In a historic and devastating move, on June 24, 2022, the United States Supreme Court did what many women across the US feared: It overturned Roe v. Wade, eliminating the constitutional right to a safe and legal abortion across the country. The ruling, which came 49 years after the landmark decision was first put into effect, placed abortion rights into the hands of the states — nearly half of which have or will pass laws banning the procedure entirely. Meanwhile, other states are set to severely roll back abortion rights and strictly regulate the procedure.
For example, in Missouri, abortion was banned immediately upon the Supreme Court’s recent ruling. Shortly afterward, Arkansas and South Dakota followed suit, and Iowa and Ohio put a six-week ban (making abortion illegal after six weeks of pregnancy) into effect, according to NPR. Georgia, on the other hand, is still awaiting a court ruling on a potential six-week abortion ban. The changes have been swift in some states, while others are still trying to figure out what restrictions they’ll enact.
As abortion clinics close and many states start to (if not already) make termination illegal, it’s important to know there’s an alternative to in-office procedures — that is, of course, in places that allow abortions. Even before SCOTUS’ June 24 ruling, medication abortions accounted for more than half of all abortions in the US, according to a recent study by Guttmacher Institute. And thanks to its accessibility, medication abortions — which can be prescribed through telemedicine consultations — are likely to become an increasingly popular choice as more and more restrictions are put into place.
“Following the Supreme Court's decision on Friday, June 24, the site traffic to Hey Jane, a digital abortion clinic, grew almost 10x and patient demand more than doubled compared to the last month's average,” according to a statement from Kiki Freedman, CEO of Hey Jane. “This spike in interest demonstrates to us that people are increasingly curious about telemedication abortion as it becomes an exceptionally viable option in the wake of Roe's overturn.”
That being said, in states where abortion is outlawed, any type of abortion — including medication ones — are or likely will become illegal.
This is an ever-evolving issue, but the following are some of the most important details to understand right now.
What Is a Medication Abortion?
Also known as the “abortion pill" or "abortion pills," medication abortion is a two-pill treatment approved by the US Food and Drug Administration (FDA) to be taken during the first 10 weeks of pregnancy as a safe, effective at-home method of termination, explains Jordan Crofton, FNP, Director of Patient Care for THE WELL New York.
“Despite propaganda you may have seen, medication abortions are safe, complications are extremely rare and there are no long-term effects on your fertility,” says Aviva Romm, MD, midwife and author of Hormone Intelligence. “What's more, they make abortion care much more accessible in communities where health services are limited and private, even for those who have access.”
And while it’s approved for use up to 10 weeks of gestational age, a medication abortion “can be done up to 11 weeks after the first day of your last period,” adds Dr. Romm. In other words, some practitioners might prescribe the treatment to be used safely off-label. The effectiveness of the abortion pill, however, depends on how far along you are in your pregnancy when you take it, according to Planned Parenthood.
In fact, per the organization, for people who are 8-9 weeks pregnant, a medication abortion works about 94-96 out of the 100 times. If it doesn’t work — say, you had an ultrasound or blood test in your practitioner’s office or took a pregnancy test at home — and you’re still pregnant, you should consult your provider about other options. These can include taking another dose of the medication or having an in-clinic procedure to complete the termination, according to Planned Parenthood.
For people who are 8-9 weeks pregnant, a medication abortion works about 94-96 out of 100 times.
As the topic of bodily autonomy becomes increasingly politicized and polarizing, it's never been more important that patients' privacy is respected and advocated for — privacy in seeking out abortions, privacy in terminating and privacy because the new laws may lead to judgement that didn’t exist before, says Crofton. Having the pills to take at home, on your own time, can allow a measure of privacy that feels increasingly necessary in a post-Roe world.
How Does a Medication Abortion Work?
In the US, a medication abortion commonly involves using two types of medicine: mifepristone and misoprostol. First, you take mifepristone, which blocks your body’s production of progesterone, a hormone required for the development of pregnancy. This first pill stops the pregnancy from growing, thereby terminating the pregnancy, explains Dr. Romm.
Then, 24 to 48 hours later, you take misoprostol to essentially empty the uterus. This part of the abortion is the most uncomfortable as the misoprostol forces the uterus to contract, causing cramping and bleeding, not unlike a miscarriage, according to Kaiser Family Foundation (KFF). The cramping will intensify over several hours until the pregnancy has been passed, at which point the cramps should stop and the bleeding either stops or lessens to a light flow or spotting.
“The process of taking the meds is straightforward,” says Dr. Romm. “Cramps, chills and heavy bleeding are normal. However, if you bleed through two pads an hour for two hours or develop persistent fever or pain post-abortion, then you'll need to seek medical follow-up.”
The entire treatment, barring there are no issues (e.g. heavy and prolonged bleeding, fever, infection), takes one to two days. However, light bleeding may continue for a couple weeks, according to Dr. Romm.
It’s important to note that a medication abortion is not the same as Plan B, aka the morning-after pill or emergency contraception. While mifepristone and misoprostol end a pregnancy and flush the uterus of the fetus, the morning-after pill lowers your chances of becoming pregnant by preventing or delaying ovulation and/or interfering with sperm movement, making fertilization less likely, according to Planned Parenthood. Also unlike the abortion pill, Plan B must be taken within 120 hours (five days) of unprotected intercourse.
As of publication, emergency contraceptives, such as Plan B, are still legal but access can vary depending on where you live. Some states are more restrictive than others about who can access the morning-after pill and under what conditions. (To find out the deal with Plan B access in your state, you can refer to the Guttmacher Institute’s online breakdown of emergency contraception policies.)
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So, How Much Does a Medication Abortion Cost?
Medication abortions can cost up to $750, but are usually less, according to Planned Parenthood. The price of the treatment varies depending on the state or health center where you receive care and whether health insurance (if you have) covers it. For example, the South Atlantic US has the lowest median price, $490, while the West North Central region of the country has the highest at $730, according to a 2022 research article. Meanwhile, if you’re eligible for abortion care from Hey Jane (e.g. you live in the states where Hey Jane operates), it can cost as little as $249 (such is the case in New York). And for comparison, the average cost of an in-office abortion is $549, according to the aforementioned research.
Whether or not your health insurance covers medication abortions depends on your specific plan, which, BTW, states can regulate, per the KFF. That being said, there are other means of financial support if you do not have abortion coverage and cannot pay for the treatment (and other costs that might come with it) in full. The National Network of Abortion Funds, for example, connects people with organizations that can provide financial and logistical support for terminating a pregnancy in the US.
All that being said, Fortune recently reported that the cost of abortions altogether are projected to go up with the overturning of Roe.
How Can You Get a Medication Abortion?
Depending on what state you live in and the rapidly changing laws surrounding abortions, if you want to get medication to terminate, you have a couple options.
As of December 2021, the FDA made mifepristone and misoprostol accessible by mail. But that’s the FDA; state and federal laws trump their ruling. If you’re 18 or older and live in California, Colorado, Illinois, New Mexico, New York or Washington, Hey Jane can mail you the medication directly. Choix is another online resource that can distribute pills to a handful of states and to people as young as 15 in California, Illinois and New Mexico.
The minimum age for medical abortions differs from state to state. However, research has found that adolescents, defined as 10 to 19 years old by the World Health Organization, experience far fewer complications than older women when they abort using mifepristone and misoprostol.
Although it can’t directly send you pills, Plan C is an digital hub that can direct you to where you can get the abortion pill, online sites and potential providers. If none of these options are accessible in the state in which you live and abortion is still legal, then contacting a medical provider who can write a prescription for medication abortions is likely your best bet.
In fact, if you live in a location where abortion is still legal, you can always consult your doc or one at a clinic, such as your local Planned Parenthood, to discuss your options for termination and potentially receive a script for a medication abortion. After all, you need an Rx from a licensed health-care provider in order to get mifepristone and misoprostol.
How Might Medication Abortion Be Affected By the Overturning of Roe v. Wade?
Because medication abortion is still an abortion, it will likely be just as affected by the overturning of Roe as in-office procedures. “Patients in the ban states will have no access to abortion by any method,” Helen Krasnoff, Vice President of Public Policy Litigation and Law at Planned Parenthood, told NBC News.
That being said, it’s still TBD as to whether states can actually institute outright bans on the abortion pill since the medications are federally approved. In a June 24 statement, Attorney General Merrick Garland said, “states may not ban mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy.”
Because medication abortion is still an abortion, it will likely be just as affected by the overturning of Roe as in-office procedures.
Currently, though, many states limit provision of abortion pills just to physicians. And some states require the practitioner to be in the same room as the patient when prescribing, essentially making telemedicine provision illegal, according to the Guttmacher Institute.
“Medication abortions are expected to be at the center of the legal battles in the coming weeks and months,” says Crofton. “The abortion laws beginning to take effect in many states ban all forms of abortion, including medication abortion, however there are organizations already working to deploy mobile clinics parked along state borders, which will provide consultations for medication abortions and dispense pills.”
As Crofton explains, there’s still a lot of grey area on the role telemedicine can and will play when it comes to providing abortions via medication. “[We’re] still in a place right now where we have more questions than answers,” she says.
The overturning of Roe v. Wade is going to have a detrimental effect on the lives of women all over the country. While the wealthy will always have access to abortions, the ruling will disproportionately affect women of color and those who are low-income. The ruling isn’t just a war on women, but racist and elitist.
Although one can hope that President Biden might change his tune and expand the Supreme Court, as it stands, the country we knew before June 24, 2022 no longer exists. What does still exist is the fight for bodily autonomy — medication abortion is proof of that, and its accessibility is going to be one of the few things that can potentially save an entire generation of women.