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Abortion? What You Need to Know About Abortion Pills

 


As legislatures across the United States impose greater restrictions on abortion care, more

people are choosing medication abortion. 

This method involves taking pills that can end a pregnancy, often without requiring an office visit or an appointment with a provider.

Medication abortion is safe and effective, and it’s been used around the world for decades.

Although Americans lost the constitutional right to abortion with the overturning of Roe v. Wade in June 2022, Attorney General Merrick Garland has since said that states can’t ban abortion pills that are approved by the Food and Drug Administration (FDA).

However, there are still plenty of misconceptions surrounding medical abortion’s legality and use, and misinformation can make it difficult to understand and access this care.

Medication abortion involves taking pills that terminate a pregnancy. A person usually takes one medication called mifepristone followed by another medication called misoprostol.

These medications stop the pregnancy from continuing to develop and cause the uterus to empty itself, ending the pregnancy.

You can access abortion pills by visiting a provider’s office or provider-staffed telehealth platform (known as a “clinician-supported” abortion) or by ordering them online and taking them at home (called a “self-managed” abortion), depending on where you live.

Medication abortion is common around the world

Medication abortion became legally available in the United States in 2000, when the FDA approved it to induce abortion early in a pregnancy.

Abortion pills are FDA-approved for ending a pregnancy up to 10 weeks, but they’re also used off-label later than this in some states.

Medication abortion has become more commonTrusted Sourceamong Americans in recent years, especially since the onset of the COVID-19 pandemicTrusted Source and the increased availability of abortion pills through telemedicine.

In fact, more than half of abortions in the United States and many European countries are medication abortions.

Abortion pills are also increasingly popular in GhanaTrusted Source, where 28–46% of abortions were medication abortions, and in IndiaTrusted Source, where up to 73% of abortions were medication abortions. 

In some countries within Latin America, people have had legal access to misoprostol to self-manage their abortions since the early 1980sTrusted Source.

Abortion pills expandTrusted Source safe abortion access, allow people more privacy and autonomy when managing their own abortions, and reduceTrusted Sourcematernal mortality — when people have reliable access to them and credible information about their use.

Is medication abortion different from emergency contraception like Plan B?

Yes, medication abortion is different from emergency contraception like Plan B One-Step and ella, known as “morning-after pills.”

Emergency contraception pills are taken within 3 to 5 days after having unprotected penis-in-vagina sex. These medications help prevent a pregnancy before it begins — they don’t end an existing pregnancy.

Medication abortion, on the other hand, ends a pregnancy.

Most medication abortions involve taking two different medications: mifepristone followed by misoprostol. However, you can also complete a medication abortion by using misoprostol on its own.

Mifepristone stops a pregnancy from growing, and misoprostol causes the uterus to shed its lining and empty itself.

Mifepristone

Mifepristone bindsTrusted Source to the body’s progesterone receptors, but the body doesn’t read it as progesterone. That means it affects the body like an antiprogestin, which blocks the body from making or using progesterone properly.

Since progesterone helps the uterus grow and sustain a pregnancy, stopping progesterone’s activity can help end a pregnancy.

Mifepristone can also soften the uterus and encourage it to contract.

Misoprostol

Misoprostol softens the cervix, too. The combination of the uterus and cervix softening, the antiprogestin activity, and the uterine contractions cause your body to expel the embryonic tissue, ending the pregnancy.

The abortion itself may feel like a very heavy period with cramping and bleeding. You may also pass large blood clots.

The process is usually complete within 4–5 hours of taking the second medication, but some milder cramping and bleeding or spotting may continue for 1–2 days or up to a few weeks.

If someone doesn’t have access to mifepristone, misoprostol can be used on its own to induce an abortion, though it may be less effective than the combination of both pills.

Medication abortion is a highly effective way to end a pregnancy. However, medication abortion becomes less effective the longer someone has been pregnant. Effectiveness appears to start waning after 12 weeks.

Rarely, if medication abortion isn’t completely effective, some pregnancy tissue will remain in the body. This is known as an “incomplete abortion.”

People who experience an incomplete abortion may need another dose of misoprostol or surgical intervention to complete the process.

Combination of mifepristone and misoprostol

ResearchTrusted Source shows that medication abortion using both mifepristone and misoprostol at 12 weeks or less of gestation completely ends pregnancy 95–99% of the time.

SeveralTrusted Source more recent studiesTrusted Source have come to the same conclusions.

If you’ve been pregnant for 9 weeks or fewer, self-managing an abortion using both pills is no less effectiveTrusted Source than a clinician-supported abortion.

Very few people reportTrusted Source adverse effects.

Misoprostol-only 

Misoprostol alone is effective, and people who can’t obtain mifepristone can take misoprostol on its own to end their pregnancy.

One large reviewTrusted Source analyzed 42 studies, totaling more than 12,800 people who only took misoprostol, and found that about 78% of those people had complete abortions.

Another review also reported a success rate of around 80%.

On the other hand, a smaller studyTrusted Source found that people who took misoprostol alone were actually more likely to report having a completed abortion than people who took both misoprostol and mifepristone.

Medication abortion is considered very safe. It’s estimated that only 2%Trusted Source of medication abortions result in complications, and most of those are minor.

One large studyTrusted Source including more than 13,000 women who had medication abortions over a five-year period found that only 6 women required hospitalization for any abortion-related reason.

Self-managed abortions with pills accessed via telemedicine aren’t associated withTrusted Source higher risks of complications compared with pills accessed in-office, according Trusted Sourceto several studiesTrusted Source.

Plus, most people reportTrusted Source feeling satisfied with their experience.

Potential risks and complications 

Serious complications of medication abortion are rare. It’s typical to experience pain, bleeding, low fever, and gastrointestinal upset for a few days following your abortion — especially during the first 24 hours.

The most common complicationTrusted Source is excessive bleeding that lasts a long time.

Other risks, though uncommon, may include:

  • incomplete abortion
  • blood clots in the uterus
  • infection
  • fever
  • diarrhea and digestive pain
  • allergic reactions to the medications

Some incomplete abortions can be treated with another dose of misoprostol. Others may require surgical intervention.

Reach out to a healthcare professional or seek emergency care if you:

  • experience no bleeding at all within 24 hours of taking misoprostol
  • have extremely heavy bleeding (soaking through more than 2 regular maxi pads in an hour) for 2 or more hours in a row
  • pass blood clots the size of, or larger than, a lemon for more than 2 hours
  • experience other side effects like fever, nausea, vomiting, or diarrhea for more than a day after taking misoprostol 

Seek care

If you experience complications and are in an abortion-hostile state, you should still seek medical care.

Healthcare professionals can’t distinguish a medication abortion from a miscarriage, and you don’t have to disclose that you induced the abortion using pills. 

You can say that you’re experiencing heavy menstrual bleeding or suspect that you’re having a miscarriage. These conditions are treated the same way.

Are abortion pills ordered online safe?

Some people may be uncomfortable with the idea of ordering mifepristone and misoprostol online without a physician’s prescription.

Depending on where you live, a physician or abortion provider may be able to prescribe you the medication, and you can take your medication in their office. However, pills ordered online appear just as safe as those administered in person.

One United States-based studyTrusted Source analyzed the pills sent from 16 websites that provide medication abortion. The websites all mailed safe, legitimate medicines as advertised, and the pills usually arrived in a timely manner.

Learn more about safely self-managing a medication abortion at home.

Prioritize your privacy

There are legal risks to self-managed at-home medication abortion. Some states restrict access to telehealth abortion or receiving abortion pills by mail.

This means discretion and privacy are absolutely paramount.

If at all possible, tell as few people as you deem necessary about your pregnancy and your decision to terminate the pregnancy.

Clear any internet search, private message, or phone call history that might connect this to you.

Trying to make sense of the limitations in your state? Our state-by-state guide to abortion restrictions can help.

To learn more about your legal rights, you can message the ReproLegal Helpline via a secure online form or call (844) 868-2812.

Are there mental health concerns surrounding abortion?

Abortion is not associated with poorer mental health. People who have had abortions are no more likelyTrusted Source to experience mental health conditions than people who have not had abortions.

Research shows that the vast majority of people do not regret their abortions. Many people experience relief, joy, and a greater sense of autonomy after accessing an abortion.

A recent study including 667 people who had abortions found that while more than half had a hard time deciding whether abortion was right for them, 97.5% said that having an abortion was the right choice one week later.

Five years later, study participants were even more likely to say that getting an abortion was right for them, at 99%.

It appears that, for many participants, the toughest part of getting an abortion was the stigma or judgment they received from others — not an inherent sense of regret or sadness.

There are studies that link abortion to mental health conditions. However, according to the American Psychological Association (APA), many of these are flawed in design.

Often, they don’t account for participants’ existing mental health conditions prior to getting abortions. The studies attribute the development of the conditions to abortions themselves, even though participants had the conditions beforehand.

The APA affirms that the ability to access safe, legal abortion actually supports mental health and well-being.

That doesn’t mean it’s unusual to feel a complex set of emotions after having an abortion. 

One week after their abortions, 17% of the aforementioned study participants reported feeling mostly negative emotions, while 12% reported a mix of negative and positive emotions. 

However, negative feelings decreased significantly within 1–3 years post-abortion.

Find support

Feel empowered to speak with an abortion-informed mental health professional or consider joining a support group if you need help navigating your feelings after having an abortion.

Other resources that can help include Exhale and All-Options, which can connect you with unbiased, nonjudgmental post-abortion emotional support.

Most people who are up to 12 weeks pregnant are eligible to end a pregnancy using pills. However, medication abortion may be unsafe for people with certain health conditions. 

This includes:

  • an ectopic pregnancy (a non-viable pregnancy that is attempting to develop outside of the uterus)
  • blood clotting disorders or anemia
  • chronic adrenal failure
  • long-term use of steroid medicines
  • inherited porphyrias (rare blood disorders)
  • intolerance or allergy to mifepristone or misoprostol

You also shouldn’t use abortion pills if you have an intrauterine device. You’ll need to have it removed before taking the pills.

People with these conditions still have options for terminating their pregnancies. It’s a good idea to speak with a qualified abortion provider or another abortion-informed healthcare professional to discuss your next steps.

If you’re experiencing symptoms of an ectopic pregnancy, you should seek immediate medical attention. 

Many states restrict abortion access, including abortion pills. That means the way you access this care might depend on where you live.

Some limitations on legal medication abortion include:

  • medication abortion providers have to be physicians (32 states)
  • medication abortion can’t be used past a certain point in pregnancy (2 states)
  • people must take abortion pills in the presence of a physician, meaning telemedicine can’t be used (19 states)

In some states, people can’t legally access any kind of abortion after they’ve been pregnant for a certain number of weeks.

The language and ever-changing nature of abortion access can be confusing. That’s especially true now that the Supreme Court has overturned Roe v. Wade, the case that upheld the right to legal abortion in the United States. 

The landscape of abortion rights has already shifted dramatically and is expected to continue. However, medication abortion is still legal, and you can order pills online.

Here’s what you need to know about telemedicine abortion in a post-Roe United States.

In the meantime, resources for accessing medication abortion by mail include:

You can visit in-person abortion providers in your area as well, whether you’re seeking a surgical or medication abortion.

Resources like the National Abortion Federation’s U.S. Abortion Clinic Locator and Planned Parenthood’s Health Center database can help you find providers.

The National Abortion Federation also operates a hotline that can help you find an abortion provider or financial support for your abortion.

Watch out for crisis pregnancy centers (CPCs)

While some CPCs offer limited healthcare services like pregnancy tests or ultrasounds, they do not provide abortions or support accessing abortions.

CPC workers are known to shame and mislead people into believing that abortion is unsafe or harmful.

The Crisis Pregnancy Center Map can help you steer clear of these predatory groups. You can also check ReproAction’s Fake Clinic Database and the #ExposeFakeClinics resource hub.

Learn more about identifying, avoiding, and leaving CPCs.

Medication abortion can be expensive, but financial assistance is available.

One studyTrusted Source found that the average price of mifepristone and misoprostol ranged from $110–$360, including shipping and fees. The cost of misoprostol alone was lower.

According to Planned Parenthood, abortion pills can cost up to $750 — though it varies by state.

Does insurance cover medication abortion?

Some health insurance plans will cover some or all of the cost of medication abortion, though some government health insurance plans only cover abortions in certain states or if you’re seeking an abortion for specific reasons.

That means it may be a good idea to contact an abortion provider ahead of time if you’re unsure about your coverage.

Can abortion funds pay for a medication abortion?

Abortion funds are organizations that help people pay for abortion care. They can help you find abortion providers and arrange appointments, too.

Many abortion funds also offer financial assistance for logistical concerns associated with abortion, like transportation, lodging, child care, and medication.

After an abortion, it’s best to take a day or two off work, school, or other activities if possible.

You may experience painful cramping and bleeding, as well as nausea and diarrhea or vomiting.

It’s best to avoid heavy lifting or intense exercise for at least a week after an abortion.

Instead, try to rest, and consider taking warm baths or using a heating pad on your abdomen to help relieve any pain.

You may not need to visit an abortion provider for a follow-up appointment, but you may want to if you have any questions or concerns. 

It might be a good idea to take a pregnancy test or receive an ultrasound to confirm that the abortion is complete.

The most important thing to know right now? That you have options. Whoever you are and wherever you live, you can end your pregnancy if you want or need to.

Medication abortion is one way to end a pregnancy, and studies show that it is extremely safe and effective.

If you choose to pursue medication abortion, you can either do it with the support of a clinician or manage it on your own.

You can receive prescribed medication from an abortion provider or access pills yourself online. Remember, self-managed abortions do not appear to be less effective or less safe than clinician-supported abortions.

Be sure that you understand the laws and restrictions in your state, and prioritize your privacy when navigating abortion care, whether clinician-supported or self-managed.

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