The Plan C Guide to Abortion Pills

“Abortion with pills,” also called a medication abortion, is a modern option for ending an early pregnancy safely and effectively. The pills are a combination of medications: 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. It involves taking 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 and 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).  The World Health Organization endorses the use of misoprostol alone for early abortion when 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, although many people choose the support of a medical professional as they go through this process.
• It’s best to use this method in a comfortable and safe environment. It may not be the right option for people who are in an unsafe relationship or do not have a safe, private space to have the abortion.
  

Abortion pills work by blocking the flow of progesterone to the developing pregnancy (mifepristone) and causing the uterus to cramp and expel what’s inside (misoprostol). They effectively cause a miscarriage. This usually involves 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. People can get a prescription for the pills from abortion clinics and some family practice clinicians. It is now possible to get both a prescription and the pills using telemedicine, meaning no clinic visit is needed. Our Guide to finding pills lists telemedicine services in some states that can mail pills directly to a patient's address.

We also know that many people are buying abortion pills through 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 will be 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 (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 “digital abortion clinics” charge between $150 and $350.
• Telemedicine services range from $200 to $750, depending on if they require tests or bloodwork.
• 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. Check with your local provider or preferred online service for more precise explanation of costs.

No. Plan B is emergency contraception, a pill to take 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 a full range of options: 

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

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.

Common symptoms:

Abortion pills cause bleeding and cramping. This is a natural 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 and the cramping can be mild to severe. This can vary for each person and by how far along the pregnancy is.

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

The website howtouseabortionpill.org has great information about what you can 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

Because there are many ways to get abortion pills in the US, it can be confusing to know what's what. There are two main ways to access abortion pills.

An at-home "clinician-supported" abortion means that a clinician (like a doctor or nurse practitioner) asks the patient for basic medical information, reviews that information, prescribes and dispenses the medications, and is available to help answer questions before, during and after the abortion. The patient takes the pills at home. Examples of clinician-supported services include: 

• Abortion on Demand
• carafem
• CHOIX
• Just the Pill
• Hey Jane
• TelAbortion
• Planned Parenthood
• Your family doctor
• Aid Access

A "self-managed" abortion means that a person finds and takes the abortion pills at home without consulting a clinician. 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 more information about the legal considerations for self-managed abortion.

Using abortion pills is very safe. Abortion pills are safest for pregnancies of less than 11 weeks (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, and the earlier in pregnancy an abortion is done, the lower the chances are of complications.

It is better to use mifepristone plus misoprostol because it is more effective. But, sometimes mifepristone pills are hard to find in the United States. The World Health Organization says it is safe to use misoprostol alone when mifepristone is not available.

One risk is that abortion pills may not work (they may not end the pregnancy). The pills are less effective when only misoprostol is used or when the pills are taken later in pregnancy. Most providers recommend doing 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. (Note: a pregnancy test done earlier than 3-4 weeks after an abortion may show a false positive because it takes time for the pregnancy hormones to leave the body. But 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). In these cases, the abortion pills will not work and the person will need timely follow up medical attention, which can be obtained at any medical facility. Because of this small risk, it is important to always do a pregnancy test 3-4 weeks after taking the pills and to seek immediate care if the test is positive. It is also important to seek care if there are any continued signs or symptoms of pregnancy after the abortion (such as severe and increasing abdominal pain, particularly if it is one sided). Ectopic pregnancy is rare but can lead to serious health consequences.

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

No one should ever be punished for providing their own medical care. But, since 2000, at least 24 people who have self-managed an abortion are known to have been 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 may 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. 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 assess their specific situation and level of risk. Contact them online or call 844-868-2812.

‍Why have some people gotten in trouble?

Everyone living in the United States has a constitutional right to abortion, including self-managed abortion. A small number of people who have used abortion pills on their own have gotten in legal trouble in the United States. To help  understand the level of risk it is helpful to compare the number of people prosecuted to the number of people who have used abortion pills on their own (without a prescription from a licensed provider). 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 should know that if they seek help at an urgent care clinic, they do not need to report 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. People who visit urgent care often say they are having a miscarriage (without mentioning that they have taken pills). The urgent care providers can give safe and effective treatment without knowing the cause of the miscarriage.

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 discovered and 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) such as TOR. VPNs can be used on computers and phones. They keep your identity and location private when you search for information and make purchases (like buying abortion pills online). People also use encrypted email (like Proton Mail) and secure texting (like Signal) to keep online communications private. Some people keep online purchases discreet by using online currency such as Bitcoin.

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 24 people have been arrested and prosecuted for self-managing their abortion.
• 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 pills.
• Many people just say they are having a miscarriage.
• Medical providers can give appropriate follow up care for bleeding and pain without knowing whether someone took pills.
• Some people use VPNs and other technology to protect their privacy.
• Legal assistance is available to those who need it.

It is not uncommon to find misinformation on the internet. Misinformation is false, inaccurate, or misleading guidance shared with the purpose of confusing someone.

If you’d like to avoid false information and abortion scams it could be helpful to know about two common tactics used to deceive people looking for abortion information.

Abortion “reversal” pills

Abortion reversal claims are false -- you can not “reverse” an abortion. People who share this information claim that flooding the body with progesterone after taking mifepristone can make the pregnancy continue. There is no scientific evidence that progesterone has resulted in pregnancy continuation.

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 deceiving people looking for abortion information. These organizations are usually called pregnancy centers or pregnancy crisis centers. They often use the same language and information-sharing techniques as reputable abortion resources. These sites trick people into thinking they are making an appointment for an abortion, delaying access to care.

To learn how to spot a fake abortion clinic this resource may be helpful.