Medication abortion (abortion pills): Common and accessible

Filed Under: Costs, Patients, Providers

pro abortion protesters at rally
- photo by Manny Becerra on Unsplash

Medication abortion (abortion pills) have been around for a while, but they are about to get a lot more common  with the Supreme Court’s decision to overturn Roe v. Wade, mandating legal abortion for all Americans. Also more than half of the states have made it clear they are certain or likely to ban abortion without Roe v. Wade, as this Guttmacher Institute essay documents.

So what’s left? Well, medication abortion (the pills) is often less expensive than a surgical abortion, and medication abortions now make up more than half of all U.S. abortions. The pills are fairly accessible (see below).

A medical abortion in a clinic often consists of a physical exam, two separate pills, Mifepristone (which blocks the progesterone needed for the pregnancy to continue) and Misoprostol (which provoke expulsion from the uterus) and a follow-up appointment.

Increasingly, pregnant people are using online guidance to do it themselves at home (see resources below).

Many states have limits on if or when  women can take the abortion pills. Some states say up to nine weeks; some prohibit this after seven weeks (though women are getting around these regulations by ordering pills to another address, having a friend send pills, or ordering from a place that sends pills in an unmarked package in the mail, meaning it’s hard to track and enforce). The Guttmacher Institute has a list of state abortion limits. The landscape is changing fairly quickly, with new legislation.

In the wake of the Supreme Court’s Roe decision, Attorney General Merrick Garland said the states cannot legally ban Mifepristone and Misoprostol, which have been approved by the Food and Drug Administration. The matter is far from settled, and will likely be in court soon.

Medication abortions are safe and effective, but in the current legal climate, there may be risks.

“Some states are not only making abortion care illegal, but are also actively criminalizing people who seek or support someone in obtaining abortion care. The public health harms of these bans, and of the criminalization they entail, are impossible to overstate,” Katelyn Jetelina, an epidemiologist who covers medical issues on her Substack, writes. “Each state has different laws as to which … models of care is legally available.”

When to use a medication abortion (abortion pills)?

Regardless of regulations, the abortion pill is safest and most effective early in the first trimester, or 12 weeks. The World Health Organization says 12 weeks; PlanCpills, a source for finding abortion medications, says it’s best in the first 11 weeks. AidAccess, another source for finding medications, says it’s up through the 10th week.

The process takes anywhere from a few hours to a few days, depending on how far apart the pills are taken and how long the body takes to abort after the second pill. If the pills come from a clinic, patients must often agree to have a surgical abortion when medical abortions don’t work, which happens less than one percent of the time. Planned Parenthood has a chart recording the effectiveness of the abortion pill — the later you take it, the less effective it is.

Here’s a thorough National Abortion Federation rundown of medical abortion. Here is a Planned Parenthood page on in-clinic abortion procedures and a page on the abortion pill. Here is the Miscarriage and Abortion hotline, with information on the process.

INeedAnA.com has updated and localized information about whether abortions are legal where you are, and other similar resources.

The F.D.A. ruled in December that pills can be mailed to patients, so they don’t have to get them in person. But conservative states are moving to limit access — just as abortion advocates are moving quickly to maintain access.

Note: In many states, as of the Roe decision on June 24, abortion is or will soon be illegal. So getting and using these pills to terminate a pregnancy may be forbidden in your state. Because of that, be careful about what you do and who you tell. Read the advice in this post. Consider downloading the Signal app, which is encrypted for secure communications. Travel to another state may also be an option for your safety.

Providers, too, are uncertain of their situation.

“Some Texas clinicians still provide abortion counseling and referrals, believing that the law does not limit their free speech, while also noting that such freedom depends on a clinician’s willingness to assume possible legal risk,” a group of authors wrote in the New England Journal of Medicine right before the court ruled, discussing interviews they had made with Texas providers. “On the basis of legal guidance, other Texas clinicians believe they are not even allowed to counsel patients regarding the availability of abortion in cases of increased maternal risks or poor fetal prognosis, although before SB8 they would have done so. Many clinicians have also been advised that they cannot provide information about out-of-state abortion facilities or directly contact out-of-state clinicians to transfer patient information. These fears have disrupted continuity of care and left patients to find services on their own. …

“The climate of fear created by SB8 has resulted in patients receiving medically inappropriate care. Some physicians with training in dilation and evacuation (D&E), the standard procedure for abortion after 15 weeks of gestation, have been unable to offer this method even for abortions allowed by SB8 because nurses and anesthesiologists, concerned about being seen as ‘aiding and abetting,’ have declined to participate.”

Getting abortion pills  in the mail

Abortion pills in the mail can cost as little as $110 from AidAccess.org  PlanCPills says the abortion pill can cost $40 to $600, with the high end being a procedure in a clinic.

“Medication abortion is also used illicitly by those who live in a place that restricts legal abortion or by those who can’t reach a clinic,” The New York Times wrote after the Roe decision. “The U.S. abortion rate is higher than officially reported by doctors, evidence suggests, because people are ordering pills online. That invisible abortion rate may rise if more states move to ban abortion — bans would apply to both surgical and medication abortions.”

Self-managing abortions is increasingly popular, with the rise of abortion restrictions. Many states have laws prohibiting telemedicine abortions, but there are a number of workarounds, including getting pills in the mail.

Resources for BUYING abortion pills

Here are some resources to buy pills:

AidAccess.org says it is a “committed team of doctors, activists and advocates for abortion rights. The purpose of the website and the service is to create social justice and improve the health status and human rights of women who do not have the possibility of accessing local abortion services.” This Austria-based group supplies abortion pills online on a sliding scale that tops out at $110.  AidAccess says in these U.S. states: Alaska, California, Colorado, Connecticut, DC, Idaho, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New York, New Jersey, New Mexico, Nevada, Oregon, Rhode Island, Vermont, Virginia and Washington, U.S. doctors can provide abortions with medications by mail for $150. For other U.S. states and other countries, “our European doctors can provide the prescriptions for abortions with the medicines mifepristone and misoprostol. You will be informed about a trustworthy pharmacy in India who will ship the medicines to you by mail.  The delivery of the packages take 1 to 3 weeks after shipment. The cost of this service is 95 Euro or 110 USD. Please let us know if you cannot afford this amount and we will try to find a solution.” Email info@aidaccess.org.

Plan C pills provides up-to-date information about how Americans are accessing abortion pills online. Researchers vet organizations selling medication and test those medications; people who want to buy can search for those vetted providers.

JustThePill.com serves pregnant people in Minnesota, Montana and Wyoming. It is a member of the National Abortion Federation and the Abortion Care Network.

HeyJane.co says it offers virtual care and abortion pills to “people (anyone with a uterus) in New York, California, Washington, Illinois, Colorado, or New Mexico. We’re expanding to more states soon.” People 18 and older with a gestational age of 10 weeks or less are eligible. Text (405) 643-7957.

Carafem will schedule a video visit and then send pills if you have a mailing address in one of these states: Colorado, Connecticut, Delaware, District of Columbia, Georgia, Illinois, Iowa, Maryland, Massachusetts, Nevada, New Jersey, New Mexico, Rhode Island, Vermont or Virginia.

Choix serves Colorado, California and Illinois.

A Mexican group called Las Libres has been sending abortion pills free of charge with instructions to women in Texas and elsewhere, Insider reported. “Verónica Cruz, the founder of the group Las Libres in Guanajuato, Mexico, told Insider her organization has helped hundreds of Americans access abortion since the beginning of 2022,” Insider wrote.

Resources for knowledge and supplies of abortion pills

Here are some resources for knowledge about medication abortion:

Here’s a thorough National Abortion Federation rundown of medical abortion. Here is a Planned Parenthood page on in-clinic abortion procedures and a page on the abortion pill. Here is the Miscarriage and Abortion hotline, with information on the process.

INeedAnA.com has updated and localized information about whether abortions are legal where you are, and other similar resources.

Abortionpillinfo.org is the website for SASS (Self-Managed Abortion, Safe and Supported), which describes itself as “the US project of Women Help Women, a global nonprofit organization that supports the rights of people around the world to have information about and access to safe abortion with pills.” The site explains: “If a person wants to use abortion pills to end an unwanted pregnancy, with or without a clinician, this website provides information about how to do that.”

The If/When/How Repro Legal Helpline is a resource where “attorneys and advocates provide legal information and support to people navigating complex laws in order to self-determine their reproductive lives.” This includes not only gaining legal access to abortion medications, but also “judicial bypass.” “If you cannot or do not want to involve your parent or guardian, or if they will not give you permission, you can go to court and ask a judge to allow you to get an abortion without having to involve your parent or guardian,” the site says. “This is called judicial bypass.”

The Miscarriage and Abortion hotline has information and resources.

Abortion On Our Own Terms is a collection of resources including how-to guides, animations and other sources of support and information on self-managed abortion brought together by a coalition of national organizations.

Self-Managed Abortion with Pills resource from We Testify describes itself as “an organization dedicated to the leadership and representation of people who have abortions, increasing the spectrum of abortion storytellers in the public sphere, and shifting the way the media understands the context and complexity of accessing abortion care.”

Apiary lists practical support organizations — groups that give different kinds of practical support to people seeking abortions, broken down by national, state and regional groups.

Getting pills in the mail is increasingly easy, as The New York Times reported. Their reporter, Farhad Manjoo, bought pills by mail three times in a year. He did have the pills he bought tested, and they were authentic. He said he paid between $200 and $300 for all three shipments, including expedited shipping. One source, Aid Access, asked him to confirm that he is a woman and pregnant, and he did not because he isn’t and wasn’t.

Related: Our blog post “How much does an abortion cost?” with information about surgical abortions, which are needed past the first 10-12 weeks or so. There’s also a lot of information about financial aid.

Want to show up for abortion access? This resource page was compiled by Alison Turkos, a longtime reproductive justice activist. It is being updated regularly.

Our blog post “How much does Plan B cost?”

Other info on reproductive matters after Roe: NPR’s Lifekit on layering contraceptives, complications and more