Editor's note: This article was updated on June 24 to reflect the Supreme Court’s decision to reverse Roe v. Wade.
Medication abortions — which you might know as the “abortion pill” method — accounted for more than half of abortions in the US in 2020, according to the Guttmacher Institute. Because the abortion pill is a safe, effective, FDA-approved method for ending a pregnancy. And in many cases, it can be taken at home after being prescribed in person or virtually. But now that Roe v. Wade has been overturned, people are asking about abortion pill access. Some states are looking to make the abortion pill easier to get (and pill manufacturers plan for a surge in demand). While other states are looking to outlaw its use.
We called up Dr. Amy Addante, a board-certified OB-GYN with expertise in complex family planning, to talk about how abortion pills work, how to get them if you need an abortion now, and how laws around them might change in the future.
Let’s start with the basics: What’s the abortion pill?
A quick point of clarification: Some people use the term “abortion pill” to describe the two pills — typically mifepristone and then misoprostol — used to end a pregnancy in a medication abortion. But Dr. Addante only calls the first of those two the “abortion pill.”
How does the abortion pill work?
Mifespristone blocks the hormone progesterone that is needed to support the pregnancy, said Dr. Addante. And misoprostol “causes the uterus to cramp and contract to help you pass the pregnancy.”
How far along is too late for the abortion pill?
The sooner you can access abortion pills, the more effective they’ll be. They’re approved for use for up to 10 weeks of pregnancy. But the WHO says they can still safely be used at home before 12 weeks.
What are the steps to getting the abortion pill today?
That process can differ depending on where you live. But Dr. Addante laid out options:
Option 1: Get it in person from a health care provider.
Dr. Addante suggests using sites like ProChoice.org or Planned Parenthood to find a reproductive health care clinic. And she cautions against Googling, because that might send you to a crisis pregnancy center that can have anti-abortion messaging.
Or, if your OB-GYN or PCP has authorization through the REMS program, Dr. Addante said you could get it that way. Note: Although the abortion pill is deemed safe, it still requires health care providers and pharmacies to have special qualifications to dispense the drug. While the second pill — which is also used to manage miscarriages and for certain gynecological procedures — can be dispensed by a doctor or pharmacy.
Option 2: Get it delivered from a telehealth company.
You might be able to access pills from home, without ever going into a clinic. Dr. Addante said that the sites Plan C and carafem can help connect you with online resources that ship pills to your state. But, again, it depends on where you live.The FDA changed some medication abortion rules during the pandemic so that patients could forgo in-person doctor’s visits to get the abortion pill. But six states still ban the use of telemedicine for medication abortion. And 28 states require at least one in-person visit before you can get the pills, according to the Kaiser Family Foundation.
What do laws around abortion pill access look like in different states?
To paint a picture of the differences, Dr. Addante can “tell you a tale of two states,” as she put it. She’s currently an abortion provider in Illinois. But she used to work in Missouri.
In Illinois, there are a number of abortion providers in the Chicago area and in the southern half of the state. "So in Illinois, if you find yourself pregnant and you want a medication abortion, you call that clinic and we get you an appointment as soon as we’re able to,” she said. You can go into the clinic to get mifepristone, or have a virtual appointment. Because telehealth for medication abortions is legal in Illinois. Also allowed in the state: The use of Medicaid for abortion services. “So in Illinois, it’s pretty easy to obtain an abortion if you decide that it’s right for you.”
But in Missouri — where a trigger law could almost entirely ban abortion and make restrictions even more severe — it’s a different story. “There is one clinic in the entire state of Missouri. It’s located in St. Louis, which is in the easternmost part of the state,” Dr. Addante said. Meaning: It’s not in a central place that people can easily access. And Missouri requires patients to meet in-person with the physician who will administer their abortion care at least 72 hours before the procedure as part of a consent process. For some patients, that could mean driving hours to the clinic to consent to the abortion, waiting three days, and then returning to the clinic to get the abortion pill. Which can be especially tough on low-income people and people of color, who are more likely to get abortions and might not have the means to travel for that long. The state also has ultrasound requirements, parental consent rules, and limits on insurance coverage — except in cases where the mother’s life is in danger.
A possible option for Missouri residents in need of an abortion: traveling to Kansas or Illinois, where there aren’t trigger laws and abortions aren't as limited. “As of right now, that’s not illegal,” Dr. Addante said. But she worries new laws in the state could punish those who travel out of state for an abortion.
All of that to say: Laws can vary dramatically depending on where you live. Here’s a look at how rules about abortion and medication abortion differ by state.
What are barriers to consider if you need to access the abortion pill?
To name a few:
Mail delays…If you order medication by mail, it could take a few days to access the pills.
Long wait times…Abortion restrictions have forced some people to wait weeks to get an appointment. Even for out-of-state clinics. And in-person visit requirements might make them longer.
Consent processes…Which can include parental consent for minors and the time between meeting with a provider and actually accessing abortion pills.
Distance to clinics…Certain states — including ones that require in-person visits — don’t have many clinics to choose from. Which means there may not be one close to home.
Cost…Insurance restrictions, travel spending, time off work, childcare costs (since more than half of women seeking abortions are already moms) are all factors.
So should people get abortion pills now before they become harder to access?
Short answer: probably not.
“At this point, I probably would not say that you should stock up, but definitely have a plan for emergency contraception in the event of unprotected intercourse or a method failure,” Dr. Addante said. And keep in mind: the abortion pill has a shelf life and can be expensive.
As for your emergency contraception, you could consider getting Plan B in advance, which is available OTC without age restrictions, or Ella (which is prescription only). Note: These morning-after pills are not abortion pills.Instead of ending a pregnancy, they delay ovulation to prevent a pregnancy from happening.
How will the overturn of Roe v. Wade affect access to abortion pills?
It’s hard to say. Because a lot remains unknown.
“That’s a very loaded question. And this is a moving target that gets confusing,” Dr. Addante said.
Every state has different laws that have either already been passed or are moving through their legislatures supporting or restricting access to abortion, and some states also have trigger laws that will go into effect now that SCOTUS has overturned Roe v. Wade, the landmark decision that affirmed a woman’s right to an abortion. “We’re unsure about how that will all play out,” she said.
But Dr. Addante can offer this recommendation: Call your local abortion clinic. “Those are going to be the people most well-versed with what is or is not legal in your state.” They’ll also be most up-to-date on what, if any, legal consequences patients could face for obtaining medication abortions. Here are additional resources for legal abortion questions that Dr. Addante recommends: Reproductive Health Access Project and If/When/How.
When it comes to obtaining a medication abortion, access differs by state and could be more limited now that Roe v. Wade is overturned. But despite some barriers to getting the abortion pill, there are still plenty of resources available to help you if you need it today.
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