The Plan C Guide: How to Get Abortion Pill Access By Mail

The “abortion pill" or "abortion with pills” is a modern option for ending an early pregnancy safely and effectively. It is also called "medication abortion." It uses two kinds of pills: mifepristone and misoprostol (or misoprostol only, if mifepristone is not available).

Method 1: Mifepristone + Misoprostol

This is the most common method of abortion with pills. You take a mifepristone pill first, followed by misoprostol pills 24 to 48 hours later. This is the most effective method of abortion with pills (95-98% of the abortions are successful). It has the fewest side effects. It is approved by the U.S. Food and Drug Administration (FDA). This is the type of abortion with pills provided by clinics like Planned Parenthood and recommended by the American College of Obstetricians and Gynecologists.

Method 2: Misoprostol Only

Abortion with pills can also be done using only misoprostol pills. This is less effective than when mifepristone and misoprostol are both taken (about 85% of the abortions are successful).  This is endorsed by the World Health Organization in places where mifepristone is not available.

• Both methods are effective and very safe. Both methods are also widely used by women around the world. We provide information about both methods on this website.
• Using abortion pills does not require the presence of a doctor. Some people find and take the medications on their own. This is called self-managed abortion.
  

Abortion pills block pregnancy hormones (mifepristone) and cause cramping and bleeding (misoprostol). This causes the pregnancy to end and come out of the body. It is like a miscarriage. You can expect a few hours of heavy bleeding and cramping and several days of lighter bleeding.

For more information, watch this video from the International Planned Parenthood Federation about how abortion pills work.

Yes, and no. Abortion pills are prescription medications in the US. But, it is also possible to get them from some places without a prescription.

People can get a prescription for the pills from abortion clinics, telemedicine services, and some medical offices. Click on "find pills" to learn how to get pills in your state.

We also know that many people are buying abortion pills from online pharmacies without a prescription. Some people also find the pills in bodegas or across the border in Mexico. Finding and using pills without consulting a medical provider is often called "self-managed" abortion. Our Guide to finding pills provides information about how people are doing this. It is important for those considering this option to understand any legal risks (see below--Can I Get in Trouble?).

Abortion pills work best in the first 11 weeks of pregnancy. Using pills later in pregnancy is more painful and less effective. The risk of complications also goes up as the pregnancy grows.

This calculator can help you know how many weeks pregnant you are. It is based on the first day of your last normal period. People who don’t know the first day of their last period or who have periods that don’t come regularly may need to have an ultrasound or pelvic exam to find out how many weeks pregnant they are.

Abortion pills can cost anywhere from $40 to $600 or more:

• Online pharmacies and new telehealth abortion services charge $150 and up.
• The in-clinic option costs $600 on average.
• The Misoprostol-only method can be found online, in bodegas, or in other countries. It costs between $40 to $300.

Many services accept insurance/Medicaid or offer discounts to those who can't pay. Just ask.

No. Plan B is emergency contraception. You can take it up to 5 days after having sex without using birth control. Plan B prevents pregnancy.

Plan C is our term for abortion pills. These are taken after a missed period (up to 77 days from the first day of your last normal period).

We believe that everyone should have access to all options: 

• Plan A is birth control to prevent pregnancy.
• Plan B is emergency contraception (also to prevent pregnancy)
• Plan C is abortion pills.

For information about where to find pills near you, visit our Guide to Pills.

Abortion pills are available from:

Clinics: Have an in-person visit with a clinician. Get pills to take home. Take the pills at home. Phone/text follow up support, if needed.

Telehealth services: Do a medical consultation using your phone or computer (online form or video visit). Receive the pills by mail. Take the pills at home. Phone/text follow up support, if needed.

Online pharmacies: Some international online pharmacies sell abortion pills. No prescription is needed. No medical screening or advice is given. Receive the pills by mail. Take the pills at home. Free phone/text follow up support available through MAhotline.org, if needed.

Other countries: Some people find abortion pills in pharmacies in other countries (like Mexico). Take the pills at home. Free phone/text follow up support available through MAhotline.org, if needed.

Most people use a pregnancy test to confirm that they are pregnant. Most people do not need any other medical tests to get abortion pills. The clinic or telehealth service may ask you to get additional tests if:

• You are unsure of when you had your last period
• You have any history or symptoms of ectopic pregnancy (like pelvic pain)

Yes. Some people who are not pregnant get abortion pills to keep in their medicine cabinet just in case their period is late. They can then take the pills right away without having to wait a long time for shipping. Some services listed in our Guide to Pills let you order pills in advance (Aid Access offers this "advance provision" in all states).

If you decide to use pills later, Aid Access will still help you with instructions and follow up support.

Some insurances and some Medicaid plans cover abortion pills. But not all providers accept insurance or Medicaid. Our Guide provides information about financial help available from individual providers. The best way to know if you can use your insurance or Medicaid is to contact the provider directly. They can help you figure it out.

Many online pharmacies sell abortion pills. They do not do a medical consultation. They do not require a prescription. They ship to addresses in all US states.

Are these services real? Yes, many are. But, they are not regulated by the US government. They sell generic abortion pills that have not been inspected by the US government.

Plan C regularly tests these online pharmacies by buying pills from them. The services we list in our Guide all shipped pills to us at our home addresses. The pills were real (based on laboratory testing). But, we do not operate these sites and cannot guarantee they will be reliable in the future.

Here is how online pharmacies work:

• The buyer selects the desired product (often called an MTP Kit, for “medical termination of pregnancy”). Our test buyers looked to make sure there was one pill of mifepristone and at least four pills of misoprostol. Some pharmacies sold only three misoprostol pills, which is not enough.
• The buyer fills out their address and payment information.
• The buyer choses the type of shipping they want. In our tests, “express” shipping was usually mailed from the United States and arrived in 4-6 days. “Regular” shipping was mailed from abroad and took several weeks.
• IMPORTANT NOTE: It is very common for these online pharmacy services to email or call soon after they get the order and request a different form of payment. They often say the credit card did not go through. They often ask the buyer to use a PayPal account in a person’s name or in the name of another business. These payment requests do seem unusual, but they worked every time we tested them.
• The pills usually arrive by US Postal Service. They usually do not require a signature.

Learn more about potential leal risks of accessing pills through online pharmacies by reading our FAQ. You can also contact the free, confidential Repro Legal Helpline (online or at 844-868-2812) to discuss your specific situation.

NOTE: If you have a problem with one of the online pharmacies listed on our website, please contact them directly to request help. We do not operate the services. We cannot help you with refunds or shipping issues.

Many groups provide information about how to take abortion pills. HowToUseAbortionPill.org provides excellent instructions for mifepristone plus misoprostol abortion and misoprostol-only abortion. The instructions are available in 27 languages. The website also includes a live chat feature.

The Miscarriage and Abortion Hotline also has instructions for how to take the pills in English and Spanish. You can also text or to talk to a clinician if you have questions.

Common symptoms:

Abortion pills cause bleeding and cramping. This is part of the abortion process and shows that the pills are working. Many people do not have any symptoms after taking the first pill (mifepristone). The bleeding and cramping usually start soon after taking the second set of pills (misoprostol).

The bleeding may be heavier than a normal period. The cramping can be mild to severe. This can vary for each person. It also depends on how far along the pregnancy is.

Other common side effects are feeling sick to your stomach, throwing up, diarrhea, headache, dizziness, and fevers.

The website howtouseabortionpill.org has great information about what to expect when you take the pills and how to manage side effects.‍

Severe symptoms that require immediate medical attention:

• bleeding that soaks through more than 2 maxi sanitary pads per hour for more than 2 hours in a row, OR
• fever of more than 100.4 degrees Fahrenheit for more than 24 hours, OR
• fever of more than 102.2 degrees Fahrenheit for any length of time

How to prepare:

‍To prepare for taking abortion pills at home, abortionfinder.org recommends gathering the following supplies in advance:

• A heating pad
• Comfortable clothes, including comfy underwear
• Super absorbent maxi pads
• A blanket in case of chills
• Ice chips and/or popsicles to suck on in case of nausea or vomiting
• Easily digestible food like plain crackers, white rice, bananas, broth, and plain white bread
• Something distracting, like movies, tv, magazines, coloring books, or video games
• A friend or other support person to help, if needed

There are two main ways to access abortion pills in the United States:

• Clinician-supported, means you get the pills after a consultation with a doctor or nurse practitioner. This can be in a clinic or through a telehealth service. Telehealth services mail you the pills after a medical consultation. You then use them at home.

• Self-managed, means you find the pills without consulting a medical professional. You then use them at home.

Examples of clinician-supported services include: 

• Abortion on Demand
• carafem
• CHOIX
• Just the Pill
• Hey Jane
• Forward Midwifery
• Full Circle Healthcare
• Metro Area Advance Practice Clinicians
• Pills by Post
• Planned Parenthood
• Your family doctor
• Aid Access

Examples of self-managed abortion include: 

• Buying and taking pills from an online pharmacy
• Finding pills in a bodega
• Purchasing pills from a pharmacy in another country, without a prescription

Both ways to access pills are safe, but self-managed abortion may have some legal risks. See our section "Can I get in trouble for using abortion pills?" for more information about the legal considerations for self-managed abortion.

Yes. There are many free services that can help support you during your abortion. The Miscarriage and Abortion Hotline provides free, confidential medical information and support by phone and text. Other services can provide emotional support by phone or text during your home abortion. There are even some chatbots that can help guide you.

Visit the support section below for more information.

Using abortion pills is very safe. Abortion pills are safest and most effective for pregnancies of less than 11 weeks. This means less than 77 days counting from the first day of the last regular period.

The rate of major complications during an early abortion is very low. Having an abortion is safer than continuing a pregnancy and having a baby.

One risk is that abortion pills may not work (they may not end the pregnancy). The pills are less effective when taken later in pregnancy. You can take a pregnancy test 3-4 weeks after taking the pills to make sure they worked:

• If the test is positive, it is important to get follow-up care.
• A pregnancy test done earlier than 3-4 weeks after an abortion may show a false positive. This is because it takes time for the pregnancy hormones to leave the body.
• Most people can tell they are no longer pregnant soon after the abortion because their symptoms of pregnancy go away.

Another risk is if the pregnancy is outside the womb. This is called an ectopic or tubal pregnancy. This is very rare (only about 2 of every 100 pregnancies). Because ectopic pregnancy can lead to serious health consequences, it is important to:

• Always do a pregnancy test 3-4 weeks after taking the pills
• Immediately seek follow up care at any medical facility if the test is positive
• Seek care if you have any continued signs or symptoms of pregnancy after the abortion. Common signs of ectopic pregnancy are severe and increasing abdominal pain, particularly if it is one sided.
  

Abortion is legal in the United States and most US Territories and abortion pills are FDA-approved medications. But, how people get the pills affects their risk of being prosecuted.

No one should ever be punished for providing their own medical care. But, since 2000, at least 60 people who have self-managed an abortion or have helped someone else are known to have been arrested or prosecuted. Those who are already at greater risk of criminalization because of their race, gender identity, economic status, or other factors may have a higher risk of prosecution. People who live in very conservative states also face a higher risk of prosecution. A few states even have laws that say that self-managing an abortion is illegal.

Plan C believes that each person should have access to information to make their own decisions about risk, including legal risk. The information below is not intended to endorse self-managed use nor is it legal advice. It is what we know from the experiences of people who have self-managed their abortions.

The Repro Legal Helpline provides free and confidential legal advice that can help people better understand the laws and legal risk they may face. Contact them online or call 844-868-2812.

‍Why have some people gotten in legal trouble?

Everyone living in the United States has a constitutional right to abortion, including self-managed abortion. Some people who have used abortion pills on their own have gotten in legal trouble in the United States. Over the past 20 years, there have been at least 24 cases where people have been prosecuted for self-managing their abortions (charges have varied from concealing a birth to homicide). During that same time, research suggests that a hundred thousand (or likely more) people have self-managed their abortions.

These examples can help you understand the ways in which people have gotten in legal trouble in the past:

Example 1: “I went to urgent care because I was scared about the bleeding, and my doctor reported me to the police.”

Everyone should be able to access urgent care when they are concerned about their health. But, in a few cases urgent care staff have called the police on people who have taken abortion pills that they purchased online. This is not ethical and should not happen. People who self-manage their abortions do not need to report to doctors that they have used abortion pills that they purchased online. No one can tell that you have used the medications, even if a blood test is taken. The symptoms after taking abortion pills are the same as a miscarriage. Because the medical treatment for an abortion with pills is not different than the medical treatment for a miscarriage, medical providers can safely and effectively care for you without needing to know your full medical history.

Example 2: “The tissue that came out was bigger than I expected and I didn’t know what to do with it.”

Sometimes people have been reported to the police because of the way in which they disposed of the miscarriage tissue. Most early abortion tissue is just blood and clots (like a heavy period) that can be flushed down the toilet. But sometimes when abortion pills are taken later in pregnancy there is more tissue. It can be hard to know how to dispose of it (this is true when someone has a miscarriage, too). Some people have been discovered when tissue has been found in the public sewer system, when they have told friends about their situation and the friends have reported them to the police, or when they have shared information with their medical provider and been reported.

Example 3: “My boyfriend found information in my search history and reported me.”

Digital communications (like email and texts) can be used as evidence against someone who has done an abortion on their own (without a prescription). People often use Incognito Mode (also called a Private Window) when searching for sensitive information. Most private browser settings/incognito window searches won’t retain your cookies, browsing history, search records, passwords, or personally identifiable information. Some people protect their digital privacy by using free VPNs (Virtual Private Networks) or by using the TOR Browser. VPNs can be used on computers and phones. When used in combination with Private Windows or Incognito Mode, they can keep your identity and location private when you search for information and make purchases (like buying abortion pills online), as long as you aren’t logging into accounts which are linked to you. People also use encrypted email (like Proton Mail) and secure texting (like Signal) to keep online communications private. Some people try to keep online purchases discreet by using online currency such as Bitcoin, but without some complicated additional steps those purchases can still be linked to an individual person. The Electronic Frontier Foundation has some additional tips about data privacy here.

Have Legal Questions?

Once someone has decided to have an abortion, they should be able to do so safely, effectively, and with dignity. No one should be arrested or jailed for ending their own pregnancy. But, if someone who chooses to use abortion pills outside of the established medical system gets into trouble it is important for them to get legal help. Organizations that can help people get legal help are:

• Repro Legal Helpline provides free, confidential legal support online or at 844-868-2812. They also defend people who are prosecuted or threatened with prosecution for self-managing their abortion. This fact sheet also has some great information about legal issues.
• National Advocates for Pregnant Women: NAPW defends women who are pregnant and attempt to have abortion, actually have an abortion, or are mistaken as someone who has had an abortion.

Remember:

• In the past 20 years, at least 60 people have been arrested and prosecuted for self-managing their abortion or helping someone else.
• Those who choose to use abortion pills on their own do not have to tell anyone that they took abortion pills (and doing so may increase the risk of prosecution).
• There is no way for a medical provider to know whether someone took abortion pills. The bleeding looks the same as a miscarriage.
• Medical providers can give appropriate follow up care for bleeding and pain without knowing whether someone took abortion pills.
• Some people use VPNs and other technology to protect their privacy.
• Legal assistance is available to those who need it.

Misinformation on the internet is common. Misinformation is false, inaccurate, or misleading guidance shared with the purpose of confusing someone.

To avoid false information and abortion scams, beware of these two common tactics used to trick people looking for abortion information.

Abortion pill “reversal”

Abortion reversal claims are false -- you can not “reverse” an abortion. People who share this information claim that taking progesterone after taking the first abortion pill can make the pregnancy continue. There is no scientific evidence that progesterone will reverse the abortion process.

If you’d like to learn more, we recommend this resource created by The American College of Obstetricians and Gynecologists.  

Fake abortion clinics

Fake abortion clinics are another method of tricking people looking for abortion information. Fake clinics are usually called "pregnancy centers" or "crisis pregnancy centers." They often use the same language and information-sharing techniques as real abortion clinics and resources. These sites trick people into thinking they are making an appointment for an abortion. This is harmful because it delays access to care.

This resource can help you learn how to spot a fake abortion clinic.