When many people picture abortion, they picture surgery ― or, in gruesome cases of a pre-Roe country, coat hangers and other devices turned to in desperation. But the most common way to end a pregnancy now is with medication. It’s safe, effective and, in some states, can be accessed from the comfort of your couch.
But with more awareness of the benefits of medication abortion, comes more attacks from anti-choice lawmakers and advocates. In recent months, Texas, Louisiana, Arizona and several other states banned telehealth for medication abortion, also referred to as abortion pills. And that was before the leaked Supreme Court draft opinion that revealed the high court is poised to overturn Roe v. Wade, the decision that expanded access to abortion nationwide.
With the looming Supreme Court decision just weeks away, many abortion advocates and opponents are preparing for a post-Roe world. And everyone’s eyes are on medication abortion.
HuffPost has answered some basic questions on medication abortion including what it is, how it’s used and the future of abortion pills as the country barrels toward a post-Roe reality.
What is medication abortion?
Medication abortion, also known as abortion pills, is the use of two different drugs — in combination or alone — that induce abortion: mifepristone and misoprostol. A person can use misoprostol or a combination of mifepristone and misoprostol to induce abortion.
The U.S. Food and Drug Administration (FDA) first approved the combination of mifepristone and misoprostol as medication abortion in 2000. Both mifepristone and misoprostol are on the World Health Organization’s list of essential medicines.
The mifepristone and misoprostol combination is widely used for miscarriage and abortion care — accounting for about 60% of all abortions in the U.S. Medication abortion is generally supplied in-clinic, although in some states it is available through online pharmacies, and can be used through the first 10 weeks of pregnancy. If someone is past 10 weeks, they can still get a surgical abortion.
How is it used?
Most clinics around the country offer a combination of mifepristone and misoprostol to induce abortion. One mifepristone pill followed 24 hours later by four misoprostol pills — placed between the gums and cheeks with two on each side — will lead to cramping and bleeding that will empty the uterus.
Misoprostol alone can also be used to induce an abortion, although it is not used in the in-clinic setting because it’s not approved by the FDA. This method is often used in countries abroad or when people are forced to self-manage their own abortions at home. The misoprostol-only method is less effective than the mifepristone and misoprostol combination method. Twelve misoprostol tablets — four tablets dissolved under the tongue every three hours over the course of nine hours — will induce an abortion and lead to similar cramping and bleeding that will end a pregnancy.
Many people liken the feeling to heavy period cramps, although the medication affects everyone differently. The results are very similar to an early miscarriage.
Is it safe and effective?
When used together, mifepristone and misoprostol are more than 95% effective and safer than Tylenol. Misoprostol used alone is also extremely safe, but less effective: somewhere between 80-85% effective.
Is it legal?
Medication abortion is legal, and is commonly prescribed by abortion clinics and certified providers around the country.
Some states allow patients to get prescriptions for medication abortion via telehealth. Others require patients to go to clinics in person. Telehealth abortion is illegal in some states like Texas, South Carolina and Florida, which means that American doctors are not legally allowed to prescribe medication abortion by mail or telehealth in those states.
GOP lawmakers have tried to restrict medication abortion by implementing laws that ban pills from being shipped or prescribed in the U.S. But, by purchasing abortion pills from overseas pharmacies like Aid Access, people can circumvent U.S. laws.
Is medication abortion the same thing as Plan B?
No. Medication abortion is a substance that induces an abortion when a person is pregnant, while Plan B is an emergency contraceptive, often referred to as the morning-after pill.
Plan B can be taken up to 72 hours, or three days, after unprotected sex to prevent pregnancy. Plan B is more effective the sooner it’s taken, and it’s less effective if a woman is over 155 pounds. Other emergency contraceptives, such as Ella, are more effective: Ella can be taken up to 120 hours, or five days, after sex and it’s most effective on women under 195 pounds.
Discussion of medication abortion has led to confusion over Plan B. Earlier this week, people on Twitter were up in arms after it was incorrectly reported that Tennessee banned emergency contraceptives like the morning-after pill or Plan B. In reality, the Tennessee governor had actually restricted medication abortion.
Where can you get abortion pills?
Abortion pills are available at abortion clinics and certain hospitals and physician’s offices around the country.
Despite the widespread use and safety of abortion pills, the FDA has restricted one of the two drugs used in medication abortion, mifepristone, for decades up until very recently. For years, the FDA required that mifepristone needed to be dispensed in person and that patients could not obtain it from a pharmacy ― a sharp departure from how people get most other medications.
But in April of last year, the FDA announced it would temporarily lift the in-person dispensing requirement as part of broader efforts to limit face-to-face interactions to curb the spread of COVID-19. The Biden administration announced that the FDA would review the restrictions on mifepristone, and by December the FDA decided that it will no longer require in-person dispensing of the drug.
This means that most people seeking abortions before 10 weeks are able to get abortion pills mailed to them from online or certified pharmacies after a telehealth visit with a provider.
“Abortion pills take all the politics and stigma out of the experience for the patient. Right now, when you’re going into an abortion clinic you are targeted by anti-abortion protesters, you’re shamed and stigmatized,” Elisa Wells, co-founder & co-director of Plan C, an advocacy organization that provides people with information on how to obtain abortion pills, told HuffPost in December. “If you’re sitting in your house, on your computer or phone, and then you go to your mailbox, it’s nobody’s business what you’re doing.”
In the states where telehealth is allowed, abortion medication is available via organizations like Abortion On Demand and Hey Jane — services that popped up in the past year or so during COVID. The services are fully compliant with all of the rules, regulations and medical protocols created by the FDA. They offer pills through an online or video consultation and then the organizations mail them directly to a person’s home.
But other states ban the use of telehealth for abortion care. In those states, there’s still access to abortion pills by mail, but it’s through “alternate mechanisms, not mainstream health systems,” said Wells.
Some of these “alternate mechanisms” include organizations like Aid Access, an international nonprofit organization that ships abortion medication to all 50 states in the U.S. Aid Access also offers advanced provision, meaning patients can order medication abortion to be stored in their medicine cabinets and kept in advance of an unintended pregnancy. Generally, mifepristone has a shelf life of about five years, and misoprostol around two years.
Online pharmacies such as Hey Jane usually have a delivery time of one to five days, depending on the state the medication is being shipped. Because Aid Access is international, the delivery time can be longer depending on the state. For example, in California it takes around two to three days to receive medication abortion from Aid Access, but in Texas or South Carolina — states that restrict access to abortion telehealth — shipping can take anywhere from 14 to 21 days.
Plan C, an organization that helps patients navigate the different restrictions on telemedicine for abortion, has more information on legal parameters in each state.
How much do abortion pills cost?
Medication abortion can cost anywhere from $40 to $600 or more, depending on which drugs are purchased, where they are purchased and if a person’s insurance covers the medication.
In-clinic costs average around $600, but that can vary depending on the state and it does not include money for travel, lodging and other logistical costs. Telemedicine services can cost up to $750 depending on if they require bloodwork or additional tests before prescribing medication abortion.
Online pharmacies, like Hey Jane and Abortion on Demand, range from $150 to $600. Aid Access ranges between $100 and $150. The misoprostol-only method can also be found online or in other countries and generally costs less, ranging from $40 to $300.
What is the future of medication abortion if Roe is overturned in June?
If Roe falls, 26 states are likely to immediately ban abortion. Those bans will include surgical abortion as well as medication abortion.
With more than half of states likely to ban abortion in the coming months, advocates and experts agree that more women and birthing people are likely to self-manage their abortions at home using medication abortion.