifepristone and misoprostol — that are used to end a pregnancy. Mifepristone is an anti-progesterone medication that’s taken first to stop the pregnancy from progressing. Misoprostol, which is taken second, causes the pregnancy to pass, Dr. Verma explains. The drugs have other uses as well — mifepristone is also used to help manage a miscarriage, and misoprostol is sometimes used to induce labor and to treat ulcers.
The medications were approved by the U.S. Food and Drug Administration in 2000 for use up to 10 weeks of pregnancy, but since studies show they can be safely used for up to 11 weeks, she says some providers use that timeframe as the cutoff. But, not all states allow the medication to be used past 10 weeks.
Misoprostol can actually be used alone to terminate a pregnancy, but the combo of both medications is the most effective method. “It’s more likely to cause complete passage of the pregnancy compared to using misoprostol alone,” Dr. Verma explains. When you take both pills, medication abortion is 95% effective, and it’s completely safe.
How does an abortion pill actually work?
Mifepristone is an anti-progesterone medication. Known as the “pregnancy hormone,” progesterone is produced naturally when a person is pregnant; it helps prepare the uterus to maintain a fertilized egg, and helps the fetus develop. Taking mifepristone blocks the hormone entirely. “It basically works to help stop the tissue growth of the pregnancy as well as soften the cervix,” says Rajita Patil, M.D., assistant clinical professor of obstetrics and gynecology at the University of California, Los Angeles. The dose comes in a 200 mg pill that you swallow, and it causes the lining of the uterus to break down so that it can more easily empty after taking the second medication.
Since a medication-based abortion requires more than one pill alone, about 24 to 48 hours after taking mifepristone, the patient then takes misoprostol. This portion of the process entails four 200 microgram tablets (around 800 micrograms total) which you dissolve in your cheek or use vaginally, Dr. Patil explains.
Misoprostol causes contractions in the uterus, and patients experience bleeding, cramping and passing blood clots that resemble a heavy period, and then the pregnancy tissue is expelled. Dr. Harris says the symptoms typically progress over about four hours before the pregnancy passes — then, the bleeding will slow and cramping will subside.
Are abortion pills the same as Plan B?
Abortion medication is not the same as the emergency contraception Plan B, and Dr. Harris adds that’s often a source of confusion.
Also known as the morning-after pill, Plan B is a progesterone medication that delays ovulation to help prevent a pregnancy in the first place. It should be taken as soon as possible after unprotected sex, but definitely within five days, which is how long sperm can live inside the body. “Plan B can’t disrupt an existing pregnancy,” Dr. Harris emphasizes.
Where is the abortion pill available?
Currently, abortion is legal in all 50 states. But how easy it is to access the pills for medication abortion is dependent on location, as abortion laws and restrictions vary across the country.
Mifepristone and misoprostol are available by prescription only, and only by a health care provider who’s been approved to prescribe it, Dr. Patil says. A pharmacy that fills the prescription must likewise be certified, according to the new rule changes. Patients must also sign an agreement to receive it.
During the COVID-19 pandemic, the FDA temporarily lifted the in-person requirement, and these rules have now been made permanent. This has broadened access to abortion pills via telemedicine, such as with the providers’ Abortion on Demand or AidAccess. Through telehealth, patients are screened and then approved for the medication, usually without the need for an ultrasound or physical exam, Dr. Patil adds. “This allows pregnant people to meet with a clinician remotely and acquire the pills through mail-order pharmacy,” Dr. Verma explains.
Still, some states have laws that place additional barriers on accessing abortion pills, including maintaining the in-person dispensing requirement. “So patients in those states continue to face burdens in accessing medication abortion,” Dr. Verma adds. Research shows that self-managed medication abortion, including in remote settings like telemedicine, is just as safe, effective and has the same outcomes as in-clinic care. Studies show that while rates of adverse effects were low, women are able to self-identify any serious symptoms and seek medical attention.
How much do abortion pills cost?
A medication abortion can cost anywhere from $40 to $600, but costs and insurance coverage vary depending on location and plan, according to the National Women’s Health Network. Insurance plans aren’t required to cover it, but many do; local Planned Parenthood health centers usually have information about any funds that are available to cover the cost. The National Network of Abortion Funds also has a state-by-state list of organizations that can help pay for abortions.
Are there any side effects with taking the abortion pill?
Medication abortion is safe, with an efficacy rate of about 95%. The chance of a serious complication that required hospitalization was less than 1%, according to research published in the journal Contraception.
Bleeding and cramping is normal in medication abortions. But Dr. Verma clarifies that some women may experience slightly more severe symptoms: “A medication abortion can cause vaginal bleeding that is heavier than a menstrual period and that may be similar to a miscarriage.” Some people experience severe cramps, nausea, vomiting, fever or chills, but, says Dr. Verma, these side effects are temporary and some can be treated with over-the-counter medications, including ibuprofen. A doctor should be consulted if a patient has any concerns.
Dr. Patil adds that taking the abortion pill brings no risk to future pregnancies or long-term fertility, which is something patients often ask her. “It does not mean that they can’t have children when they’re ready, so that’s important for patients to know,” she says.
Should you visit your doctor after taking abortion pills?
A week or two after a medication abortion, it’s a good idea to follow up with a health care provider, either in person or via telemedicine, to make sure the abortion is complete and that the pregnancy has been ended, Dr. Patil says. That can be done by discussing symptoms, a blood or urine pregnancy test or ultrasound.
How to find local resources:
State abortion laws and regulations can be tough to navigate. Dr. Patil recommends that people seeking to end a pregnancy first check with an OB-GYN. Doctors will know what’s allowed in your area and can refer to a provider if they don’t provide medication abortions themselves. A local Planned Parenthood center would also have information.
Several online resources exist, too. Plan C has searchable information about medication abortion by state and AbortionFinder.org offers details about both abortion pills and procedures. The National Abortion Federation Hotline (1-800-772-9100) provides free referrals and information. Finally, the Guttmacher Institute, a sexual and reproductive health research and policy organization, tracks state abortion laws and pending legislation.
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