Medication Abortion
Overview
Medication abortion refers to ending a pregnancy using medications—most commonly mifepristone and misoprostol—and is sometimes obtained and used outside clinical settings through self-managed methods. Research and global health authorities note that medication abortion is a safe, effective, and essential tool for expanding access to acceptable abortion care.
- “Medication abortion plays a crucial role in providing access to safe, effective and acceptable abortion care.” World Health Organization. Medical Management of Abortion, Geneva, 2018, p. 54 Linked here.
- On December 16, 2021, the FDA announced it will no longer require in-person dispensing of mifeprex (mifepristone) in clinics, medical offices, and hospitals. This modification to REMS allows for dispensing of medication abortion by mail under the supervision of a certified healthcare provider. U.S Food and Drug Administration. “Questions and Answers on Mifeprex.” Linked here
- But see; 19 states prohibit access to medication abortion by mail. Guttmacher Institute. Medication Abortion, State Laws and Policies. 1 June 2023, Linked here
- Updated Mifepristone REMS Requirements Linked here
- FDA permanently removed the in-person dispensing requirement for mifepristone and added a pharmacy certification process that will permit retail pharmacies to dispense mifepristone directly to patients who have a prescription from a certified provider.
- Additionally, the FDA’s modification on the REMS now allows certified pharmacies to dispense medication abortion. U.S Food and Drug Administration. “Questions and Answers on Mifeprex.” Linked here
- The Safety of Medication Abortion Care: Fact Sheet Linked here
- Expanding Medical Abortion Access (EMAA) Project Factsheet Linked here
- “The disproportionate burdens of the mifepristone REMS.” Thompson, Alexandra et al., Guttmacher Institute. Contraception, July 2021, Linked here.
- Information about Mifepristone for Medical Termination of Pregnancy Through Ten Weeks Gestation Linked here.
- FDA Questions and Answers on Mifepristone for Medical Termination of Pregnancy Through Ten Weeks Gestation Linked here
- Medication Abortion Up to 70 Days of Gestation, ACOG Practice Bulletin, American College of Obstetricians and Gynecologists, Society for Family Planning, Number 225, Vol. 136, No. 4, October 2020 Linked here.
- Mifreprex (mifepristone) Information. U.S. Food and Drug Administration (FDA). U.S. Food and Drug Administration, Linked here.
- World Health Organization, Self-management of medical abortion, Sexual and reproductive health, 2021, Linked here.
- Medication abortion also referred to as medical abortion is the use of medicines to induce an abortion. Often referred to as the “abortion pill”, the U.S. Food and Drug Administration (FDA) has approved a regimen of two medicines, mifeprex (generic version is mifepristone ) and misoprostol for medical abortion up to 70 days gestation. The first pill, mifeprex is taken orally, and then 24 to 48 hours later, misoprostol is applied buccally. If mifeprex is unavailable then misoprostol alone is dispensed. Mifeprex (mifepristone) is subject to the FDA’s Risk Evaluation and Mitigation Strategy (REMS) which imposes a series of requirements for administering the medicine to individuals seeking a medication abortion. For example, mifeprex must be “…ordered, prescribed and dispensed by or under the supervision of a healthcare provider….” U.S. Food and Drug Administration (FDA). Mifreprex (mifepristone) Information. U.S. Food and Drug Administration, linked
- 2022 State Legislative Sessions: Abortion Bans and Restrictions on Medication Abortion Dominate, Policy Analysis, Guttmacher Institute, March 2002, Linked here
- Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: A population-based study Linked here
- February 24, 2022, “Medication Abortion Now Accounts for More Than Half of All US Abortions.” Rachel K. Jones, et al., Guttmacher Institute. Linked here
- “Specifically, preliminary data from the Guttmacher Institute’s periodic census of all known abortion providers show that in 2020, medication abortion accounted for 54% of US abortions.(emphasis added) That year is the first time medication abortion crossed the threshold to become the majority of all abortions and it is a significant jump from 39% in 2017, when Guttmacher last reported these data. This 54% estimate is based on preliminary findings from ongoing data collection; final estimates will be released in late 2022 and the proportion for medication abortion use is not expected to fall below 50%.”
- Medication abortion provided without conducting an ultrasound had an effectiveness rate of 95%, which is comparable to the effectiveness rate of medication abortion provided with ultrasound screening. Study conducted by Advancing New Standards in Reproductive Health (ANSIRH), Linked here
- According to The Centers for Disease Control (CDC) 2018 Surveillance Reporting for Abortions in the U.S., 38.6% of individuals had medical abortions at or before 9 weeks gestation while only 1.4% had medical abortions later than 9 weeks gestation. Abortion Surveillane—United States 2018. MMWR Surveillance Summaries 2020 Linked here
- Grossman, Daniel et al,. “Continuing pregnancy after mifepristone and “reversal” of first-trimester medical abortion: a systematic review.” Contraception, vol. 92, 2015, pp. 206-2011. Advancing New Standards in Reproductive Health, Linked here.
- American Bar Association, Resolution 107A, opposes criminal prosecution of any person having an abortion, or for experiencing a miscarriage, stillbirth, or other pregnancy outcome.
See Resolution and Report at: Linked here - American College of Obstetricians and Gynecologists (ACOG). Improving Access to Mifepristone for Reproductive Health Indications, 2018, Linked here.
- Institute for Women’s Policy Research: A Quest to Expand Abortion Access Linked here
- “Facts are Important: Medication Abortion Reversal is not Supported by Science.”American College of Obstetricians and Gynecologists, (ACOG), Linked here.
- State Law and Policies for Medication Abortion, Guttmacher Institute, Linked here
- “The Availability and Use of Medication Abortion.” Linked here
- “Legal Challenges to the FDA Approval of Medication Abortion Pills.” Linked here
- “SCOTUS Blocks Lower Court Rulings and Preserves Access to Medication Abortion for Millions of American Women” April, 2023 Linked here
- The Availability and Use of Medication Abortion by State Linked here
- State Requirements for the Provision of Medication Abortion Linked here
- The Intersection of State and Federal Policies on Access to Medication Abortion Via Telehealth Linked here
- To dispense medication abortion, 32 states require health care providers to be a physician.
Guttmacher Institute. Medication Abortion, State Laws and Policies. 1 August 2022, Linked here - Medication abortion is prohibited from being dispensed via telemedicine in 19 states. It requires clinicians to be physically present when providing pills to patients. Guttmacher Institute. Linked here
- State Waiting Period Requirements for Abortion. Guttmacher Institute. Linked here
- Texas Judge Moves to Undermine Access to Medication Abortion for Millions of American Women Linked here
- NC experts, health care providers watch courts as access to abortion drug mifepristone is contested Linked here
- Targeted Regulation of Abortion Providers Linked here
- Alliance for Hippocratic Medicine v. FDA: The Statute of Limitations and the Impact on Abortion Access Linked here
- US appeals judges express support for opponents of abortion pill Linked here
- Challenges to the FDA’s Approval of Medication Abortion Pills Could Curtail Access Throughout the United States Linked here
- Perspectives on Alternative Models of Medication Abortion Provision Among Abortion Patients in the United States Linked here
- Availability of Telehealth Services for Medication Abortion in the U.S., 2020-2022 Linked here
- Abortion Bans May Limit Essential Medications for Women with Chronic Conditions Linked here
- “Facts are Important: Medication Abortion “Reversal” Is Not Supported by Science.” The American College of Obstetricians and Gynecologists. 26 March 2022. Linked here
- Advancing New Standards in Reproductive Health (ANSIRH). “Medication Abortion.” University of California at San Francisco (UCSF), Linked here.
- “Federal and state-level regulations have effectively limited the use of mifepristone, particularly in underserved areas without a nearby clinic. Studies show providers of medication abortion are mostly concentrated where surgical abortion is already available.” The Availability and Use of Medication Abortion, Women’s Health Policy, Kaiser Family Foundation. June 2021. KFF Linked here
- In response to COVID-19, many clinics provided medication abortion using history-based screening alone, forgoing ultrasounds. This JAMA Internal Medicine Study found that 95% of these medication abortions were completed without requiring additional medical intervention. Study concludes screening for medication abortion based on history alone is effective and safe. Linked here
Self-Managed Abortion
Self-managed abortion is the use of medicines such as mifepristone and misoprostol, herbs, Vitamin C or other means and methods without clinical supervision to induce an abortion. Self-managed abortion may be referred to as self-induced, self-sourced, self-administered, or “DIY” abortion. Moseson, Heidi et al. “Self-managed abortion: A systematic scoping review.” Obstetrics and Gynecology, vol. 63, 2020, pp. 87-110. Linked here.
- Exploring Attitudes About the Legality of Self-Managed Abortion in the US: Results from a Nationally Representative Survey. Linked here
- A cross-sectional study examining consideration of self-managed abortion among people seeking facility-based care in the United States Linked here
- Self-managed abortion via the internet: Analysis of one year of service delivery data from Women Help Women Linked here
- “Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: A population based study,” Aiken, Abigail, et al., The Lancet Regional Health Americas, 17 February 2022, Linked here
- “Exploring Attitudes About the Legality of Self-Managed Abortion in the US: Results from a Nationally Representative Survey,” Raifman, S., Biggs et al., Sexuality, Research and Social Policy, 16 March 2021, Linked here
- Barriers to abortion care and incidence of attempted self-managed abortion among individuals searching Google for abortion care: A national prospective study, Contraception, 2021 by Upadhyay, Cartwright and Grossman Linked here
- World Health Organization, Self-management of medical abortion, Sexual and reproductive health, 2021, Linked here.
- Advance Provision of Mifepristone and Misoprostol via Online Telemedicine in the US Linked here
- Association of Texas Senate Bill 8 With Requests for Self-managed Medication Abortion Linked here
- The American College of Obstetricians and Gynecologists (ACOG), Opposition to the Criminalization of Self-Managed Abortion, Position Statement 6 July 2022, Linked here
- American Bar Association, Resolution 107A, Opposes Criminal Prosecution for Abortion, Miscarriage, Stillbirth or Other Pregnancy Outcome, 22 February 2021,See Resolution and Report at: Linked here
- American Medical Association, Opposes the Criminalization of Self-Induced Abortion: Resolution 007 (A-18), 1 May 2018. Linked here
- Physicians for Reproductive Health, Self-Managed Abortion Policy Statement, Approved June 2017, reviewed November 2018. Linked here