When the Supreme Court overturned Roe v. Wade and the constitutional right to abortion in 2022, strict bans on abortion began nationwide, leaving women in at least 22 states with fewer options to terminate their pregnancies and, in some cases, even endangering their lives.
ProPublica found at least two cases of women dying after their states banned abortion. In both cases, the woman takes medication to terminate the pregnancy, but the abortion is not completely completed, leading to complications, which can occur in the few cases involving abortifacient drugs.
Their stories speak to the challenges women face when abortion is banned, rather than the safety of abortion pills taken correctly and with appropriate follow-up care.
We looked at information from the U.S. Food and Drug Administration and groups that closely track the latest medical advice and scientific evidence to answer the most common questions about the abortion pill.
What is an abortion pill?
What some people call the “abortion pill” is actually a combination of two pills – mifepristone and misoprostol – commonly referred to as the “abortion pill.”
Mifepristone lozenges, also sold under the brand name Mifeprex, have been approved by the U.S. Food and Drug Administration since 2000 for use with misoprostol to terminate intrauterine pregnancies up to 10 weeks of pregnancy. (This is 70 days or less from the first day of the patient’s last menstrual period.)
Currently, more than 60% of abortions in the U.S. health care system use the abortion pill.
How do abortion pills work?
Mifepristone blocks a hormone called progesterone, which is needed to continue pregnancy. The FDA-approved treatment regimen is to take 200 mg of mifepristone on the first day. Patients should take misoprostol within 24 to 48 hours after taking mifepristone. Misoprostol works by removing fetal tissue from the uterus.
In some cases, patients take misoprostol solely to terminate a pregnancy.
If any unusual symptoms are noticed, patients should follow up with their healthcare provider approximately 7 to 14 days or earlier after taking mifepristone. (see below.)
Are abortion pills safe?
Yes. The FDA first approved Mifeprex 25 years ago, so the drug has an extensive safety record.
Since then, of the nearly 6 million women taking mifepristone, there have been only 32 deaths among women who used the drug to terminate pregnancies by the end of 2022, regardless of whether the drug was involved in the death.
Eleven of the cases involved women dying from sepsis. Most of the remaining cases involved intentional and accidental drug overdoses, suicides, homicides and ruptured ectopic pregnancies.
The American College of Obstetricians and Gynecologists opposes laws and court rulings that restrict or ban the availability of abortion pills. “Mifepristone has been used safely and effectively for medical abortion for more than two decades. This safety and effectiveness are supported by strong, evidence-based clinical data and is widely used by obstetricians and gynecologists. With the support of clinicians, its use has been observed by millions of people,” the organization states on its website.
Who should not take abortion pills?
Abortion pills are not approved for use in certain pregnancies. According to the FDA, people should not use abortion pills if:
- Ectopic pregnancy (pregnancy outside the uterus).
- Problems with the adrenal glands (glands near the kidneys).
- Are receiving long-term corticosteroid therapy (drugs).
- Have an allergic reaction to mifepristone, misoprostol, or similar drugs.
- Have bleeding problems or are taking anticoagulant (blood thinning) medications.
- Have hereditary porphyria (a rare disease that affects the liver and other organs).
- Inserting an intrauterine device. (Must be removed before taking mifepristone.)
What are the common side effects of abortion pills? How long do they usually last?
Bleeding and cramping are initially expected. If you develop abdominal pain or discomfort more than 24 hours after taking misoprostol, or if you feel unwell, including weakness, nausea, vomiting, or diarrhea, with or without fever, your doctor recommends that you contact your healthcare provider immediately. These symptoms may be signs of a serious infection or other problem.
In the days after treatment, if you develop a fever of 100.4°F or higher that lasts more than four hours, doctors recommend that you should contact your health care provider or go to the nearest emergency room immediately. Fever can be a symptom of a serious infection or other problem.
How much bleeding is normal after taking abortion pills?
If you bleed enough to saturate two thick, full-size tampons every hour for two hours, or if you are worried about heavy bleeding, contact your healthcare provider right away. If you are unable to contact your health care provider, go to an emergency room for care.
How effective are abortion pills?
Taken as directed, they are very effective. About one percent of women require surgery to remove the remaining tissue. That’s why it’s important to seek follow-up care for any of the above symptoms.
What if the abortion pill doesn’t work?
Doctors say if you experience any of these unusual symptoms, you should seek medical attention immediately. (This patient agreement form required by the FDA describes what to look for.)
Although 14 states ban the use of abortion pills, it is not a crime to seek medical assistance for taking them. In fact, the federal government requires hospitals to treat emergency medical conditions such as infections. If you have ongoing bleeding, pain, and/or fever, always seek help from your doctor or emergency room. This infection is unlikely to go away on its own and can be fatal.
Is it legal to order abortion pills online?
Yes, in some states. In January 2023, the FDA lifted restrictions that prevented patients from obtaining medical abortion pills from retail pharmacies and allowed the drugs to be distributed by mail if certain requirements are met.
But patients cannot legally order abortion pills in 14 states that ban abortion: Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Russia Oklahoma, South Dakota, Tennessee, Texas and West Virginia. In 15 states, there are various restrictions that make it harder for patients to obtain abortion pills.
Some pharmacies and organizations that provide abortion pills by mail are not FDA approved. Patients should exercise caution when ordering medications from unregulated pharmacies to determine whether the medication is authentic and safe.
