What is medication abortion? What to know about mifepristone

Medication abortions currently make up the majority of abortion procedures in the US, accounting for around 54% of all procedures. But abortion pills, such as Mifeprex (mifepristone) and Cytotec (misoprostol), have been difficult to access in some states ever since the Supreme Court issued a ruling on Dobbs v. Jackson in June 2022. With that decision, the Court took an additional step to overturn Roe v. Wade, which upheld a woman’s right to an abortion for nearly 50 years. 

As a result, many states had trigger bans in place that immediately took effect, making abortion illegal within their borders. In other states, new restrictions were created, such as prohibiting access to abortion pills.

Just this week, the Supreme Court announced that it will hear a case challenging the Food and Drug Administration’s (FDA) approval of the commonly used abortion pill, which could significantly impact access. More than 5 million women in the US have used mifepristone to terminate their pregnancies, and dozens of other countries have approved the drug, The New York Times reports.

When healthcare providers are barred from providing access to safe abortions, many women will be forced to carry their pregnancy to term and potentially face new health risks. Here’s what to know about medication abortion, sometimes called Plan C.

What is a medication 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 is abortion pills. 

Of note: The FDA also recently moved to clarify on the label of Plan B pills that it does not cause abortion, thereby distinguishing the emergency contraceptive from medication abortion pills. 

Also called a medication abortion, Plan C is an option for safely and effectively ending a pregnancy. The medication used is a combination of mifepristone and misoprostol (or misoprostol may be used solo, if mifepristone is not available). The entire process can be self-managed at home.

Mifepristone is also sometimes used in the treatment of a missed miscarriage.

According to ACOG, a medication abortion is most effective if used before 10 weeks of pregnancy, up to 70 days from the first day of your last normal 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 a statement, Attorney General Merrick Garland asserted that access to abortion pills and other reproductive care will be protected by the Justice Department.

“States may not ban Mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy,” Garland writes.

Related: Resources for safe abortion access and reproductive rights

Though state laws can make it illegal or very difficult for clinicians to prescribe and for patients to access the pills. At least half of states have enacted regulations that restrict abortion care via medication or telemedicine, which means people living in those states who obtain the pills could risk legal consequences.

The FDA’s new ruling (updated via its website, though no announcement was released), outlines that retail pharmacies will need to meet certain requirements to dispense the medication, namely, designating a specific employee to ensure compliance, along with additional administrative duties. 

The FDA had previously required that one of the medications used in abortion pills, mifepristone, be dispensed in person. But as of December 2021, that requirement has been permanently lifted, also paving the way for telehealth platforms to arrange safe access to abortion care. 

Guttmacher Institute has a list of each state’s regulations, and Plan C offers FAQs on accessing medication abortion resources.

Are abortion pills safe?

Yes. Abortion pills are safe and effective. Abortion pills currently make up the majority of abortion procedures in the US.

The protocol of taking mifepristone first (which blocks progesterone, a hormone needed to maintain pregnancy viability), followed by misoprostol 24 to 48 hours later (which causes your 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 medication abortion or early pregnancy loss.

Related: 10 facts about the state of abortion in America right now

The organization “supports the use of and expanded access to mifepristone for these indications and opposes restrictions such as on-site dispensing requirements and mandatory in-person exams prior to and following a medication abortion.”

The protocol is also recommended by Planned Parenthood. 

This method of medication abortion is low risk (less than 1% of women who have used medication abortion have reported serious adverse side effects such as infection or hemorrhage), highly effective (95% to 98% of abortions are successful), and it has the fewest side effects. 

Studies show that medication abortions tend to take longer and require you to monitor yourself at home, as compared to a surgical abortion, known as uterine aspiration, which is typically performed by a clinician in one office visit. Though no medical procedure is without risk, the risks of a medication abortion are most serious if you have an IUD or an ectopic pregnancy. A small 2021 cohort study examined the safety record of medication abortion care administered by telehealth, and found it to be “feasible, safe and efficacious.”

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What is the shelf life of abortion pills?

If you’re wondering if abortion pills ever expire, the answer is yes, though they do have a long shelf life. Both misoprostol and mifespristone tablets carry a shelf life of about two years, according to the International Federation of Gynecology and Obstetrics (FIGO). Some resources say that mifepristone may last as long as five years. If used after their expiration date, the pills may still work, but you risk a higher rate of failure.

Abortion medication makes abortions more accessible

In some European countries, such as Finland, medication abortions account for up to 90% of all abortion procedures. Many healthcare providers recommend medication abortions to their patients seeking this type of care—as it may be preferable over a uterine aspiration in some cases. 

Add to that, Plan C pills offer additional benefits: they’re more accessible, much more affordable (pills can cost $40-$105; uterine aspiration typically costs upwards of $500) and can be self-managed at home. That self-management factor is hugely important, considering we’re now living in a post-Roe world, where abortion clinics across the country have been forced to shutter.

Related: How to care for yourself after an abortion

Resources for finding abortion pills

Resources for finding abortion pills near you are available via Planned Parenthood, Choix Health (which offers virtual clinician services for California, Illinois and Colorado) and Plan C, where you can enter your location and determine the best method of getting access to the medication, whether that’s clinician-supported or self-managed. Some clinics may allow advance provision of abortion pills, where you can order the pills for future use.

In some states, you can visit a clinic or seek support from an online clinician then take the pills at home, in other cases, you can order the pills for delivery to your home without consulting a healthcare provider. Plan C also has a list of online resources, such as The M+A Hotline, that are available for additional support. 

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Abortion care is healthcare. “Like all patients, women obtaining abortion 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 December 3, 2021. It has been updated.