Since 2020, the most common way to terminate a pregnancy in the United States is with medications rather than via a surgical procedure, according to the Guttmacher Institute. This trend has further accelerated since the COVID-19 pandemic and the growing number of restrictions on abortion in many states since the June 2022 overturning of Roe v. Wade.
Known as a medication abortion, medical abortion, or the abortion pill, the process typically involves a two-drug combination. Mifepristone, which was approved in 2000 by the U.S. Food and Drug Administration (FDA), stops pregnancy cells from growing and replicating. This pill is followed one or two days later by misoprostol, a drug that brings on heavy cramping that expels the tissue in the uterus.
But myths and misconceptions about medication abortions are widespread.
Here are eight incorrect beliefs about the abortion pill, and the accurate facts everyone should know.
Myth 1: A Surgical Procedure Is Required to Terminate a Pregnancy
When we think of abortion, many of us visualize a “surgical” or procedural abortion, which is done in a sterile clinical setting.
A surgical abortion, per MedlinePlus, generally involves dilating the opening of the uterus, known as the cervix, and using suction to remove the fetus and other tissue from the pregnancy. Sedative medication is often used to help a person relax during the procedure. After the procedure, medicines may be given to contract the uterus and stem bleeding, along with an antibiotic to reduce infection risks.
This was once the most popular method of abortions, but in 2020 medication abortions surpassed surgical procedures for the first time, according to the Guttmacher Institute. This represents a significant increase from the group’s prior research, when medical abortions accounted for 39 percent, in 2017.
This trend toward more medical abortions further increased during the COVID-19 pandemic, when surgical procedures were limited or delayed and people began looking for other options.
Myth 2: Medication Abortions Aren’t Super Effective
Medication abortion has proven to be overwhelmingly effective as well as safe during the two decades it has been in use. When the National Academies of Sciences, Engineering, and Medicine conducted a comprehensive review of the science of abortion care, it concluded that medication abortions effectively end early pregnancies with extremely low rates of serious complications.
According to Planned Parenthood, the pills are most effective when taken at 8 weeks of pregnancy or earlier. But medication abortion still works more than 90 percent of the time for those 9 to 10 weeks pregnant, and about 87 percent of the time for people up to 11 weeks.
Even when it’s less effective in these later weeks of the first trimester, people can be given an extra pill, and then the abortion is almost always completed, Planned Parenthood says.
Another option in these rare cases is to follow up with an in-clinic surgical procedure to complete the abortion.
Myth 3: Medication Abortions Are Also Called Plan B
Many people confuse the abortion pill with another medication known as Plan B.
Plan B consists of a drugstore pill that contains the hormone levonorgestrel, a synthetic progestin similar to the progesterone the body naturally makes to regulate the menstrual cycle. The hormone inhibits or delays ovulation.
“Plan B can be used within 72 hours of having sex,” says Sherry Ross, MD, a gynecologist and the author of She-ology and She-ology, the She-quel. “It is most effective when taken within 24 hours of having sex,” she notes.
By contrast, abortion pills work by a completely different mechanism, inhibiting the growth of pregnancy tissue rather than delaying ovulation. One prevents a pregnancy, and the other ends it.
Myth 4: You Have to Visit a Doctor in Their Office or Clinic to Get Abortion Pills
Actually, you may not need to.
First, a doctor does not necessarily have to be involved. Many states allow non-physician medical professionals like physician assistants and advanced practice nurses to prescribe the pills. Some states, though, have laws requiring the person administering medication abortion to be a licensed medical doctor.
Second, during the pandemic, a growing number of telehealth medical abortion providers became available in various states. With telehealth abortions, Plan C’s Wells says, “you can have this safe and effective procedure without needing to take time off work, find childcare, and the like.”
Telehealth abortions allow for more privacy, since women don’t have to go to an abortion clinic — or navigate their way past protesters, Wells adds. And in areas of the country that are rural or underserved by providers, telehealth medication abortions can save a patient hundreds of miles of travel, according to the nonprofit Guttmacher Institute.
Plan C lists a number of these telehealth abortion sites that work in various states. They include Hey Jane, Just the Pill, Choix, Forward Midwifery, and Aid Access. You can search which telehealth providers are available in your state on the website of Plan C.
Telehealth abortions were the subject of a study published in August 2021 in Obstetrics & Gynecology. Researchers at the University of California in San Francisco followed 110 Choix telehealth patients and found 95 percent had complete abortions from the pills. The 5 percent who required further medical care is similar to the rate for in-person medical abortions, the study authors note. And no patients reported any adverse events.
Myth 5: Abortion Pills Need to Be Taken in a Doctor’s Office or Clinic
Women who get the abortion pills after a telehealth consultation or who order it online take the pills in the comfort of their own home.
Even women who go to an office or clinic for a medication abortion generally take pills at home. They might take the first pill, mifepristone, in the medical setting and take the second medication home with them to take later. Or both drugs might be taken after the patient returns home.
Because it takes a while for the medicines to be effective, a medical abortion is nearly always completed in the person’s home or other comfortable location.
Myth 6: You Must Have a Prescription to Get Abortion Pills
That used to be the case, but it isn’t any longer.
For a long time, mifepristone was regulated under a special provision of the FDA that required it to be administered in a clinic, hospital, or under the direct supervision of a certified medical provider, known as the “in-person dispensing requirement.”
This prevented it from being delivered by mail or from being readily available in retail pharmacies.
But during the pandemic the FDA changed this requirement to remove the in-person specification and added a requirement that any dispensing pharmacies must be certified. In December of 2021, it made the changes permanent.
Although the FDA cautions people not to buy the drugs over the internet, “because you will bypass important safeguards designed to protect your health,” many health experts say buying from reputable sites is fine.
The growth of online dispensing pharmacies is allowing a greater number of women to “self-manage” their abortion, Wells says. They simply order abortion pills directly from certain websites, without a healthcare provider prescribing it.
Myth 7: Medication Abortions Are Not Covered by Insurance
According to Planned Parenthood, many health insurance plans do, in fact, cover abortions, making the procedure free or low-cost to those with this insurance. (Check with your insurance provider directly to see if your insurance is in this category.) Note that in several states, laws prohibit private insurers from covering abortion.
People on Medicaid may or may not have their abortion pills covered. “Some … plans in certain states cover abortion, while others don’t. Some plans only cover abortion in certain cases,” Planned Parenthood advises.
If your insurance won’t cover the cost of a medical abortion, which can run hundreds of dollars, you may still be able to get assistance. A number of organizations offer funds to help pay for abortions. You can find some of these groups through the National Network of Abortion Funds.
Myth 8: If Abortion Is Not Legal in Your State, You Can’t Get a Medical Abortion
Medication abortions are always legal in states that have not banned or severely restricted abortions.
In states that do have severe abortion restrictions, determining whether a medical abortion is legal can be complex.
According to the Guttmacher Institute, banning medication abortion outright has been found to be unconstitutional. But it notes that other state-level restrictions have been allowed to go into effect.
For example, South Dakota approved regulations that require patients to make four trips to a clinic in order to obtain a medication abortion, although this was blocked pending the outcome of litigation. Other states have banned the use of telehealth abortions.
Abortion advocates say some women are getting around state bans by having the medications mailed to another state where abortion pills are explicitly legal. This can be a friend’s address or a “general delivery” mailbox at a post office in that state, where the person then drives to pick up the pills.
Of course, there is a legal risk of being prosecuted in some states that prohibit medical abortions or the mailing of pills. You can learn more about the possible legal repercussions from the Repro Legal Helpline, a free site designed to educate women about their legal rights in obtaining a desired abortion.