medical abortion#side effects

File:Abortion pill.jpg

For medical abortion up to 12 weeks' gestation, the recommended drug dosages are 200 milligrams of mifepristone by mouth, followed one to two days later by 800 micrograms of misoprostol inside the cheek, vaginally, or under the tongue.{{cite book |title=Abortion Care Guideline |date=2022 |publisher=World Health Organization (WHO) |location=Geneva |isbn=9789240039483 |url=https://www.who.int/publications/i/item/9789240039483}} The success rate of this drug combination is 96.6% through 10 weeks' pregnancy.{{cite journal | vauthors = Chen MJ, Creinin MD | title = Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review | journal = Obstetrics and Gynecology | volume = 126 | issue = 1 | pages = 12–21 | date = July 2015 | pmid = 26241251 | doi = 10.1097/AOG.0000000000000897 | s2cid = 20800109 | url = https://escholarship.org/uc/item/2pw521h5 }}

Medical abortion performed very early, before the pregnancy can be detected by ultrasound, is just as safe and effective as medical abortion after the pregnancy is detectable by ultrasound.{{cite journal |vauthors=Brandell K, Jar-Allah T, Reynolds-Wright J, Kopp Kallner H, Hognert H, Gyllenberg F, Kaislasuo J, Tamang A, Tuladhar H, Boerma C, Schimanski K, Gibson G, Løkeland M, Teleman P, Bixo M, Mandrup Kjaer M, Kallfa E, Bring J, Heikinheimo O, Cameron S, Gemzell-Danielsson K |date=2024 |title=Randomized Trial of Very Early Medication Abortion |url=https://www.nejm.org/doi/full/10.1056/NEJMoa2401646 |journal=New England Journal of Medicine |volume=391 |issue=18 |pages=1685–1695 |doi=10.1056/NEJMoa2401646 |pmid=39504520|url-access=subscription }} Misoprostol should be administered 24 to 48 hours after the mifepristone; taking the misoprostol before 24 hours have elapsed reduces the probability of success.{{cite journal | vauthors = Raymond EG, Shannon C, Weaver MA, Winikoff B | title = First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review | journal = Contraception | volume = 87 | issue = 1 | pages = 26–37 | date = January 2013 | pmid = 22898359 | doi = 10.1016/j.contraception.2012.06.011 }} However, one study showed that the two drugs may be taken simultaneously with nearly the same efficacy.{{cite journal | vauthors = Creinin MD, Schreiber CA, Bednarek P, Lintu H, Wagner MS, Meyn LA | title = Mifepristone and misoprostol administered simultaneously versus 24 hours apart for abortion: a randomized controlled trial | journal = Obstetrics and Gynecology | volume = 109 | issue = 4 | pages = 885–894 | date = April 2007 | pmid = 17400850 | doi = 10.1097/01.AOG.0000258298.35143.d2 | s2cid = 43298827 | url = https://escholarship.org/uc/item/4b25p01k }}

For pregnancies after 9 weeks, two doses of misoprostol (the second drug) makes the treatment more effective.{{cite journal | vauthors = Kapp N, Eckersberger E, Lavelanet A, Rodriguez MI | title = Medical abortion in the late first trimester: a systematic review | journal = Contraception | volume = 99 | issue = 2 | pages = 77–86 | date = February 2019 | pmid = 30444970 | pmc = 6367561 | doi = 10.1016/j.contraception.2018.11.002 }} From 10 to 11 weeks of pregnancy, the National Abortion Federation suggests second dose of misoprostol (800 micrograms) four hours after the first dose. If the pregnancy involves twins, a higher dosage of mifepristone may be recommended.{{cite journal |vauthors=Sørensen EC, Iversen OE, Bjørge L |date=March 2005 |title=Failed medical termination of twin pregnancy with mifepristone: a case report |journal=Contraception |volume=71 |issue=3 |pages=231–233 |doi=10.1016/j.contraception.2004.09.002 |pmid=15722075 |doi-access=free |title-link=doi}}

After the patient takes mifepristone, they must also administer the misoprostol. While there is a chance for the pregnancy to successfully abort, failure to take the misoprostol may result in any of these outcomes: the fetus may be terminated, but not fully expelled from the uterus (possibly accompanied by hemorrhaging) and may require surgical intervention to remove the fetus; or the pregnancy may continue with a healthy fetus. For those reasons, misoprostol should always be taken after the mifepristone.{{cite journal | vauthors = Creinin MD, Hou MY, Dalton L, Steward R, Chen MJ | title = Mifepristone Antagonization With Progesterone to Prevent Medical Abortion: A Randomized Controlled Trial | journal = Obstetrics and Gynecology | volume = 135 | issue = 1 | pages = 158–165 | date = January 2020 | pmid = 31809439 | doi = 10.1097/AOG.0000000000003620 | quote = Patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage. | s2cid = 208813409 | doi-access = free | title-link = doi }}

In the first trimester, self-administered medical abortion is available for patients who prefer to take the abortion drugs at home without direct medical supervision (in contrast to provider-administered medical abortion where the patient takes the second abortion drug in the presence of a trained healthcare provider). Evidence from clinical trials indicates self-administered medical abortion is as effective as provider-administered abortion; however additional research is required to confirm that safety is equivalent.{{cite journal | vauthors = Gambir K, Kim C, Necastro KA, Ganatra B, Ngo TD | title = Self-administered versus provider-administered medical abortion | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 3 | pages = CD013181 | date = March 2020 | pmid = 32150279 | pmc = 7062143 | doi = 10.1002/14651858.CD013181.pub2 }}{{cite journal | vauthors = Schmidt-Hansen M, Pandey A, Lohr PA, Nevill M, Taylor P, Hasler E, Cameron S | title = Expulsion at home for early medical abortion: A systematic review with meta-analyses | journal = Acta Obstetricia et Gynecologica Scandinavica | volume = 100 | issue = 4 | pages = 727–735 | date = April 2021 | pmid = 33063314 | doi = 10.1111/aogs.14025 | s2cid = 222819835 | doi-access = free | title-link = doi }}

The procedure used to administer the two drugs depends on specific drugs prescribed. A typical procedure, for 200 mg mifepristone tablets, is:{{Cite web |title=MIFEPREX (mifepristone) Tablets Label |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20687lbl.htm |access-date=June 30, 2022 |publisher=FDA}}{{Cite web |date=January 30, 2020 |title=Mifepristone and misoprostol: Recommended regimen |url=https://www.ipas.org/clinical-update/english/recommendations-for-abortion-at-or-after-13-weeks-gestation/medical-abortion/mifepristone-and-misoprostol-recommended-regimen/ |access-date=June 30, 2022 |publisher=Ipas }}{{Cite web |date=February 7, 2022 |title=Mifeprex (mifepristone) Information |url=https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information |archive-url=https://web.archive.org/web/20190427211028/https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information |url-status=dead |archive-date=April 27, 2019 |publisher=U.S. Food and Drug Administration (FDA) }}{{cite journal | vauthors = | title = Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin, Number 225 | journal = Obstetrics and Gynecology | volume = 136 | issue = 4 | pages = e31–e47 | date = October 2020 | pmid = 32804884 | doi = 10.1097/AOG.0000000000004082 }}

1. Take the 200 mg mifepristone tablet by mouth
2. Take the 800 μg misoprostol (typically four pills) between 24 hours and 48 hours after the mifepristone (instructions supplied with the misoprostol will specify how to take it, such as: buccally (between the gums and the inner lining of the mouth cheek), or under the tongue, or in the vagina by vaginal suppository)
3. The pregnancy (embryo and placenta) will be expelled through the vagina within 2 to 24 hours after taking misoprostol, so the patient should remain near toilet facilities at that time. Cramps, nausea and bleeding may be experienced while the pregnancy is being expelled, and afterwards
4. To avoid infection, the patient should not use tampons, be submerged in water (swimming pool or bath), or engage in intercourse for 2 to 3 weeks
5. The patient should contact their provider 7 to 14 days after the administration of mifepristone to confirm that complete termination of pregnancy has occurred and to evaluate the degree of bleeding

Medical abortion is safe and effective in the second and third trimesters.{{Cite book|title=Safe abortion: technical and policy guidance for health systems-2nd ed|publisher=World Health Organization (WHO)|year=2012|isbn=9789241548434|location=Italy|pages=42}}{{cite journal | vauthors = Gómez Ponce de León R, Wing DA | title = Misoprostol for termination of pregnancy with intrauterine fetal demise in the second and third trimester of pregnancy - a systematic review | journal = Contraception | volume = 79 | issue = 4 | pages = 259–271 | date = April 2009 | pmid = 19272495 | doi = 10.1016/j.contraception.2008.10.009 }}{{cite journal | vauthors = Mendilcioglu I, Simsek M, Seker PE, Erbay O, Zorlu CG, Trak B | title = Misoprostol in second and early third trimester for termination of pregnancies with fetal anomalies | journal = International Journal of Gynaecology and Obstetrics | volume = 79 | issue = 2 | pages = 131–135 | date = November 2002 | pmid = 12427397 | doi = 10.1016/s0020-7292(02)00224-2 | s2cid = 44373757 }} The World Health Organization (WHO) recommends that medical abortions performed after 12 weeks' gestation be supervised by a generalist medical practitioner or specialist medical practitioner (in contrast to first trimester, where the patient may safely take the drugs at home without supervision).{{Cite web |date=November 19, 2021 |title=Self-management Recommendation 50: Self-management of medical abortion in whole or in part at gestational ages < 12 weeks (3.6.2) - Abortion care guideline |url=https://srhr.org/abortioncare/chapter-3/service-delivery-options-and-self-management-approaches-3-6/self-management-recommendation-50-self-management-of-medical-abortion-in-whole-or-in-part-at-gestational-ages-12-weeks-3-6-2/ |access-date=June 30, 2022 |publisher=WHO Department of Sexual and Reproductive Health and Research }}

For medical abortion after 12 weeks' gestation, the WHO recommends 200 mg of mifepristone by mouth followed one to two days later by repeat doses of 400 μg misoprostol under the tongue, inside the cheek, or in the vagina. Misoprostol should be taken every 3 hours until successful abortion is achieved, the mean time to abortion after starting misoprostol is 6–8 hours, and approximately 94% will abort within 24 hours after starting misoprostol.{{cite journal | vauthors = Borgatta L, Kapp N | title = Clinical guidelines. Labor induction abortion in the second trimester | journal = Contraception | volume = 84 | issue = 1 | pages = 4–18 | date = July 2011 | pmid = 21664506 | doi = 10.1016/j.contraception.2011.02.005 }} When mifepristone is not available, misoprostol may still be used though the mean time to abortion after starting misoprostol will be extended compared to regimens using mifepristone followed by misoprostol.{{cite journal | vauthors = Perritt JB, Burke A, Edelman AB | title = Interruption of nonviable pregnancies of 24-28 weeks' gestation using medical methods: release date June 2013 SFP guideline #20133 | journal = Contraception | volume = 88 | issue = 3 | pages = 341–349 | date = September 2013 | pmid = 23756114 | doi = 10.1016/j.contraception.2013.05.001 | doi-access = free | title-link = doi }}

The mifepristone-misoprostol combination is, by far, the most recommended drug regimen for medical abortions, but other drug combinations are available.

Misoprostol alone, without mifepristone, may be used in some circumstances for medical abortion, and has even been demonstrated to be successful in the second trimester.{{cite journal | vauthors = | title = ACOG Practice Bulletin No. 135: Second-trimester abortion | journal = Obstetrics and Gynecology | volume = 121 | issue = 6 | pages = 1394–1406 | date = June 2013 | pmid = 23812485 | doi = 10.1097/01.AOG.0000431056.79334.cc | s2cid = 205384119 }} Misoprostol is more commonly available than mifepristone, and is easier to store and administer, so misoprostol without mifepristone may be suggested by the provider if mifepristone is not available. If misoprostol is used without mifepristone, the WHO recommends 800 μg of misoprostol inside the cheek, under the tongue, or in the vagina. The success rate of misoprostol alone for terminating pregnancy (93%) is nearly the same as the mifepristone-misoprostol combination (96%). However, 15% of the women using misoprostol alone required a surgical follow-up procedure, which is significantly more than the mifepristone-misoprostol combination.{{cite journal | vauthors = Raymond EG, Harrison MS, Weaver MA | title = Efficacy of Misoprostol Alone for First-Trimester Medical Abortion: A Systematic Review | journal = Obstetrics and Gynecology | volume = 133 | issue = 1 | pages = 137–147 | date = January 2019 | pmid = 30531568 | pmc = 6309472 | doi = 10.1097/AOG.0000000000003017 }}

Tests have shown that letrozole or methotrexate may be included in the mifepristone-misoprostol regimen to improve the outcome in the first trimester.{{cite journal | vauthors = Zhuo Y, Cainuo S, Chen Y, Sun B | title = The efficacy of letrozole supplementation for medical abortion: a meta-analysis of randomized controlled trials | journal = The Journal of Maternal-Fetal & Neonatal Medicine | volume = 34 | issue = 9 | pages = 1501–1507 | date = May 2021 | pmid = 31257957 | doi = 10.1080/14767058.2019.1638899 | s2cid = 195764644 }}{{cite journal | vauthors = Yeung TW, Lee VC, Ng EH, Ho PC | title = A pilot study on the use of a 7-day course of letrozole followed by misoprostol for the termination of early pregnancy up to 63 days | journal = Contraception | volume = 86 | issue = 6 | pages = 763–769 | date = December 2012 | pmid = 22717187 | doi = 10.1016/j.contraception.2012.05.009 }}

A rarely used drug combination for uterine pregnancies is methotrexate-misoprostol, which is typically reserved for ectopic pregnancies.{{Cite web |title=Medical abortion | publisher = Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/medical-abortion/about/pac-20394687 |access-date=July 10, 2022 }} Methotrexate is given either orally or intramuscularly, followed by vaginal misoprostol 3–5 days later.{{cite web|url=https://prochoice.org/education-and-advocacy/cpg/|title=NAF Clinical Policy Guidelines | publisher = National Abortion Federation|access-date=April 10, 2020 }} The methotrexate combination is available through 63 days. The WHO authorizes the methotrexate-misoprostol combination{{Cite web |url=http://www.webmd.com/women/methotrexate-and-misoprostol-for-abortion | archive-url = https://web.archive.org/web/20150227080619/http://www.webmd.com/women/methotrexate-and-misoprostol-for-abortion | archive-date = February 27, 2015 |title=Methotrexate and Misoprostol for Abortion | work = Women's Health | publisher = WebMD }} but recommends the mifepristone combination because methotrexate may be teratogenic to the embryo in cases of incomplete abortion. The methotrexate-misoprostol combination is considered more effective than misoprostol alone.{{cite book|title=Management of unintended and abnormal pregnancy : comprehensive abortion care|url=https://archive.org/details/managementuninte00paul|url-access=limited| vauthors = Creinin MD, Danielsson KG |publisher=Wiley-Blackwell|year=2009|isbn=978-1-4051-7696-5| veditors = Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |location=Oxford|pages=[https://archive.org/details/managementuninte00paul/page/n130 111]–134|chapter=Medical abortion in early pregnancy}}

Contraindications to mifepristone are inherited porphyria, chronic adrenal failure, and ectopic pregnancy.{{cite book|url=http://whqlibdoc.who.int/publications/2006/9241594845_eng.pdf|archive-url=https://web.archive.org/web/20090117164404/http://whqlibdoc.who.int/publications/2006/9241594845_eng.pdf|url-status=dead|archive-date=January 17, 2009|title=Frequently asked clinical questions about medical abortion|author=International Consensus Conference on Non-surgical (Medical) Abortion in Early First Trimester on Issues Related to Regimens and Service Delivery|publisher=World Health Organization (WHO)|year=2006|isbn=978-92-4-159484-4|location=Geneva}}{{cite journal | vauthors = | title = Medical management of first-trimester abortion | journal = Contraception | volume = 89 | issue = 3 | pages = 148–161 | date = March 2014 | pmid = 24795934 | doi = 10.1016/j.contraception.2014.01.016 | publisher = American College of Obstetricians and Gynecologists; Society of Family Planning | doi-access = free | title-link = doi }} Some consider an intrauterine device in place to be a contraindication as well. A previous allergic reaction to mifepristone or misoprostol is also a contraindication.

Many studies excluded women with severe medical problems such as heart and liver disease or severe anemia. Caution is required in a range of circumstances including:

• long-term corticosteroid use;
• bleeding disorder;
• severe anemia

In some cases, it may be appropriate to refer people with preexisting medical conditions to a hospital-based abortion provider.{{cite journal | vauthors = Guiahi M, Davis A | title = First-trimester abortion in women with medical conditions: release date October 2012 SFP guideline #20122 | journal = Contraception | volume = 86 | issue = 6 | pages = 622–630 | date = December 2012 | pmid = 23039921 | doi = 10.1016/j.contraception.2012.09.001 | s2cid = 21464833 }}

Conversely, some medical conditions may make medication abortion more favorable than surgical abortion, such as large uterine fibroids, congenital uterine anomalies, or genital scarring related to infibulation.{{cite journal | vauthors = Mark K, Bragg B, Chawla K, Hladky K | title = Medical abortion in women with large uterine fibroids: a case series | journal = Contraception | volume = 94 | issue = 5 | pages = 572–574 | date = November 2016 | pmid = 27471029 | doi = 10.1016/j.contraception.2016.07.016 }}{{cite journal | vauthors = Goldthwaite LM, Teal SB | title = Controversies in family planning: pregnancy termination in women with uterine anatomic abnormalities | journal = Contraception | volume = 90 | issue = 4 | pages = 460–463 | date = October 2014 | pmid = 24958107 | doi = 10.1016/j.contraception.2014.05.007 }}{{cite journal | vauthors = Mistry H, Jha S | title = Pregnancy with a pinhole introitus: A report of two cases and a review of the literature | journal = The European Journal of Contraception & Reproductive Health Care | volume = 20 | issue = 6 | pages = 490–494 | date = May 11, 2015 | pmid = 25960283 | doi = 10.3109/13625187.2015.1044083 | s2cid = 207523628 }}

Most women will have cramping and bleeding heavier than a menstrual period. Other adverse effects may include nausea, vomiting, fever, chills, diarrhea, headache, dizziness, warmth or hot flashes.{{Cite web |date=October 21, 2021 |title=Medical Abortion: What Is It, Types, Risks & Recovery |url=https://my.clevelandclinic.org/health/treatments/21899-medical-abortion |access-date=June 30, 2022 |publisher=Cleveland Clinic}} When used inside the vagina, misoprostol tends to have fewer gastrointestinal side effects. Nonsteroidal anti-inflammatory medications such as ibuprofen reduce pain with medication abortion.

• Heavy bleeding (if you bleed through two or more pads for two or more consecutive hours, seek medical attention){{Cite web|url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020687s020lbl.pdf|archive-url=https://web.archive.org/web/20160330220744/http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020687s020lbl.pdf|url-status=dead|archive-date=March 30, 2016|title=Mifepristone Prescribing Information|publisher=U.S. Food and Drug Administration (FDA) }}
• Abdominal pain, nausea, vomiting, diarrhea, fever for more than 24 hours after taking mifepristone
• Fever of {{Cvt|38|C|1}} or higher for more than 4 hours

Complications under 10 weeks' pregnancy are rare; according to two large reviews, bleeding requiring a blood transfusion occurred in 0.03–0.6% of women and serious infection in 0.01–0.5%. Because infection is rare after medication abortion, preventative antibiotics are not recommended (in contrast to surgical abortions, where antibiotics are routinely provided).{{cite journal | vauthors = Achilles SL, Reeves MF | title = Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102 | journal = Contraception | volume = 83 | issue = 4 | pages = 295–309 | date = April 2011 | pmid = 21397086 | doi = 10.1016/j.contraception.2010.11.006 | doi-access = free | title-link = doi }} A few rare cases of deaths from clostridial toxic shock syndrome have occurred following medical abortions.{{cite journal | vauthors = Murray S, Wooltorton E | title = Septic shock after medical abortions with mifepristone (Mifeprex, RU 486) and misoprostol | journal = CMAJ | volume = 173 | issue = 5 | pages = 485 | date = August 2005 | pmid = 16093445 | pmc = 1188182 | doi = 10.1503/cmaj.050980 }}

A 2013 systematic review which included 45,000 women who used the 200 mg mifepristone followed by misoprostol combination found that less than 0.4% had serious complications requiring hospitalization (0.3%) and/or blood transfusion (0.1%).{{ cite news | url=https://www.nytimes.com/2022/08/07/health/abortion-self-managed-medication.html | title=Some Women 'Self-Manage' Abortions as Access Recedes - Information and medications needed to end a pregnancy are increasingly available outside the health care system. | vauthors = Rabin RC | newspaper=The New York Times | date=August 7, 2022 | quote=More than half a million women had medication abortions in 2020 in the United States, and fewer than half of 1 percent experience serious complications, studies show. Medical interventions like hospitalizations or blood transfusions were needed by fewer than 0.4 percent of patients, according to a 2013 review of dozens of studies involving tens of thousands of patients. }}

Vaginal bleeding generally diminishes gradually over about two weeks after a medical abortion, but in individual cases spotting can last up to 45 days. Emergency surgical or medical interventions for prolonged bleeding may be considered based on how the patient feels and if the bleeding seems to be getting better. Overall, less than 1% of individuals who undergo a medical abortion must obtain emergency services for excessive bleeding, and about 0.1% require a blood transfusion.{{cite journal | vauthors = Creinin MD | title = Randomized comparison of efficacy, acceptability and cost of medical versus surgical abortion | journal = Contraception | volume = 62 | issue = 3 | pages = 117–124 | date = September 2000 | pmid = 11124358 | doi = 10.1016/s0010-7824(00)00151-7 }}{{cite journal | vauthors = Henshaw RC, Naji SA, Russell IT, Templeton AA | title = Comparison of medical abortion with surgical vacuum aspiration: women's preferences and acceptability of treatment | journal = BMJ | volume = 307 | issue = 6906 | pages = 714–717 | date = September 1993 | pmid = 8401094 | pmc = 1678709 | doi = 10.1136/bmj.307.6906.714 }}{{cite journal | vauthors = Peyron R, Aubény E, Targosz V, Silvestre L, Renault M, Elkik F, Leclerc P, Ulmann A, Baulieu EE | title = Early termination of pregnancy with mifepristone (RU 486) and the orally active prostaglandin misoprostol | journal = The New England Journal of Medicine | volume = 328 | issue = 21 | pages = 1509–1513 | date = May 1993 | pmid = 8479487 | doi = 10.2307/2939250 | jstor = 2939250 }} Remaining products of conception will be expelled during subsequent vaginal bleeding. Still, surgical intervention may be carried out on the patient's request, if the bleeding is heavy or prolonged, or causes anemia, or if there is evidence of endometritis.

Medical abortion is as safe, or safer, than childbirth, surgical abortion, or unsafe ("back-alley") abortion.

Medical abortion is about 14 times safer than childbirth, and also safer than the mortality rate for Penicillin and Viagra.{{ cite web | url=https://www.ansirh.org/sites/default/files/publications/files/mifepristone_safety_4-23-2019.pdf | title=Analysis of Medication Abortion Risk and the FDA report - "Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018" | publisher=Bixby Center for Global Reproductive Health | date=April 1, 2019 | quote=The mortality rate for women known to have had a live-born infant is 8.8 per 100,000 live births, which is about 14 times higher than the mortality rate associated with medication abortion. Other medications that are commonly prescribed or administered in outpatient settings also have risks, including a small risk of death. Penicillin causes a fatal anaphylactic reaction at a rate of 2 deaths per 100,000 patients administered the drug. Phosphodiesterase type-5 inhibitors, which are used for erectile dysfunction and include Viagra, have a fatality rate of 4 deaths per 100,000 users. These risks are several times higher than the risk of death with medication abortion. }}{{ cite web | url=https://www.fda.gov/media/112118/download | archive-url=https://web.archive.org/web/20190428143542/https://www.fda.gov/media/112118/download | url-status=dead | archive-date=April 28, 2019 | title=Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018 | publisher=Food and Drug Administration | date=December 31, 2018 }}

Medical abortion is as safe, or safer, than surgical abortion. In the United States, an FDA report states that of the 3.7 million women who have had a medication abortion between 2000 and 2018, 24 died afterward, with 11 of those deaths likely unrelated to the abortion, including drug overdoses, homicides, and a suicide. When not taking the 11 likely unrelated deaths into account, the mortality rate for medication abortion is half the mortality rate of abortion overall. Including all deaths in the study, the data shows that the mortality rate for medication abortion is about equal to abortion overall.

Legal medical abortions reduce the risks associated with unsafe abortions. Globally, individuals who can get pregnant face substantial dangers to their health due to the significant challenges in obtaining safe abortion services.{{cite journal | vauthors = Doran F, Nancarrow S | title = Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review | journal = The Journal of Family Planning and Reproductive Health Care | volume = 41 | issue = 3 | pages = 170–180 | date = July 2015 | pmid = 26106103 | doi = 10.1136/jfprhc-2013-100862 }}{{cite journal | vauthors = Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, Gonzalez-Medina D, Barber R, Huynh C, Dicker D, Templin T, Wolock TM, Ozgoren AA, Abd-Allah F, Abera SF, Abubakar I, Achoki T, Adelekan A, Ademi Z, Adou AK, Adsuar JC, Agardh EE, Akena D, Alasfoor D, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Al Kahbouri MJ, Alla F, Allen PJ, AlMazroa MA, Alsharif U, Alvarez E, Alvis-Guzmán N, Amankwaa AA, Amare AT, Amini H, Ammar W, Antonio CA, Anwari P, Arnlöv J, Arsenijevic VS, Artaman A, Asad MM, Asghar RJ, Assadi R, Atkins LS, Badawi A, Balakrishnan K, Basu A, Basu S, Beardsley J, Bedi N, Bekele T, Bell ML, Bernabe E, Beyene TJ, Bhutta Z, Bin Abdulhak A, Blore JD, Basara BB, Bose D, Breitborde N, Cárdenas R, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavlin A, Chang JC, Che X, Christophi CA, Chugh SS, Cirillo M, Colquhoun SM, Cooper LT, Cooper C, da Costa Leite I, Dandona L, Dandona R, Davis A, Dayama A, Degenhardt L, De Leo D, del Pozo-Cruz B, Deribe K, Dessalegn M, deVeber GA, Dharmaratne SD, Dilmen U, Ding EL, Dorrington RE, Driscoll TR, Ermakov SP, Esteghamati A, Faraon EJ, Farzadfar F, Felicio MM, Fereshtehnejad SM, de Lima GM, Forouzanfar MH, França EB, Gaffikin L, Gambashidze K, Gankpé FG, Garcia AC, Geleijnse JM, Gibney KB, Giroud M, Glaser EL, Goginashvili K, Gona P, González-Castell D, Goto A, Gouda HN, Gugnani HC, Gupta R, Gupta R, Hafezi-Nejad N, Hamadeh RR, Hammami M, Hankey GJ, Harb HL, Havmoeller R, Hay SI, Pi IB, Hoek HW, Hosgood HD, Hoy DG, Husseini A, Idrisov BT, Innos K, Inoue M, Jacobsen KH, Jahangir E, Jee SH, Jensen PN, Jha V, Jiang G, Jonas JB, Juel K, Kabagambe EK, Kan H, Karam NE, Karch A, Karema CK, Kaul A, Kawakami N, Kazanjan K, Kazi DS, Kemp AH, Kengne AP, Kereselidze M, Khader YS, Khalifa SE, Khan EA, Khang YH, Knibbs L, Kokubo Y, Kosen S, Defo BK, Kulkarni C, Kulkarni VS, Kumar GA, Kumar K, Kumar RB, Kwan G, Lai T, Lalloo R, Lam H, Lansingh VC, Larsson A, Lee JT, Leigh J, Leinsalu M, Leung R, Li X, Li Y, Li Y, Liang J, Liang X, Lim SS, Lin HH, Lipshultz SE, Liu S, Liu Y, Lloyd BK, London SJ, Lotufo PA, Ma J, Ma S, Machado VM, Mainoo NK, Majdan M, Mapoma CC, Marcenes W, Marzan MB, Mason-Jones AJ, Mehndiratta MM, Mejia-Rodriguez F, Memish ZA, Mendoza W, Miller TR, Mills EJ, Mokdad AH, Mola GL, Monasta L, de la Cruz Monis J, Hernandez JC, Moore AR, Moradi-Lakeh M, Mori R, Mueller UO, Mukaigawara M, Naheed A, Naidoo KS, Nand D, Nangia V, Nash D, Nejjari C, Nelson RG, Neupane SP, Newton CR, Ng M, Nieuwenhuijsen MJ, Nisar MI, Nolte S, Norheim OF, Nyakarahuka L, Oh IH, Ohkubo T, Olusanya BO, Omer SB, Opio JN, Orisakwe OE, Pandian JD, Papachristou C, Park JH, Caicedo AJ, Patten SB, Paul VK, Pavlin BI, Pearce N, Pereira DM, Pesudovs K, Petzold M, Poenaru D, Polanczyk GV, Polinder S, Pope D, Pourmalek F, Qato D, Quistberg DA, Rafay A, Rahimi K, Rahimi-Movaghar V, ur Rahman S, Raju M, Rana SM, Refaat A, Ronfani L, Roy N, Pimienta TG, Sahraian MA, Salomon JA, Sampson U, Santos IS, Sawhney M, Sayinzoga F, Schneider IJ, Schumacher A, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shakh-Nazarova M, Sheikhbahaei S, Shibuya K, Shin HH, Shiue I, Sigfusdottir ID, Silberberg DH, Silva AP, Singh JA, Skirbekk V, Sliwa K, Soshnikov SS, Sposato LA, Sreeramareddy CT, Stroumpoulis K, Sturua L, Sykes BL, Tabb KM, Talongwa RT, Tan F, Teixeira CM, Tenkorang EY, Terkawi AS, Thorne-Lyman AL, Tirschwell DL, Towbin JA, Tran BX, Tsilimbaris M, Uchendu US, Ukwaja KN, Undurraga EA, Uzun SB, Vallely AJ, van Gool CH, Vasankari TJ, Vavilala MS, Venketasubramanian N, Villalpando S, Violante FS, Vlassov VV, Vos T, Waller S, Wang H, Wang L, Wang X, Wang Y, Weichenthal S, Weiderpass E, Weintraub RG, Westerman R, Wilkinson JD, Woldeyohannes SM, Wong JQ, Wordofa MA, Xu G, Yang YC, Yano Y, Yentur GK, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Jin KY, El Sayed Zaki M, Zhao Y, Zheng Y, Zhou M, Zhu J, Zou XN, Lopez AD, Naghavi M, Murray CJ, Lozano R | title = Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 384 | issue = 9947 | pages = 980–1004 | date = September 2014 | pmid = 24797575 | pmc = 4255481 | doi = 10.1016/s0140-6736(14)60696-6 }}{{cite journal | vauthors = Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF | title = WHO analysis of causes of maternal death: a systematic review | journal = Lancet | volume = 367 | issue = 9516 | pages = 1066–1074 | date = April 2006 | pmid = 16581405 | doi = 10.1016/s0140-6736(06)68397-9 | s2cid = 2190885 }}{{cite journal | vauthors = Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B, Rossier C, Gerdts C, Tunçalp Ö, Johnson BR, Johnston HB, Alkema L | title = Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends | journal = Lancet | volume = 388 | issue = 10041 | pages = 258–267 | date = July 2016 | pmid = 27179755 | pmc = 5498988 | doi = 10.1016/s0140-6736(16)30380-4 }} These negative outcomes arise from stringent abortion regulations, ineffective healthcare systems, a shortage of adequately trained healthcare professionals, societally imposed stigma, and limited services in remote regions.{{cite journal | vauthors = Turan JM, Budhwani H | title = Restrictive Abortion Laws Exacerbate Stigma, Resulting in Harm to Patients and Providers | journal = American Journal of Public Health | volume = 111 | issue = 1 | pages = 37–39 | date = January 2021 | pmid = 33326286 | pmc = 7750605 | doi = 10.2105/AJPH.2020.305998 }}{{cite journal | vauthors = Culwell KR, Hurwitz M | title = Addressing barriers to safe abortion | journal = International Journal of Gynaecology and Obstetrics | volume = 121 | issue = S1 | pages = S16–S19 | date = May 2013 | pmid = 23477700 | doi = 10.1016/j.ijgo.2013.02.003 | s2cid = 22430819 }} Additionally, within low and middle-income countries where abortion is legally allowed, a considerable number of unsafe abortions occur. Approximately 7 million women are hospitalized annually in these areas as a result of complications arising from unsafe abortion. Unsafe abortion is attributed to 4.7% to 13.2% of maternal deaths each year, with the estimated expense for managing its complications reaching $553 million.{{cite journal | vauthors = Singh S, Maddow-Zimet I | title = Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries | journal = BJOG | volume = 123 | issue = 9 | pages = 1489–1498 | date = August 2016 | pmid = 26287503 | pmc = 4767687 | doi = 10.1111/1471-0528.13552 }}{{Cite book | vauthors = Vlassoff M, Shearer J, Walker D, Lucas H |title=Economic impact of unsafe abortion-related morbidity and mortality: evidence and estimation challenges. |publisher=Institute of Development Studies |year=2008 |volume=59 |location=Brighton, UK |pages=94}} Many factors contribute to these health risks including lack of education about available choices, the varying stances of healthcare providers on abortion, a shortage of qualified personnel for safe abortion services, insufficient privacy and confidentiality, and services that fall short of meeting the demand.{{Citation |title=Consequences of Unsafe Abortion |date=July 28, 2006 |work=The Human Drama of Abortion |pages=33–44 |url=http://dx.doi.org/10.2307/j.ctv17vf7g1.10 |access-date=January 23, 2024 |publisher=Vanderbilt University Press|doi=10.2307/j.ctv17vf7g1.10 |url-access=subscription }}

Before taking medication for abortion, individuals should be advised about the potential harmful effects of misoprostol if the abortion is not successful. If the pregnancy continues after using mifepristone and misoprostol, it is advised to seek proper medical care to discuss pregnancy options, with a thorough discussion of the risks and benefits for each. There is no evidence of mifepristone causing birth defects,{{cite journal | vauthors = Bernard N, Elefant E, Carlier P, Tebacher M, Barjhoux CE, Bos-Thompson MA, Amar E, Descotes J, Vial T | title = Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study | journal = BJOG | volume = 120 | issue = 5 | pages = 568–574 | date = April 2013 | pmid = 23346916 | doi = 10.1111/1471-0528.12147 | s2cid = 9691636 }} but misoprostol, when used in the first trimester, can be teratogenic and lead to congenital anomalies like limb defects, with or without Möbius' syndrome (facial paralysis).{{cite journal | vauthors = Yip SK, Tse AO, Haines CJ, Chung TK | title = Misoprostol's effect on uterine arterial blood flow and fetal heart rate in early pregnancy | journal = Obstetrics and Gynecology | volume = 95 | issue = 2 | pages = 232–235 | date = February 2000 | pmid = 10674585 | doi = 10.1016/s0029-7844(99)00472-x | s2cid = 33217047 }}

{{main|Mifepristone#Pharmacology}}

Mifepristone blocks the hormone progesterone,{{Cite web | vauthors = Little B | date = June 23, 2017 | url=https://www.smithsonianmag.com/health-medicine/science-behind-abortion-pill-180963762/ |title = The Science Behind the "Abortion Pill" | work = Smithsonian Magazine }}{{cite journal | vauthors = | title = Medical management of first-trimester abortion | journal = Contraception | volume = 89 | issue = 3 | pages = 148–161 | date = March 2014 | pmid = 24795934 | doi = 10.1016/j.contraception.2014.01.016 | doi-access = free }} causing the lining of the uterus to thin, preventing an embryo from latching on to the uterine wall to grow. Methotrexate, which is sometimes used instead of mifepristone, stops the cytotrophoblastic tissue from growing and becoming a functional placenta, the organ that supplies nutrients to a developing fetus.{{Cite web | url=https://www.medicationabortions.com/methotrexate | title=Methotrexate | work = Medication Abortion | publisher = Ibis Reproductive Health }} Misoprostol, a synthetic prostaglandin, causes the uterus to contract and expel the embryo through the vagina.{{Cite web | url=https://www.medicationabortions.com/misoprostol |title = Misoprostol | work = Medication Abortion | publisher = Ibis Reproductive Health }} Letrozole is an aromatase inhibitor that prevents estrogen synthesis and encourages ovulation. Recent studies suggest the use of letrozole before misoprostol or mifepristone for initiation of medical abortion can enhance treatment efficacy and reduce the need for surgical interventions.{{cite journal | vauthors = Yeung TW, Lee VC, Ng EH, Ho PC | title = A pilot study on the use of a 7-day course of letrozole followed by misoprostol for the termination of early pregnancy up to 63 days | journal = Contraception | volume = 86 | issue = 6 | pages = 763–769 | date = December 2012 | pmid = 22717187 | doi = 10.1016/j.contraception.2012.05.009 }}

Self managed abortion is not new--it is a historical practice involving herbs and other interventions.{{Cite journal | vauthors = Hall LA |date=1998-10-01 |title=John M. Riddle. Eve's Herbs: A History of Contraception and Abortion in the West. Cambridge: Harvard University Press. 1997. Pp. 341. $39.95 |url=https://doi.org/10.1086/ahr/103.4.1211 |journal=The American Historical Review |volume=103 |issue=4 |pages=1211–1212 |doi=10.1086/ahr/103.4.1211 |issn=1937-5239|url-access=subscription }} Swedish researchers began testing potential abortifacients in 1965. In 1968, the Swedish physician Lars Engström published a paper on a clinical trial, conducted at the women's clinic of Karolinska Hospital in Stockholm, of the compound F6103 on pregnant Swedish women with the aim of inducing abortion. It was the first clinical trial of an abortion pill to be conducted in Sweden.{{Cite book | vauthors = Ramsey M |url=https://books.google.com/books?id=J_9CzgEACAAJ |title=The Swedish Abortion Pill: Co-Producing Medical Abortion and Values, Ca. 1965-1992 |date=2021 |publisher=Acta Universitatis Upsaliensis |isbn=978-91-513-1121-0 }} The paper, originally titled The Swedish Abortion Pill, was renamed to The Swedish Postconception Pill, due to the small number of induced abortions that occurred in the trial population. After these efforts were largely unsuccessful with F6103, the same researchers attempted to find an abortion pill with prostaglandins, capitalizing on the number of well-established prostaglandin scientists working in Sweden at the time; they were eventually awarded the 1982 Nobel Prize in Physiology for their work.{{cite journal | vauthors = Raju TN | title = The Nobel chronicles. 1982: Sune Karl Bergström (b 1916); Bengt Ingemar Samuelsson (b 1934); John Robert Vane (b 1927) | journal = Lancet | volume = 354 | issue = 9193 | pages = 1914 | date = November 1999 | pmid = 10584758 | doi = 10.1016/s0140-6736(05)76884-7 | s2cid = 54236400 }}

Medical abortion became a successful alternative method of abortion with the availability of prostaglandin analogs in the 1970s. One such analog is carboprost, which was successfully trialed in the United States in 1979.{{cite web | title = Carboprost - Drug fact sheet | work = Mayo Clinic | date = 1 July 2024 | url = https://www.mayoclinic.org/drugs-supplements/carboprost-intramuscular-route/proper-use/drg-20067975 }}{{cite journal | vauthors = Vukelić J | title = Second trimester pregnancy termination in primigravidas by double application of dinoprostone gel and intramuscular administration of carboprost tromethamine | journal = Medicinski Pregled | volume = 54 | issue = 1-2 | pages = 11–16 | date = 2001 | pmid = 11436877 }}{{cite journal | vauthors = Bygdeman M, Gemzell-Danielsson K | title = An historical overview of second trimester abortion methods | journal = Reproductive Health Matters | volume = 16 | issue = 31 Suppl | pages = 196–204 | date = May 2008 | pmid = 18772101 | doi = 10.1016/S0968-8080(08)31385-8 }}{{cite journal | vauthors = Schwallie PC, Lamborn KR | title = Induction of abortion by intramuscular administration of (15S)-15-methyl PGF2 alpha. An overview of 815 cases | journal = The Journal of Reproductive Medicine | volume = 23 | issue = 6 | pages = 289–293 | date = December 1979 | pmid = 392084 }}{{cite journal | vauthors = Bhaskar A, Dimov V, Baliga S, Kinra G, Hingorani V, Laumas KR | title = Plasma levels of 15 (S) 15-methyl-PGF 2 alpha-methyl ester following vaginal administration for induction of abortion in women | journal = Contraception | volume = 20 | issue = 5 | pages = 519–531 | date = November 1979 | pmid = 527343 | doi = 10.1016/0010-7824(79)90057-x }}

In 1981, French pharmaceutical company Roussel-Uclaf developed the antiprogestogen mifepristone (also known as RU-486).{{cite journal| vauthors = Rowan A |date=2015|title=Prosecuting Women for Self-Inducing Abortion: Counterproductive and Lacking Compassion|url=http://www.guttmacher.org/pubs/gpr/18/3/gpr1807015.html |journal= Guttmacher Policy Review|volume=18|issue=3|pages=70–76|access-date=October 12, 2015}}{{cite book|title=Management of unintended and abnormal pregnancy : comprehensive abortion care|url=https://archive.org/details/managementuninte00paul|url-access=limited| vauthors = Kapp N, von Hertzen H |publisher= Wiley-Blackwell |year=2009|isbn=978-1-4051-7696-5| veditors = Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |location=Oxford|pages=[https://archive.org/details/managementuninte00paul/page/n197 178]–192 |chapter=Medical methods to induce abortion in the second trimester}} Mifepristone was first approved for use in China and France in 1988, in Great Britain in 1991, in Sweden in 1992, in Austria, Belgium, Denmark, Finland, Georgia, Germany, Greece, Iceland, Israel, Lichtenstein, Luxembourg, Netherlands, Russia, Spain, and Switzerland in 1999, in Norway, Taiwan, Tunisia, and the United States in 2000, and in 70 additional countries from 2001 to 2023.{{cite web |author=Gynuity Health Projects |date=March 14, 2023 |title=Map of Mifepristone Approvals |location=New York |publisher=Gynuity Health Projects |url=https://gynuity.org/assets/resources/mapmifelist_en.pdf |access-date=April 16, 2023 |archive-date=May 29, 2023 |archive-url=https://web.archive.org/web/20230529053718/https://gynuity.org/assets/resources/mapmifelist_en.pdf |url-status=dead }} Map and list of mifepristone approvals by year in 93 countries from 1988 to 2023.

In 2000, mifepristone was approved by the US FDA for abortions through 49 days gestation.{{cite journal | vauthors = Creinin MD, Chen MJ | title = Medical abortion reporting of efficacy: the MARE guidelines | journal = Contraception | volume = 94 | issue = 2 | pages = 97–103 | date = August 2016 | pmid = 27129936 | doi = 10.1016/j.contraception.2016.04.013 | doi-access = free | title-link = doi }} In 2016, the US FDA updated mifepristone's label to support usage through 70 days gestation.

In the United States, the portion of abortions that are medical abortions has increased: 0% in 2000, 24% in 2011, 53% in 2022, and 63% in 2023 (figures include only clinic-supervised abortions, and exclude self-managed abortions).{{ r | Guttmacher_2022-02 }}{{cite journal | vauthors = Fjerstad M, Trussell J, Sivin I, Lichtenberg ES, Cullins V | title = Rates of serious infection after changes in regimens for medical abortion | journal = The New England Journal of Medicine | volume = 361 | issue = 2 | pages = 145–151 | date = July 2009 | pmid = 19587339 | pmc = 3568698 | doi = 10.1056/NEJMoa0809146 }}
{{cite news | vauthors = Allday E |date=July 9, 2009 |title=Change cuts infections linked to abortion pill |newspaper=San Francisco Chronicle |page=A1 |url=http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2009/07/09/MNJE18L6TR.DTL}}{{cite news| vauthors = Mindock C |title=Abortion Pill Statistics: Medication Pregnancy Termination Rivals Surgery Rates In The United States|url=http://www.ibtimes.com/abortion-pill-statistics-medication-pregnancy-termination-rivals-surgery-rates-united-2439421|access-date=April 19, 2018|work=International Business Times|date=October 31, 2016}}

In England and Wales, the portion of medical abortions has increased: 47% in 2011, 70% in 2019, 85% in 2020, and 87% in 2021.

In Scotland, the portion of medical abortions has increased: 16% in 1992, 77% in 2012, 85% in 2018, and over 99% in 2021.

For second-trimester abortions, in 2009, medical abortion (using mifepristone in combination with a prostaglandin analog) was the most common method of abortion in Canada, most of Europe, China and India; in contrast to the US, where 96% of second-trimester abortions were performed surgically by dilation and evacuation.{{cite book|title=Management of unintended and abnormal pregnancy : comprehensive abortion care|url=https://archive.org/details/managementuninte00paul|url-access=limited| vauthors = Hammond C, Chasen ST |publisher=Wiley-Blackwell|year=2009|isbn=978-1-4051-7696-5 | veditors = Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |location=Oxford|pages=[https://archive.org/details/managementuninte00paul/page/n197 178]–192|chapter=Dilation and evacuation }}

Both drugs{{snd}}mifepristone and misoprostol{{snd}}are no longer covered by drug patents, and hence are available as generic drugs. In countries where the medications are not legally available, people do access these medications through international organizations such as [https://www.womenonweb.org/en/ Women on Web] and Women Help [https://womenhelp.org/en/ Women].

The requirements for a prescription vary widely between countries. Many countries make the medical abortion drugs available over the counter, without a prescription, such as China, India, and others. Other countries require a prescription (Canada, most of Western Europe, the United States, and others). Some countries require a prescription but are lax about enforcing that requirement (Russia, Brazil, and others).{{cite web | title = Global Oral Contraception Availability | author = Oral Contraceptives Over-the-Counter Working Group | url = https://ocsotc.org/wp-content/uploads/worldmap/worldmap.html | publisher = }}

{{see also|Telehealth}}

Telehealth includes access to medical services that the person can perform at home, without in-person visits to clinic or provider offices. People who have used telehealth report being satisfied with the access it provides to abortion services.{{cite journal | vauthors = Ireland S, Belton S, Doran F | title = 'I didn't feel judged': exploring women's access to telemedicine abortion in rural Australia | journal = Journal of Primary Health Care | volume = 12 | issue = 1 | pages = 49–56 | date = March 2020 | pmid = 32223850 | doi = 10.1071/HC19050 | doi-access = free | title-link = doi }}{{cite journal | vauthors = Ehrenreich K, Kaller S, Raifman S, Grossman D | title = Women's Experiences Using Telemedicine to Attend Abortion Information Visits in Utah: A Qualitative Study | journal = Women's Health Issues | volume = 29 | issue = 5 | pages = 407–413 | date = September 2019 | pmid = 31109883 | doi = 10.1016/j.whi.2019.04.009 | doi-access = free | title-link = doi }} However, those who might need the service the most (those who are incarcerated, unhoused, or live on low income) are often inhibited from accessing it.{{Cite web | vauthors = Craven J |date=March 21, 2022 |title=The FDA made mail-order abortion pills legal. Access is still a nightmare. |url=https://www.vox.com/the-highlight/22968993/abortion-pills-mail-medication-fda-texas |access-date=May 19, 2022 |website=Vox }} Public information on telehealth options is available [https://www.plancpills.org/ on line]. Some populations cannot directly access telehealth services but there are non-traditional means for people to obtain the medications through third party outlets.

In this model, a provider communicates with a patient located at another site using clinic-to-clinic videoconferencing to provide medication abortion. This was introduced by Planned Parenthood of the Heartland in Iowa to allow a patient at one health facility to communicate via secure video with a health provider at another facility.{{Cite web|title=Improving Access to Abortion via Telehealth|url=https://www.guttmacher.org/gpr/2019/05/improving-access-abortion-telehealth|date=May 7, 2019|publisher=Guttmacher Institute|access-date=April 21, 2020}} This model has expanded to other Planned Parenthoods in multiple states as well other clinics providing abortion care.

The direct-to-patient model allows for medication abortion to be provided without an in-person clinic visit. Instead of an in-person clinic visit, the patient receives counseling and instruction from the abortion provider via videoconference. The patient can be at any location, including their home. The medications necessary for the abortion are mailed directly to the patient. This is a model, called TelAbortion or no-test medication abortion (formerly no-touch medication abortion), being piloted and studied by Gynuity Health Projects, with special approval from the US Food and Drug Administration (FDA).{{Cite web|title=Telabortion Project|url=https://telabortion.org/about/|access-date=April 26, 2020}} This model has been shown to be safe, effective, efficient, and satisfactory.{{cite journal | vauthors = Raymond E, Chong E, Winikoff B, Platais I, Mary M, Lotarevich T, Castillo PW, Kaneshiro B, Tschann M, Fontanilla T, Baldwin M, Schnyer A, Coplon L, Mathieu N, Bednarek P, Keady M, Priegue E | title = TelAbortion: evaluation of a direct to patient telemedicine abortion service in the United States | journal = Contraception | volume = 100 | issue = 3 | pages = 173–177 | date = September 2019 | pmid = 31170384 | doi = 10.1016/j.contraception.2019.05.013 | s2cid = 174811252 | doi-access = }}{{cite journal | vauthors = Upadhyay UD, Koenig LR, Meckstroth KR | title = Safety and Efficacy of Telehealth Medication Abortions in the US During the COVID-19 Pandemic | journal = JAMA Network Open | volume = 4 | issue = 8 | pages = e2122320 | date = August 2021 | pmid = 34427682 | pmc = 8385590 | doi = 10.1001/jamanetworkopen.2021.22320 }} Complete abortion can be confirmed via telephone-based assessment.{{cite journal | vauthors = Chen MJ, Rounds KM, Creinin MD, Cansino C, Hou MY | title = Comparing office and telephone follow-up after medical abortion | journal = Contraception | volume = 94 | issue = 2 | pages = 122–126 | date = August 2016 | pmid = 27101901 | doi = 10.1016/j.contraception.2016.04.007 | s2cid = 27825883 | url = https://escholarship.org/uc/item/8d2753qm | url-access = subscription }} Reasons why people might choose this option include the need for low-cost care, inability to travel, unhealth relationship status.

The COVID-19 pandemic challenged health policymakers worldwide which led to both indirect and direct affects on reproductive health access.{{cite journal | vauthors = Neill R, Hasan MZ, Das P, Venugopal V, Jain N, Arora D, Gupta S | title = Evidence of integrated health service delivery during COVID-19 in low and lower-middle-income countries: protocol for a scoping review | journal = BMJ Open | volume = 11 | issue = 5 | pages = e042872 | date = May 2021 | pmid = 33941625 | doi = 10.1136/bmjopen-2020-042872 | pmc = 8098290 | doi-access = free | title-link = doi }}{{cite journal | vauthors = McDonnell S, McNamee E, Lindow SW, O'Connell MP | title = The impact of the Covid-19 pandemic on maternity services: A review of maternal and neonatal outcomes before, during and after the pandemic | journal = European Journal of Obstetrics, Gynecology, and Reproductive Biology | volume = 255 | pages = 172–176 | date = December 2020 | pmid = 33142263 | pmc = 7550066 | doi = 10.1016/j.ejogrb.2020.10.023 }} The overall decrease in availability and delivery of crucial sexual health care, including safe abortions, amid the COVID-19 pandemic led to an increased incidence of complications and fatalities during pregnancy.{{cite journal | vauthors = Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, Sawadogo-Lewis T, Walker N | title = Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study | journal = The Lancet. Global Health | volume = 8 | issue = 7 | pages = e901–e908 | date = July 2020 | pmid = 32405459 | pmc = 7217645 | doi = 10.1016/S2214-109X(20)30229-1 }}{{cite journal | vauthors = Riley T, Sully E, Ahmed Z, Biddlecom A | title = Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health In Low- and Middle-Income Countries | journal = International Perspectives on Sexual and Reproductive Health | volume = 46 | pages = 73–76 | date = April 2020 | pmid = 32343244 | doi = 10.1363/46e9020 | s2cid = 216595145 | jstor = 10.1363/46e9020 }}

Pregnant individuals requested access to medical abortion more than surgical abortion during the pandemic, and preferred the ability to perform medical abortions at home via telehealth services.{{cite journal | vauthors = Qaderi K, Khodavirdilou R, Kalhor M, Behbahani BM, Keshavarz M, Bashtian MH, Dabir M, Irani M, Manouchehri E, Farahani MF, Mallah MA, Shamsabadi A | title = Abortion services during the COVID-19 pandemic: a systematic review | journal = Reproductive Health | volume = 20 | issue = 1 | pages = 61 | date = April 2023 | pmid = 37055839 | pmc = 10098996 | doi = 10.1186/s12978-023-01582-3 | doi-access = free | title-link = doi }}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}{{cite journal | vauthors = Boydell N, Reynolds-Wright JJ, Cameron ST, Harden J | title = Women's experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID-19) pandemic: a qualitative evaluation | journal = BJOG | volume = 128 | issue = 11 | pages = 1752–1761 | date = October 2021 | pmid = 34138505 | pmc = 8441904 | doi = 10.1111/1471-0528.16813 }}{{cite journal | vauthors = Chong E, Shochet T, Raymond E, Platais I, Anger HA, Raidoo S, Soon R, Grant MS, Haskell S, Tocce K, Baldwin MK, Boraas CM, Bednarek PH, Banks J, Coplon L, Thompson F, Priegue E, Winikoff B | title = Expansion of a direct-to-patient telemedicine abortion service in the United States and experience during the COVID-19 pandemic | journal = Contraception | volume = 104 | issue = 1 | pages = 43–48 | date = July 2021 | pmid = 33781762 | pmc = 9748604 | doi = 10.1016/j.contraception.2021.03.019 }}{{cite journal | vauthors = Aiken AR, Starling JE, Gomperts R, Tec M, Scott JG, Aiken CE | title = Demand for Self-Managed Online Telemedicine Abortion in the United States During the Coronavirus Disease 2019 (COVID-19) Pandemic | journal = Obstetrics and Gynecology | volume = 136 | issue = 4 | pages = 835–837 | date = October 2020 | pmid = 32701762 | pmc = 7505141 | doi = 10.1097/AOG.0000000000004081 }}{{cite journal | vauthors = Romanis EC, Parsons JA | title = Legal and policy responses to the delivery of abortion care during COVID-19 | journal = International Journal of Gynaecology and Obstetrics | volume = 151 | issue = 3 | pages = 479–486 | date = December 2020 | pmid = 32931598 | pmc = 9087790 | doi = 10.1002/ijgo.13377 }}{{cite journal | vauthors = Reynolds-Wright JJ, Johnstone A, McCabe K, Evans E, Cameron S | title = Telemedicine medical abortion at home under 12 weeks' gestation: a prospective observational cohort study during the COVID-19 pandemic | journal = BMJ Sexual & Reproductive Health | volume = 47 | issue = 4 | pages = 246–251 | date = October 2021 | pmid = 33542062 | pmc = 7868129 | doi = 10.1136/bmjsrh-2020-200976 }} Data suggest that the increased use of telemedicine for abortion services during this period were a result of COVID-19 fear, reduced travel ability, stay-at-home orders, greater concealment, and the solace of home-care.{{cite journal | vauthors = Kaller S, Muñoz MG, Sharma S, Tayel S, Ahlbach C, Cook C, Upadhyay UD | title = Abortion service availability during the COVID-19 pandemic: Results from a national census of abortion facilities in the U.S | journal = Contraception | volume = 3 | pages = 100067 | date = 2021 | pmid = 34308330 | pmc = 8292833 | doi = 10.1016/j.conx.2021.100067 }}{{cite journal | vauthors = Porter Erlank C, Lord J, Church K | title = Acceptability of no-test medical abortion provided via telemedicine during Covid-19: analysis of patient-reported outcomes | journal = BMJ Sexual & Reproductive Health | volume = 47 | issue = 4 | pages = 261–268 | date = October 2021 | pmid = 33602718 | doi = 10.1136/bmjsrh-2020-200954 | doi-access = free }} This data supported the safety and efficacy of telehealth abortion services, and demonstrated its increasing demand. The severity and rate of complications after telehealth abortion services were low, mirroring overall medical abortion complication rates, including those performed within clinics or other medical facilities.

{{main|Abortion_in_the_United_States#Medical_abortion}}

In the US, prescriptions for mifepristone may be filled by any pharmacy - online or brick-and-mortar - that has obtained a special certification.{{Cite news |date=December 16, 2021 |title=FDA relaxes restrictions on abortion pill |publisher=NPR |url=https://www.npr.org/2021/12/16/1064951611/today-is-the-fda-s-deadline-to-complete-a-review-of-its-rules-for-abortion-pill |access-date=May 19, 2022}} However many pharmacies choose not to supply the drugs and no pharmacy is required by law to do so. This regulation was provisionally implemented in Dec 2021, and was finalized by the US Food and Drug Administration (FDA) in January 2023.{{Cite web |date=January 4, 2023 |title=FDA finalizes rule expanding availability of abortion pills |url=https://www.latimes.com/world-nation/story/2023-01-03/fda-finalizes-rule-allowing-mail-order-abortion-pills |access-date=June 14, 2023 |website=Los Angeles Times }}{{cite web | title=Mifeprex (mifepristone) Information | publisher=U.S. Food and Drug Administration (FDA) | date=3 January 2023 | url=https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-about-mifepristone-medical-termination-pregnancy-through-ten-weeks-gestation | access-date=3 April 2024}}{{dead link|date=May 2025|bot=medic}}{{cbignore|bot=medic}}

From 2011 until 2021, a person was required to visit a healthcare provider in-person (at a clinic or office) and receive mifepristone directly from the provider.{{Cite web |date=April 6, 2022 |title=The Availability and Use of Medication Abortion |url=https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion/ |access-date=May 19, 2022 |publisher=Kaiser Family Foundation}} The requirement to visit a clinic to receive the medication was removed by the FDA in December 2021, during the COVID-19 pandemic. Under the new rules, the prescription may be obtained via telehealth (phone calls or video conferencing with a healthcare provider), and then filled at any certified pharmacy.{{Cite web |date=December 16, 2021 |title=Questions and Answers on Mifeprex |url=https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex |archive-url=https://web.archive.org/web/20190428171949/https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex |url-status=dead |archive-date=April 28, 2019 |publisher=U.S. Food and Drug Administration (FDA) }}{{Cite news| vauthors = Belluck P |title=Abortion by Telemedicine: A Growing Option as Access to Clinics Wanes|work=The New York Times|date=April 28, 2020 |url=https://www.nytimes.com/2020/04/28/health/telabortion-abortion-telemedicine.html|access-date=May 5, 2020}}{{Cite web | vauthors = Ramaswamy A, Weigel G, Sobel L | date = June 16, 2021 |title=Medication Abortion and Telemedicine: Innovations and Barriers During the COVID-19 Emergency|url=https://www.kff.org/policy-watch/medication-abortion-telemedicine-innovations-and-barriers-during-the-covid-19-emergency/|access-date=August 3, 2020|publisher = Kaiser Family Foundation (KFF) }} At the same time the FDA removed the requirement for an in-person visit, they added a requirement that dispensing pharmacies be "certified", which requires the pharmacy to have special permission to dispense the medications{{Snd}}a requirement the FDA imposes on only 40 medications out of more than 19,000 it manages.{{Cite news | vauthors = Koons C |date=May 3, 2022 |title=The Abortion Pill Is Safer Than Tylenol and Almost Impossible to Get |work=Bloomberg |url=https://www.bloomberg.com/news/features/2022-02-17/abortion-pill-mifepristone-is-safer-than-tylenol-and-almost-impossible-to-get |access-date=June 30, 2022}}

The second medication used in medical abortion, misoprostol, is most commonly used for treating ulcers, and was never subject to the in-person dispensing constraints of mifepristone, and was always available from pharmacies with a prescription.{{cite journal | vauthors = Ferketa M, Moore A, Klein-Barton J, Stulberg D, Hasselbacher L | title = Pharmacists' experiences dispensing misoprostol and readiness to dispense mifepristone | journal = Journal of the American Pharmacists Association | volume = 64 | issue = 1 | pages = 245–252.e1 | date = January 2024 | pmid = 37913990 | doi = 10.1016/j.japh.2023.10.030 }}

The FDA does not authorize the use of mifepristone for medical abortion after 70 days, unlike most other countries, which authorize medical abortion into the second trimester and even the third trimester.{{cite journal | vauthors = Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N | title = Medical methods for mid-trimester termination of pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2011 | issue = 1 | pages = CD005216 | date = January 2011 | pmid = 21249669 | pmc = 8557267 | doi = 10.1002/14651858.cd005216.pub2 }}

Some states have passed laws that prohibit providers from examining the patient via phone or video conferencing, and instead require the patient to make an in-person visit to the provider to get the prescription.{{Cite news | vauthors = Matei A |date=April 7, 2022 |title=Mail-order abortion pills become next US reproductive rights battleground |url=https://www.theguardian.com/us-news/2022/apr/07/us-mail-order-abortions-oklahoma |access-date=June 30, 2022 |website=The Guardian }}

In most states, abortion medications may be sent from a pharmacy to the patient via mail, but certain states have passed laws making that illegal, and requiring the medications to be obtained from a pharmacy or provider in-person.{{Cite news | vauthors = Watts A |date=May 6, 2022 |title=Governor signs bill criminalizing mail-in abortion drugs |url=https://www.cnn.com/2022/05/06/us/tennessee-abortion-pills-by-mail-bill/index.html |access-date=June 30, 2022 |publisher=CNN}}{{Cite news | vauthors = Bluth R |date=April 15, 2022 |title=State regulations are shutting down doctors prescribing abortion pills |url=https://www.salon.com/2022/04/15/state-regulations-are-shutting-down-doctors-prescribing-abortion-pills_partner/ |access-date=June 30, 2022 |website=Salon }}

File:2022.06.24 Roe v Wade Overturned - SCOTUS, Washington, DC USA 175 143208 (52170905969).jpg

Interest in abortion medications in the United States reached record highs in 2022, after the Supreme Court of the United States draft Dobbs v. Jackson Women's Health Organization ruling that would overturn 1973's Roe v. Wade decision was leaked online.{{cite journal | vauthors = Poliak A, Satybaldiyeva N, Strathdee SA, Leas EC, Rao R, Smith D, Ayers JW | title = Internet Searches for Abortion Medications Following the Leaked Supreme Court of the United States Draft Ruling | journal = JAMA Internal Medicine | volume = 182 | issue = 9 | pages = 1002–1004 | date = September 2022 | pmid = 35767270 | pmc = 9244771 | doi = 10.1001/jamainternmed.2022.2998 }} Interest was higher in states with more restrictions on access to abortion. Pro-choice activists in the US were exploring ways to make medical abortion more available, particularly in states where it is subject to limitations, with social media resources being utilized for this purpose.{{Cite web | vauthors = Bruder J |date=April 4, 2022 |title=The Future of Abortion in a Post-Roe America |url=https://www.theatlantic.com/magazine/archive/2022/05/roe-v-wade-overturn-abortion-rights/629366/ |access-date=June 30, 2022 |website=The Atlantic }}{{Cite web | vauthors = Noor P |date=May 7, 2022 |title=The activists championing DIY abortions for a post-Roe v Wade world |url=https://www.theguardian.com/us-news/2022/may/07/abortion-pill-at-home-activists-future-roe-v-wade |access-date=June 30, 2022 |website=The Guardian }}{{Cite web | vauthors = Azar T |date=June 28, 2022 |title=Need help getting an abortion? Social media flooded with resources after Roe reversal |url=https://www.usatoday.com/story/news/investigations/2022/06/28/supreme-court-roe-abortion-help-funds-instagram-tiktok/7728639001/ |access-date=June 29, 2022 |website=USA Today }}{{cite journal | vauthors = Grossi P, O'Connor D | title = FDA preemption of conflicting state drug regulation and the looming battle over abortion medications | journal = Journal of Law and the Biosciences | volume = 10 | issue = 1 | pages = lsad005 | date = 2023 | pmid = 36938304 | pmc = 10017072 | doi = 10.1093/jlb/lsad005 | doi-access = free | title-link = doi }}

In response to abortion restrictions imposed by some states after the Dobbs legal decision, several organizations that provide telehealth services related to medical abortion, such as Plan C and Hey Jane, saw an increase in inquiries and usage.{{cite journal | vauthors = Baker CN | title = History and Politics of Medication Abortion in the United States and the Rise of Telemedicine and Self-Managed Abortion | journal = Journal of Health Politics, Policy and Law | volume = 48 | issue = 4 | pages = 485–510 | date = August 2023 | pmid = 36693178 | doi = 10.1215/03616878-10449941 }}{{cite journal | vauthors = Jenkins J, Woodside F, Lipinsky K, Simmonds K, Coplon L | title = Abortion With Pills: Review of Current Options in The United States | journal = Journal of Midwifery & Women's Health | volume = 66 | issue = 6 | pages = 749–757 | date = November 2021 | pmid = 34699129 | doi = 10.1111/jmwh.13291 }}{{cite journal | vauthors = Howard S, Krishna G | title = How the US scrapping of Roe v Wade threatens the global medical abortion revolution | journal = BMJ (Clinical Research Ed.) | volume = 379 | issue = | pages = o2349 | date = October 2022 | pmid = 36261168 | doi = 10.1136/bmj.o2349 }}{{cite web | vauthors = Miller CC, Sanger-Katz M | title=Insurers Are Starting to Cover Telehealth Abortion | website=The New York Times | date=18 April 2023 | url=https://www.nytimes.com/2023/04/18/upshot/abortion-pills-telehealth-insurance.html | access-date=22 April 2024}}{{cite web | vauthors = Nast C, Levin B | title=A Texas Republican Wants to Ban People From Reading About How to Get an Abortion Online | website=Vanity Fair | date=1 March 2023 | url=https://www.vanityfair.com/news/2023/03/texas-abortion-websites-ban | access-date=22 April 2024}}

In March 2023, Governor Mark Gordon of Wyoming signed a bill outlawing the use of abortion pills in the state, making it the first US state to separately ban medical abortions from a ban on all abortion services. The new legislation, which went into effect in July 2023, criminalizes the "prescription, dispensation, distribution, sale, or use of any drug" for the purpose of obtaining or performing an abortion.{{Cite web | title = SF0109 - Prohibiting chemical abortions. |url=https://www.wyoleg.gov/Legislation/2023/SF0109 |access-date=February 1, 2024 |publisher=Wyoming Legislature}} Those who violate the law, excluding the pregnant person, may be charged with a misdemeanor and could face a $9,000 fine and up to six months in jail.{{Cite news |date=March 18, 2023 |title=Wyoming Becomes First State to Outlaw Abortion Pills |url=https://www.nytimes.com/2023/03/17/us/wyoming-abortion-pills-ban.html |access-date=March 18, 2023 |work=The New York Times |vauthors=Chen DW, Belluck P}} Fourteen other states have enacted blanket abortion bans that include medical abortions, however, and fifteen states already limit access to these medications.{{Cite web | vauthors = ((Public Policy Office)) |date=March 14, 2016 |title=Medication Abortion | publisher = Guttmacher Institute |url=https://www.guttmacher.org/state-policy/explore/medication-abortion |access-date=February 1, 2024 }} Abortion seekers do travel between states to seek care, often with significant difficulty.{{Cite web |date=2023-11-29 |title=The High Toll of US Abortion Bans: Nearly One in Five Patients Now Traveling Out of State for Abortion Care {{!}} Guttmacher Institute |url=https://www.guttmacher.org/2023/12/high-toll-us-abortion-bans-nearly-one-five-patients-now-traveling-out-state-abortion-care |access-date=2025-04-24 |website=www.guttmacher.org |language=en}}

In March 2024, some major pharmacy chains, such as CVS and Walgreens, received certification from the FDA to dispense mifepristone and they plan to make it available for sale in states where it is legal. In those states, women seeking an abortion will have to visit a healthcare provider to obtain a prescription, but will be able to buy the medication at a certified pharmacy, instead of needing to physically receive it directly from a certified hospital, clinic, or healthcare provider.{{cite news | vauthors = Tirrell M, Carvajal N | title=CVS, Walgreens say they'll start dispensing abortion pill mifepristone | publisher=CNN | date=1 March 2024 | url=https://www.cnn.com/2024/03/01/health/cvs-walgreens-to-dispense-abortion-pill-mifepristone/index.html | access-date=3 April 2024}} While legally allowed to dispense, most pharmacies choose not to supply. This does not violate US law.

In December 2024, the state of Texas filed a civil suit against a physician based in New York, alleging that the physician prescribed abortion drugs to a Texas resident. New York has a shield law that allows a prescriber who is sued to countersue in this type of situation. The legal status of interstate telemedicine, in particular, writing prescriptions, is an emerging area of law in the United States."Texas' abortion pill lawsuit against N.Y. doctor marks new challenge to interstate telemedicine" Sean Murphy, 14 Dec 2024, Los Angeles Times, https://www.latimes.com/world-nation/story/2024-12-14/texas-abortion-pill-lawsuit-against-new-york-doctor-marks-new-challenge-to-interstate-telemedicine

The WHO affirms that laws and policies should support people's access to evidence-based medically approved care, including medical abortion.{{Cite book|title=Medical management of abortion|publisher=World Health Organization (WHO)|year=2018|isbn=978-9241550406|pages=24}}{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health|title=Human Rights and Health|date=September 21, 2019|publisher=World Health Organization (WHO)}} There are more controversies surrounding taking these pills and if people should self manage their abortion or not. Some reasons why people might choose to self managed include the desire for more privacy, reduced costs, and convenience.{{cite journal | vauthors = Aiken AR, Tello-Pérez LA, Madera M, Starling JE, Johnson DM, Broussard K, Padron E, Ze-Noah CA, Baldwin A, Scott JG | title = Factors Associated With Knowledge and Experience of Self-managed Abortion Among Patients Seeking Care at 49 US Abortion Clinics | journal = JAMA Network Open | volume = 6 | issue = 4 | pages = e238701 | date = April 2023 | pmid = 37071424 | doi = 10.1001/jamanetworkopen.2023.8701 | pmc = 10114063 }}

Some anti-abortion groups claim that patients who change their mind about the abortion after taking mifepristone can "reverse" the abortion by administering progesterone (and not administering misoprostol).{{cite news | vauthors = Cha AE | date = April 4, 2018 |title=As controversial 'abortion reversal' laws increase, researcher says new data shows protocol can work|url=https://www.washingtonpost.com/news/to-your-health/wp/2018/04/03/as-controversial-abortion-reversal-laws-multiply-researcher-says-new-data-shows-it-can-work-critics-are-still-skeptical/|access-date=April 23, 2018}}{{cite news|title=California Board of Nursing Sanctions Unproven Abortion 'Reversal' (Updated) - Rewire|url=https://rewire.news/article/2017/08/17/california-board-nursing-sanctions-unproven-abortion-reversal/|access-date=November 23, 2017|work=Rewire}} As of 2022, there is no scientifically rigorous evidence that the effects of mifepristone can be reversed this way.{{cite journal | vauthors = Bhatti KZ, Nguyen AT, Stuart GS | title = Medical abortion reversal: science and politics meet | journal = American Journal of Obstetrics and Gynecology | volume = 218 | issue = 3 | pages = 315.e1–315.e6 | date = March 2018 | pmid = 29141197 | doi = 10.1016/j.ajog.2017.11.555 | s2cid = 205373684 }}{{Cite news|url=https://www.npr.org/sections/health-shots/2019/12/05/785262221/safety-problems-lead-to-early-end-for-study-of-abortion-pill-reversal|title=Safety Problems Lead To Early End For Study Of 'Abortion Pill Reversal'|newspaper=NPR|date=December 5, 2019|access-date=December 6, 2019| vauthors = Gordon M }}{{cite journal | vauthors = Grossman D, White K, Harris L, Reeves M, Blumenthal PD, Winikoff B, Grimes DA | title = Continuing pregnancy after mifepristone and "reversal" of first-trimester medical abortion: a systematic review | journal = Contraception | volume = 92 | issue = 3 | pages = 206–211 | date = September 2015 | pmid = 26057457 | doi = 10.1016/j.contraception.2015.06.001 }} Even so, several states in the US require providers of non-surgical abortion who use mifepristone to tell patients that reversal is an option.{{Cite web | url=https://www.guttmacher.org/state-policy/explore/counseling-and-waiting-periods-abortion | title=Counseling and Waiting Periods for Abortion| date= March 14, 2016 | publisher = The Guttmacher Institute }} In 2019, researchers initiated a small trial of the so-called "reversal" regimen using mifepristone followed by progesterone or placebo.{{Cite news | url=https://www.npr.org/sections/health-shots/2019/03/22/688783130/controversial-abortion-reversal-regimen-is-put-to-the-test |title = Controversial 'Abortion Reversal' Regimen is Put to the Test|newspaper = NPR|date = March 22, 2019| vauthors = Gordon M }}{{Cite web | vauthors = Sherman C | url=https://www.vice.com/en/article/theres-no-proof-abortion-reversals-are-real-this-study-could-end-the-debate/ |title = There's no proof "abortion reversals" are real. This study could end the debate|date = April 17, 2019 | work = Vice }} The study was halted after 12 women enrolled and three experienced severe vaginal bleeding. The results raise serious safety concerns about using mifepristone without follow-up misoprostol.

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{{Wikiquote}}

• {{cite web | title=The Care of Women Requesting Induced Abortion (Evidence-based Clinical Guideline No. 7) | publisher=RCOG | date=23 July 2018 | url=https://www.rcog.org.uk/guidance/browse-all-guidance/other-guidelines-and-reports/the-care-of-women-requesting-induced-abortion-evidence-based-clinical-guideline-no-7/ }}
• {{cite web|author=ICMA|year=2013|title=ICMA Information Package on Medical Abortion|location=Chișinău, Moldova|publisher=International Consortium for Medical Abortion (ICMA)|url=https://www.medicalabortionconsortium.com/information-package-on-medical-abortion.html}}

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Category:Medication abortion

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