Medication abortions currently make up the majority of abortion procedures in the US, approx 54% of all procedures. But abortion pills like Mifeprex (mifepristone) and Cytotec (misoprostol) have been hard to come by in some states since the Supreme Court ruled on Dobbs vs. Jackson in June 2022. With this decision, the Court took an additional overturning step Roe v. Wadewhich supported a woman’s right to an abortion for nearly 50 years.
As a result, many states enacted bans that went into effect immediately, making abortion illegal within their borders. In other states, new restrictions were created, such as banning access to abortion pills.
Just this week, the announced the Supreme Court that he will hear a case challenging the Food and Drug Administration’s (FDA) approval of the commonly used abortion pill, which could significantly affect access. More than 5 million women in the US have used mifepristone to end their pregnancies, and dozens of other countries have approved the drug, The New York Times reports.
When health care providers are barred from providing access to safe abortions, many women will be forced to terminate their pregnancies and face potentially new health risks. Here’s what you need to know about medical abortion, sometimes called Plan C.
What is a medical abortion or Plan C?
Plan A is birth control to prevent pregnancy, Plan B is emergency contraception (to prevent pregnancy after sex), and Plan C they are abortion pills.
Note: The FDA also recently moved to clarify on the label of Plan B pills that does not cause miscarriagethus distinguishing emergency contraception from medicinal abortion pills.
Also called medical abortion, Plan C is an option safely and effectively terminating a pregnancy. The drug used is a combination of mifepristone and misoprostol (or misoprostol can be used alone if mifepristone is not available). The entire process can be self-administered at home.
Mifepristone is also sometimes used to treat a missed miscarriage.
According to ACOG, a medication abortion is most effective if it is used before 10 weeks of pregnancyup to 70 days from the first day of your last regular period, but in some cases, it can also be used with more advanced pregnancies.
Related: Here’s the thing: Many women don’t even know they’re pregnant at 6 weeks
Are abortion pills legal?
In short, it’s complicated. Abortion pills are approved by the FDA at the federal level, but access may be restricted at the state level depending on where you live.
In his statement, Attorney General Merrick Garland argued that access to abortion pills and other reproductive care would be protected by the Justice Department.
“States cannot ban Mifepristone because of a disagreement with the FDA’s expert judgment about its safety and effectiveness,” Garland writes.
Related: Resources for safe abortion access and reproductive rights
Although state laws may make it illegal or very difficult for clinicians to prescribe and for patients to access the pills. At least half the states have enacted regulations restricting medication or telemedicine abortion care, meaning people living in those states who take the pills may be at risk of legal consequences.
The new FDA decision (updated via Websitealthough no announcement was released), it highlights that retail pharmacies will have to meet certain requirements to dispense the drug, namely, designate a specific employee to ensure compliance, along with additional administrative duties.
The FDA previously required one of the drugs used in abortion pills, mifepristone, to be administered in person. But from December 2021, this requirement has been permanently removedalso paving the way for telehealth platforms to organize safe access to abortion care.
The Guttmacher Institute has a list of regulations of each stateand Plan C offers frequently asked questions on access to medication abortion resources.
Are abortion pills safe?
Yes. Abortion pills are safe and effective. Abortion pills make up the majority of abortion procedures in the US today.
The protocol of first taking mifepristone (which blocks progesterone, a hormone needed to keep the pregnancy viable), followed by misoprostol 24 to 48 hours later (which causes the uterus to cramp and contract, emptying its contents) is approved by the Food and Drug Administration (FDA).
Plan C pills are considered by the American College of Obstetricians and Gynecologists (ACOG) to be a safe and effective regimen for medical abortion or early pregnancy loss.
Related: 10 facts about the state of abortion in America right now
The agency “supports the use and expanded access to mifepristone for these indications and opposes restrictions such as point-of-care requirements and mandatory personal examinations before and after a medical abortion.”
The protocol is also recommended by Planned Parenthood.
This method of medical abortion is low risk (less than 1% of women who have used abortion medication have reported serious adverse side effects such as infection or bleeding), highly effective (95% to 98% of abortions are successful)and has the least side effects.
Studies show that medication abortions tend to take longer and require you to monitor yourself at home, compared to a surgical abortion, known as hysterectomy, which is usually performed by a clinician in one office visit. Although no medical procedure is without risk, the risks of a medical abortion are more serious if you have an IUD or an ectopic pregnancy. A small 2021 cohort study reviewed the safety record of telehealth-provided abortion medication and found it to be “feasible, safe, and effective.”
What is the shelf life of birth control pills?
If you’re wondering if abortion pills ever expire, the answer is yes, although they do have a long shelf life. Both misoprostol and mifepristone tablets carry a lifespan of about two years, according to the International Federation of Gynecology and Obstetrics (FIGO). Some resources say mifepristone can last as long 5 years. If used after their expiration date, the pills may still work, but you risk a higher failure rate.
Medical abortion makes abortions more accessible
In some European countries, such as Finland, medication abortions are responsible up to 90% of all abortion procedures. Many health care providers recommend medication abortions to their patients seeking this type of care—as it may be preferable to uterine aspiration in some cases.
Add to that, Plan C pills offer additional advantages: they’re more affordable, much more affordable (pills can cost $40-$105, hysterectomy usually costs over $500), and they can be self-administered at home. This factor of self-management is extremely important given that we now live in a post- Roe world where abortion clinics across the country have been forced to close.
Related: How to take care of yourself after an abortion
Resources for Finding Abortion Pills
Resources for finding abortion pills near you are available through Planned Parenthood, Choix Health (offering virtual clinic services for California, Illinois and Colorado) and Plan C, where you can enter your location and determine the best method of accessing the medication, whether it’s clinician-assisted or self-administered. Some clinics may allow an advance supply of abortion pills, where you can order the pills for later use.
In some states, you can visit a clinic or seek support from an online clinician and then take the pills at home, in other cases, you can order the pills to be delivered to your home without consulting a healthcare provider. Plan C also has a list of online resourcessuch as The M+A hotlinewhich are available for additional support.
Abortion care is health care. “Like all patients, women who have abortions are entitled to privacy, dignity, respect and support,” writes the American College of Obstetricians and Gynecologists (ACOG). Plan C offers them just that.
A version of this story was published on December 3, 2021. It has been updated.
