A report suggesting the U.S. Supreme Court may soon overturn Roe v. Wade raised the possibility of widespread changes in access to reproductive health care.
The leaked draft of a majority opinion, reported by Politico and upheld by the court as legitimate, would dismantle constitutional abortion rights. Although the court said the opinion was not final, it led many to wonder how such a decision might affect them personally. Online searches for over-the-counter emergency contraceptives are increasing. Some rush to get IUDs or stockpile Plan B.
>> RELATED: The next battle over abortion access will focus on pills
So if the court strikes down Roe v. Wade, what does this mean for the abortion pill?
What is the abortion pill and how do I get it?
The majority of abortions in the United States are now what are called medical abortions, according to data from the Guttmacher Institute. Medical abortions refer to the use of the abortion pill, mifepristone, in combination with the more widely used drug misoprostol, to end an early pregnancy. Both drugs are approved for use by the Food and Drug Administration and are considered safe and effective when used according to the FDA-approved regimen up to 70 days after the first day of a woman’s last menstrual period.
Mifepristone is more tightly regulated by the FDA than many other drugs. It undergoes what is called a Risk Assessment and Mitigation Strategy, or REMS, to ensure its continued benefit. But REMS also means that women can only be prescribed the drug by a certified healthcare provider who has obtained a signed consent from the patient. Until December 2021, the FDA also required the drug to be administered in person by a healthcare professional. This requirement was lifted during the pandemic, however, when the agency found that the abortifacient drug was still safe and effective when prescribed via telemedicine and self-administered. It can be mailed to a patient or picked up at a certified pharmacy. Only 40 of the more than 19,000 drugs approved by the FDA must meet this certification requirement.
How does obtaining it differ from place to place in the United States?
The short answer: Even though mifepristone is federally approved, states can still block access to it.
Mifepristone is federally regulated by the FDA, so it’s legal no matter where you live. But states are still able to make pills hard to access. This year, as of February 22, 16 states have introduced legislation that would ban or restrict the use of abortion drugs, according to the Guttmacher Institute. Some states already had such restrictions in place or restrict abortions to minors without parental consent.
For example, 32 states require clinicians who prescribe mifepristone to be physicians, making the pill harder to obtain in rural or underserved areas where it can be difficult to find a doctor to prescribe it. In Texas, medical abortions are banned after seven weeks of pregnancy, and Indiana draws a hard line at 10 weeks.
Telehealth may in some cases offer an alternative when in-person access to the pill is limited, but despite the FDA lifting its in-person requirements, some states have also sought to block virtual access to the pill. Currently, 19 states still say that the clinician performing a medical abortion must be physically present when the medication is administered. Three states (Arizona, Arkansas and Texas) go even further by prohibiting the sending of abortion pills to patients. An attempt to enact such bans in three other states (Montana, Oklahoma and South Dakota) has been blocked by the courts for now.
This is important because studies show that nearly nine out of 10 American women live in counties with no abortion clinics. In South Dakota, regulations that would have required patients to visit a clinic four times in order to obtain the abortion drug are also blocked by the courts pending litigation.
Sites like Plan C can help connect people to abortion pills in states where it’s increasingly difficult.
How much does it cost and is it covered by insurance?
In 2014, the average cost of a medical abortion was $535, according to a study published in the journal Women’s Health Issues. For those who are uninsured or unable to afford the high cost themselves, funds from non-profit organizations supporting access to abortion are available to help. But when it comes to insurance, things get complicated.
The Hyde Amendment banned the use of federal funds for abortion for more than 40 years, unless the pregnancy was the result of rape or incest, or it was determined to be. endangers the woman’s life, according to the Kaiser Family Foundation. The law also applies to medical abortions. But in 2019, the Government Accountability Office found that 14 state Medicaid programs didn’t even cover abortions in cases specified in the Hyde Amendment.
Whether a private health insurance plan covers mifepristone varies widely. Some plans cover abortion services but do not cover medical abortions. State laws can also affect whether or not insurance is allowed to pay for an abortion. Danco Laboratories, a pharmaceutical company that distributes the brand name mifepristone, offers information on its website about how coverage is handled by different insurers in each state. Plan C recommends contacting suppliers directly for the most accurate information.
What does worldwide availability look like?
The abortion pill is available in countries around the world, but the regulations are varied and depend on the laws of that country.
According to the Center for Reproductive Rights, 24 countries completely ban abortion, while 42 countries allow it only when necessary to save the life of the mother.
Is the abortion pill safe?
Yes. Years of evidence shows that Mifepristone is very safe when used according to FDA guidelines – in fact, it is safer than Tylenol. The abortion pill sends fewer people to the hospital than Viagra. Even when prescribed via telemedicine, mifepristone continues to maintain its record of safety and effectiveness, according to a study published in the journal Contraception.
Combined with misoprostol, mifepristone is effective 95% of the time in early pregnancy. A 2013 paper that looked at abortion data from 45,000 women shows that only 0.3% of patients who took the pill were hospitalized. The study authors concluded that abortion by pill is “very effective and safe”.
Is Plan B an abortion pill?
Plan B, or by its generic name levonorgestrel, is not an abortion pill. It should not be used as an alternative to a. Plan B is an emergency contraceptive method and is not intended for women who are already pregnant. Instead, it helps delay or prevent ovulation after unprotected sex or as a backup when birth control fails.
What is a “DIY abortion pill”?
The abortion pill is mifepristone, but it is used in combination with misoprostol. Mifepristone is highly regulated and is only used for abortion. Misoprostol has other uses, such as reducing the risk of stomach ulcers caused by certain medications. The drugs are used in combination for maximum effectiveness – mifepristone blocks progesterone, a hormone that causes the uterine lining to grow, while misoprostol causes the uterus to contract, which helps push the fetus out.
However, although misoprostol has many use cases, it comes with a warning label for pregnant women and those planning to become pregnant that it can cause abortion. When mifepristone is not available, as is the case in some states and countries outside of the United States, misoprostol alone may be a less effective alternative option. The WHO has recommendations for misoprostol-induced abortions in places where mifepristone is not available.