On April 7, a federal judge suspended the Food and Drug Administration’s longtime approval of a drug commonly used in medication abortions. The ruling to suspend mifepristone will go into effect on April 14, unless a higher court intervenes, which would further restrict access for many to safely end their pregnancies as states across the country continue to limit access to abortion care after the Supreme Court overturned Roe v. Wade.
In 2020, medication abortions overtook surgical abortions in popularity for the first time and now account for more than half of all abortions in the United States, according to data collected by the Guttmacher Institute, a policy and research organization devoted to advancing sexual and reproductive health and rights. Before the recent ruling, analysts there said they expected the medication abortion trend to continue increasing.
A medication abortion, also known as the "abortion pill," actually consists of two oral medications — mifepristone and misoprostol — and was approved by the FDA more than 20 years ago.
How does a medication abortion work?
"You first take the mifepristone orally, by swallowing the pills, and then a set amount of time later, take the misoprostol pills by dissolving them between the cheek and gums, or inserting them vaginally," Dr. Rebecca Miller, a pediatrician, psychiatrist, abortion provider in Pennsylvania and fellow with Physicians for Reproductive Health, tells TODAY.com. "The first, mifepristone, blocks the hormone progesterone. Progesterone is needed for a pregnancy to continue and blocking progesterone starts the process of ending the pregnancy. The second medication, misoprostol, works by causing the uterus to contract and bleed, and push out the contents of the uterus, including the pregnancy tissue."
Studies have shown that these medications are safer than Tylenol and Viagra, and 14 times safer than childbirth. Miller said heavy cramping and bleeding are common side effects of the second medication, misoprostol, and some may experience "fevers, chills, nausea, vomiting and diarrhea."
"Serious complications that would require hospitalization happen in less than 1% of people who have a medication abortion," she adds. "This is an enviable safety record compared to other medications or procedures."
In December, 2021, the Food and Drug Administration (FDA) ruled it would permanently allow abortion medications to be mailed to patients as it gets harder in many states to access surgical abortion care. But since the U.S. District Judge Matthew Kacsmaryk's recent ruling, the ability to access this form of health care is less clear.
"Medications can be mailed from a physician's office, or it can come from a mail-order pharmacy," Melissa Grant, chief operations officer for Carafem, a network of reproductive health clinics that focus on early abortion care, told TODAY.com in March 2022. "So that means that a pharmacy can send it directly to the client, unless you're in one of the 19 states where this medication option is restricted through the mail. In those states, you're forced to go in, in person."
Grant said there are other ways to obtain a medication abortion — what is commonly referred to as a "self-managed abortion" — via alternative means, including ordering medications online or in stores from Mexico. This avenue, however, comes with great legal risk. One study published in JAMA Network Open found that searches for "at-home abortions" increased after Texas successfully passed a 6-week abortion ban, all but outlawing abortion care in the state.
According to Grant, there are a variety of reasons why more people have been choosing to have medication abortion. Part of the reason is simply more people finding out that it's an option.
"In terms of medical care, people do best when they can have the kind of medical care that really fits their own life the best," she added. "Not everyone is able to get to a health center or clinic to receive care. So that's another reason for certain people — it's just more flexible and fits into their lifestyle better. It's also true that medication abortion oftentimes is less expensive than a traditional in-office abortion."
TODAY.com spoke to five people who have had medication abortions, and who were willing to share the details of their experience. Their comments have been edited for brevity and clarity.
Layidua Salazar, 36, California
Salazar had her abortion in 2013 at 10 weeks gestation. At the time, she was married and on birth control, so at first she didn't believe her primary health care provider when she told her she was pregnant. She said her relationship "was not in a place" that would allow her to consider starting a family. She was also concerned about her immigration status.
I never thought I would find myself in a place where I would have an unplanned pregnancy.
As someone who used to be a sex educator for high school students, I had a full understanding of what I could do to prevent a pregnancy. I never thought I would find myself in a place where I would have an unplanned pregnancy. I scheduled the abortion without speaking to my spouse — I did not want the opportunity to have anyone's opinion shift what I knew I needed to do for myself. So I asked about what the available appointments were and there was an appointment two days out for medical abortion.
When I took the second medication I felt pretty alone. And because I did not consult with my husband, he was not necessarily there for for me — he decided to take the day off and went on a day trip with friends. Despite all of the emotions, I didn't feel conflicted at all. There was a comfort and a beauty in being able to go through everything in the comfort of my own home, and in knowing that I didn't have to continue my pregnancy.
I binge-watched "Scandal" and eventually told my parents I had a minor medical procedure. I did not disclose what it was, but it was nice to have my family eventually come and bring me food to make sure I was OK.
Hannah Matthews, 34, New England
Matthews had her medication abortion this year, at 5 weeks gestation. She said she wanted to go through the process at home, so that she could spend time with her 1-year-old baby, her partner, and friends who dropped by to give her food, love, and support.
I felt — and still feel — a lot of grief about my abortion, and wanted to be surrounded with community and especially to be close to my son and remember why I was doing it.
The pain was pretty manageable — I would say no worse than many periods and menstrual cramping I’ve experienced, and nothing close to my Pitocin-induced labor.
(During my abortion) I snuggled with my baby, gave him a bath, read him books and put him to bed. Then I curled up with my heating pad and my husband and my dog, and ate the treats my friends brought me — brownies, ice cream, and homemade chicken noodle soup.
Kelsea McLain, 36, North Carolina
McLain has had three medication abortions — the first at the age of 24; the second at 31; the third when she was 34. All three of her medication abortions occurred between 6-8 weeks gestation.
The overwhelming reason for me choosing this method the first time was I wanted the privacy and comfort of the abortion happening at home and I was uncomfortable with the idea of a D&E procedure — it felt invasive and more uncomfortable since I would have to be in stirrups and undergoing a gynecological procedure, which I have never really enjoyed much. I chose the option for a second time because I was familiar with it and knew what to expect, and the third abortion I decided on a medication abortion mainly for privacy.
My first medication abortion was pretty painful, both emotionally and physically — my partner and I were long distance at the time and he couldn't come to town to be with me through the process. I felt stigma and shame about being pregnant when I didn't want to be, and was self-isolating and attempting to self-manage with herbs due to being unable to afford the procedure and unwilling to disclose my need for an abortion to my family and friends. When I did finally involve my family and get the medications through my local clinic, it was just a painful abortion process.
The second medication abortion was a completely different experience — I didn't feel shame or stigma around my choice, my partner was by my side, and I had recently joined We Testify and had an amazing community of fellow abortion-having friends who were by my side every step of the way. The abortion was relatively painless, I barely bled, and I was convinced it didn't work — but it did! It was such a positive, pain-free experience.
Angel Kai, 23, Texas
Kai was 20 years old when she had a medication abortion at 5 weeks gestation. She said because she was so early in her pregnancy, the option was recommended to her as "the easiest way" to end her pregnancy.
The first day I had a little cramping (that lasted) about a week — I had bad, period-like cramps. It was a fast process.
I went back to work immediately and continued on my normal life as soon as I got back home. My only support was a worker from Fund Texas Choice — she checked on me through out the whole process and after.
Cynthia Gutierrez, 32, California
Gutierrez was 22 when she had a medication abortion at 7 weeks gestation. She didn't realize medication abortion was an option until she was attempting to access care. She said the "narrative" of abortion led her to believe care was always "intrusive and traumatizing." So once she discovered medication abortion, she "immediately selected the option."
I wasn’t provided as much support as I would have liked, nor was I properly informed of the impact the abortion would have on my body. At the time, I shared a living space with a roommate that was not supportive of my decision. Once I took the medication and began having a negative physical reaction, my roommate immediately called an ambulance. That ambulance took me to a Catholic hospital, I experienced subpar and unsupportive medical care.
Though the physical reaction I experienced was not ideal, it inspired me to want to learn more about medication abortion and show up for others in this journey. Now, I’m an abortion doula and board member for a local abortion fund.
As was my experience, not everyone has access to a private space but it is important to create a sacred space to safely have an abortion. Just like I support creating a sacred space for other birth or reproductive health services, it is important that we honor individuals as they are terminating a pregnancy.