+ What is "abortion with pills"?

There are essentially two types of abortion with pills possible in the United States:

1) Those in the U.S. who go to a doctor or a clinic for a medication abortion (an abortion using pills) will most likely be prescribed a combination of pills: mifepristone followed 24 to 48 hours later with misoprostol. This is the most effective method of abortion with pills (95-98% of the abortions are successful), has the fewest side effects, and is approved by the U.S. Food and Drug Administration (FDA) for early abortion. Sold under the name of Mifeprex, it is the medication abortion method provided by Planned Parenthood and recommended by the American College of Obstetricians and Gynecologists.

2) Abortion with pills is also possible using only misoprostol pills, though it is less effective than when used in combination with mifepristone (about 80-85 percent of early abortions are successful when only misoprostol is used). The World Health Organization has endorsed the use of misoprostol alone for early abortion when mifepristone is not available.

Both methods - the combination of the two pills and misoprostol alone - are effective and extremely safe; people worldwide have successfully ended their pregnancies using both approaches. While the most effective method is the combination method of mifepristone plus misoprostol, this website also includes information on the use of misoprostol alone since access to mifepristone in the United States is very restricted.

+ Is it safe? What are the risks?

Using abortion pills to terminate early pregnancies (fewer than 70 days counting from the first day of the last regular period) is extremely safe. Using mifepristone plus misoprostol is preferable to using misoprostol alone because the combination is more effective. But, the World Health Organization has endorsed using misoprostol alone when mifepristone is not available.

· Around the world, misoprostol alone has been used to induce early abortion for decades and this use has reduced the injury and death otherwise associated with self-performed abortions. This is because misoprostol is much safer (and more effective) than most other methods people have used when they did not have access to safe abortion services. Increasingly, people are able to access abortion kits that contain both mifepristone plus misoprostol, so self-performed abortions have become even more effective. One study from Ireland found that those who ordered pills from Women on Web and used them at home had similar safety and effectiveness outcomes as those who obtained services in a clinic.

· As with any abortion, the earlier the process is started, the easier it is. As the gestational age (how far along the pregnancy is, as measured in weeks from the first day of the woman's last menstrual cycle) increases, the amount of pain and bleeding increases. Abortion pills work best in the first 10 weeks of pregnancy. Risk of a complication and need for medical attention increases as the pregnancy advances. SASS offers a pregnancy calculator that can be used to determine how far along they are into a pregnancy based on the first day of their last menstrual period (LMP).

· One risk is that abortion pills, even if taken correctly, may not work (i.e. may not end the pregnancy). This is more likely when only misoprostol is used and the risk increases as the pregnancy advances. When using either type of abortion pills, providers strongly recommend doing a pregnancy test 3-4 weeks after taking the pills to ensure that there is no more pregnancy. If the test is positive, providers recommend seeking follow-up care. (Note: using a pregnancy test earlier than 3-4 weeks after an abortion may result in a false positive because it takes time for the hormones produced during pregnancy to leave the body.)

· One type of pregnancy that cannot be aborted using pills is when the pregnancy takes place in the fallopian tubes, outside of the uterus (referred to as an ectopic pregnancy); this happens in about 2 of every 100 pregnancies. In these cases, the abortion pills will not work the person will require medical attention, which can be obtained at any medical facility. For this reason again, it is important to do a pregnancy test after taking the pills and to seek care if the test is positive or if there are any continued signs or symptoms of pregnancy after the abortion (such as severe and increasing abdominal pain, particularly if it is one sided). Although rare, an undiagnosed ectopic pregnancy can lead to serious health consequences.

+ Where can I get abortion pills?

The most common way to obtain these medications is through health centers or providers who provide abortion care. Planned Parenthood has a great web page explaining abortion with pills.

Both mifepristone and misoprostol require a prescription in the United States.

Access to mifepristone is further restricted because only specialized providers can obtain it (it is not stocked in pharmacies).

Alternatively, those in the United States who choose to self-manage their abortions report being able to find both medications outside of the formal medical system in the following ways:

On the internet.

o Online purchasing – A Google search for "online abortion pills" will give many options for purchasing products. We have ordered from a number of the sites and received pills, as advertised. (The pills appear to be authentic but we have not tested them to verify this). Some of these sites accept credit cards, others require wiring money from a bank account or Western Union. The cost of the pills, including shipping, ranges between $180-$230 for an abortion "kit" containing both mifepristone and misoprostol. Buying misoprostol (Cytotec) alone may be less expensive: there is a generic equivalent of Cytotec sold in Canada for about $0.65 per tablet. Some websites require a prescription and others do not.

o Pet medicine sites – Veterinarians commonly prescribe misoprostol for stomach ulcers in dogs. (On one site, a bottle of 100 misoprostol tablets cost $1.49.) Some websites require a prescription and others do not. Because these online pharmacy services are unregulated, there is currently no way to assess the authenticity or quality of the products they provide.

o WomenOnWeb and safe2choose do not ship pills to the United States but have some information on how women in the United States have been able to get abortion pills.

Locally.

Some have found misoprostol available for sale in bodegas, farmacias, and other local community medicine sellers.

Internationally.

Some people obtain these medicines while traveling or from friends who have traveled. Mifepristone plus misoprostol abortion "kits" are sold in some countries at the pharmacy, without a prescription. Those who travel to Mexico or Latin American countries have discovered that misoprostol is available over-the-counter and sold at a low cost in these countries.

At home.

Many have noted that misoprostol is already in their medicine cabinets because it is a very commonly prescribed drug, especially for people who have peptic ulcers or arthritis.

+ Where can I get instructions?

Women Help Women offers a secure online way to chat with trained counselors who can advise you about the medical and legal issues involved in self-managed abortion in the United States.

Safe2choose offers a live chat where you can ask all your questions to professionals and receive immediate answers.

Women on Web has complete information about taking mifepristone plus misoprostol.

Women on Waves has a visual that shows how to take misoprostol alone.

Other resources include:

howtouseabortionpill.org - instructions for both methods of abortion.

Gynuity - instructions for misoprostol alone abortion.

Ibis Reproductive Health - instructions for both methods of abortion, and

All of these sites have very accurate and detailed descriptions of:

  • how many pills to take and how to take them
  • what to expect once the bleeding and cramps begin
  • important information about what to do if there is heavy bleeding (described as bleeding that lasts for more than 2-3 hours and soaks more than 2-3 sanitary pads per hour)
  • what painkillers to use for cramps
  • when to seek medical attention for complications or ongoing pregnancy, and
  • how to confirm that the pills were effective (that you are no longer pregnant).

    + What can I expect after taking abortion pills?

Most people will experience bleeding and cramping, which are a natural and necessary aspect of medical abortion.

The bleeding is likely to be heavier than a normal period (the American College of Obstetrics and Gynecology describes the bleeding as “comparable with a miscarriage”), and the cramping can be mild to severe, depending on the individual and on how far along the pregnancy has progressed.

Other side effects commonly associated with taking abortion pills include nausea, vomiting, diarrhea, headache, dizziness, and fevers.

The sites referenced above have additional detailed information on what you need to know, what you can expect, and how to manage side effects.

+ Can I get in trouble for using abortion pills?

The short answer is: it depends. If you go to your doctor and are prescribed the pills for the specific purpose of inducing your abortion, then no. However, if you obtain or use the pills on your own, without a prescription or supervision of a health professional, the legal risk is unclear. Even though abortion is legal in the U.S., people who have abortions with pills ordered online through non-clinical channels may face unwarranted risk of arrest.

The federal government and the U.S. states and territories have a wide variety of laws that prosecutors may try to use to punish someone who uses abortion pills outside of an approved medical context. There have been a small number of womenen in the U.S. who have been arrested for trying to or actually inducing an abortion by using pills. Attorneys have, in most cases, been able to get the charges thrown out. Most of the cases came to police attention because women took the abortion pills at a later stage of pregnancy than they had realized and then sought medical help or they were identified because of the way in which they disposed of the miscarriage tissue. Those who are already marginalized due to their race, gender identity, economic status, or other factors may face increased risk of prosecution.

Although health care providers have legal as well as strong ethical obligations to protect patient privacy and confidentiality, some have reported patients who have used abortion medications to the police. In these cases, the women being reported most likely told their care provider that they took abortion medication. However, those who choose to self-manage their abortion have no obligation to report that they have used misoprostol and there is no way it can be detected in the body, even if a blood test is taken. Scientists have found that there is no noticeable difference between a naturally occurring miscarriage and the bleeding that happens after taking misoprostol. Additionally, because the misoprostol is metabolized rapidly (quickly absorbed by the blood) it will not be detectable in a blood sample. So women who seek medical follow-up due to heavy bleeding or excessive cramping (and are concerned about maintaining their medical privacy) and choose not to mention the fact that they have taken pills and they can rest assured that the medication cannot be detected and that providers can provide safe and effective treatment without knowing the cause of the miscarriage.

Because people who order pills online leave digital footprints about their abortion which can be used in criminal prosecutions, some people who choose to use abortion pills outside of the established medical system report taking extra precautions to protect the privacy of their decision to self-manage their abortion. For example, some report installing VPNs (Virtual Private Networks) on their computers or phones to help protect their private identity and location when searching for information or making purchases. One free VPN service is TOR. Some people report using encrypted email services, such as Proton Mail, or secure texting services, such as Signal. And, some choose to make purchases using non-traceable payment methods, like Bitcoin.

Because it is constitutionally impermissible to punish people for having abortions, legal experts believe that no law may result in people going to jail for buying abortion pills, regardless of where the pills came from. But, if you do choose to use abortion pills outside of the established medical system and get into trouble it is important to get legal help. An organization that may be able to help, or assist you in getting legal help, is National Advocates for Pregnant Women.

Once you have decided to have an abortion, you should be able to do so safely, effectively and with dignity. You deserve to have the help of medical professionals and lawyers if you need them and there are people who want to provide you with the support you need. Remember: • Self-use of abortion pills may have some legal risks and risks may be higher for those who are already unfairly targeted by law enforcement. • You are not obligated to tell anyone that you took abortion pills (and doing so may increase your risk of prosecution). • There is no way for a provider to know whether you took pills. • Many people just say they are having a miscarriage. • Medical providers can give you appropriate follow up care for bleeding and pain without knowing whether you took pills. • Some people use VPNs and other technology to protect their privacy. • If you are questioned by the police or your provider, seek legal assistance immediately (SIALegalTeam@protonmail.org).

+ How can I help?

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