Using medication like abortion pills to terminate a pregnancy at home without a doctor’s supervision or outside of a traditional health care setting is referred to as self-managed abortion. Studies have proved the effectiveness of using pills to have an abortion at home, and these medications have been recommended by organizations including Doctors Without Borders and the World Health Organization.
Bear in mind, as the laws across the country continue to shift rapidly, some means of accessing medication may not remain legal indefinitely. Glamour spoke with a leader in reproductive law and consulted peer-reviewed research to bring you everything you need to know about abortion pills.
Mifepristone and misoprostol are both FDA-approved medications that are proven both safe and highly effective at inducing miscarriage within 10 weeks of pregnancy. In the United States they are usually prescribed as a pair when used for self-managed abortion. However, evidence shows that misoprostol—which is much cheaper and easier to obtain—is also effective for first-trimester self-managed abortion when used alone. Misoprostol has other common uses as well, such as for the treatment of ulcers, which is part of why it is so much more widely available.
Mifepristone blocks the progesterone hormone, thereby keeping pregnancy from progressing, while misoprostol induces uterine contractions to expel the pregnancy. This is not the same thing as Plan B or other morning-after pills, which forestalls a pregnancy by preventing the egg from being released by the ovary or a fertilized egg from attaching to the uterus. Abortion pills essentially induce a miscarriage, and in the 1% of cases of cases where medical intervention becomes necessary, treatment is the same.
Studies indicate that abortion pills successfully end a pregnancy with no complications in about 95% of cases, while fewer than 1% of cases require medical intervention for complications. In 2018 the FDA reported that the mortality rate for mifepristone comes to 0.35 deaths out of 100,000. For scale, erectile dysfunction medications like Viagra have a mortality rate of 4 out of 100,000. The maternal mortality rate in the United States is 18 out of 100,000 live births nationally, and 40 out of 100,000 for Black women.
That said, abortion pills are not recommended for people on blood thinners or who show signs of a potential ectopic pregnancy.
People who live in states where abortion is banned or severely restricted—such as Alabama, Arkansas, Kentucky, Missouri, Ohio, South Dakota, Utah, Oklahoma, or Texas, among others—can still obtain pills through a variety of means. One resource is Plan C, a well-known abortion access advocacy organization. The site offers practical guides and tools for obtaining abortion pills in all 50 states, including through telehealth.
Patients who have trouble accessing telehealth for abortion care in their own states may consult Plan C’s guide to finding the nearest state where telehealth is accessible. The organization also provides advice on how to order abortion medication through the mail or online.
Aid Access is another resource for obtaining abortion pills via telehealth that has gotten a lot of press lately. The nonprofit was started in 2018 by Dutch doctor Rebecca Gomperts. The team consults with patients online, then ships pills directly from a pharmacy in India.
Independent online pharmacies have also mobilized in the wake of the Roe decision to make abortion pills more easily accessible. Honeybee Health, a California-based start-up begun by pharmacist Jessica Nouhavandi, has become one of the largest national distributors of abortion medications, according to . Just the Pill, a telehealth service that ships abortion pills, has begun setting up mobile clinics near the borders of states that have severely restricted or banned abortion.
Jill E. Adams, executive director at If/When/How—a reproductive justice legal advocacy organization—says that there are only three states that explicitly outlaw self-managed abortion: Nevada, Oklahoma, and South Carolina. Outside of these three states, there have been attempted abortion prosecutions on charges such as “child endangerment,” though almost never successfully. Adams says that while deleting period tracking apps may be advisable, the best way to avoid potential harassment for self-managed abortion is to tell as few people as possible—including medical providers. In the unlikely event that you do have a medical emergency following a self-managed abortion, you can tell your provider that you had a miscarriage, as the medical care provided will be the same, she adds.
Adams explains that functionally all abortion bans target the provider of abortion care, not the patient seeking the abortion. As newer laws criminalizing abortion go into effect, it will be up to local law enforcement to interpret the statutes and prosecute as they see fit.
