Can I Take the Abortion Pill at Home?

Since the Supreme Court struck down Roe v. Wade on June 24, reversing the constitutional right to abortion, internet searches for abortion medication have skyrocketed, according to research published the same month in JAMA Internal Medicine. Although preliminary data has not yet been released, more women are presumably seeking abortion pills online since they may no longer have abortion access in their state.

Many patients first turned to telehealth providers for medication abortions after the Biden administration loosened restrictions during the COVID-19 pandemic, according to the American College of Obstetricians and Gynecologists. Now, since abortion is banned in 44 states after a certain point in pregnancy, per The 19th News, abortion pills have become the only option for terminating a pregnancy for many. However, legal penalties for abortion vary widely across states, with some as severe as a charge of a first-degree felony punishable by a life sentence in places like Texas (PDF).

For this reason, public health advocates, social justice activists, researchers, and nonprofits alike are speaking out to educate and inform people about their options moving forward, including medically safe, self-managed medication abortions, facilitated with abortion pills bought online through vetted sources.

RELATED: How to Find Trustworthy Abortion, Emergency Contraception, and Birth Control Resources

Medication Abortions Make Up the Majority of All U.S. Abortions

According to a recent report published by the Guttmacher Institute, a research nonprofit focused on reproductive rights, medication abortion made up 54 percent of all U.S. abortions in 2020, a significant increase from just 39 percent in 2017. The so-called “abortion pill” has found favor with patients and providers “thanks to its track record of safe and effective use for more than two decades,” per the report.

Why Are Abortion Pills Popular?

Abortion pills have become the most common form of abortion for several reasons, not least of which is their ease of use and noninvasive nature. Other reasons include:

  • Convenience at Home These medications can safely be taken outside of a medical setting, in the privacy of your own home, says the sex educator and self-managed abortion advocate Lux Alptraum. “If you’re doing it at home,” she says, “you can have whoever you want present. You can just design the experience for yourself.”
  • Ability to Purchase Online Acquiring the pills online increases the convenience factor even more, especially for women who may have a challenging time getting to a medical facility, or have trouble scheduling an appointment with their healthcare provider due to work or childcare obligations.
  • Discretion In places where abortion has been criminalized, abortion pills allow women to pursue abortion discreetly, regaining control over their bodies if they cannot travel out of state for care, says Alptraum. “It’s harder to get surgical abortion where it’s criminalized because there’s more evidence … and you have to loop more people in.”
  • Quick and Less Disruptive Abortion pills can oftentimes be mailed quickly, or at the very least, you don’t have to take time off work to travel far away to get them. “If you travel to another state,” Alptraum says, “it may take a long time to get an appointment,” she says.

How Does the Abortion Pill Work?

The treatment is administered in two doses. The first dose of the abortion pill regimen consists of mifepristone, a drug that works by blocking the hormone progesterone, which normally stops uterine contractions keeping the embryo implanted. Some people report nausea, diarrhea, chills, or vomiting, or start bleeding after taking this pill, but this is not common.

The second pill, taken one or two days later, is misoprostol, a hormone that induces labor and softens and dilates the cervix, causing the uterine lining to shed and the embryo to detach and exit the uterus. Women can expect uncomfortable cramps and bleeding, so it’s best to rest at home for one to two days. Pain can be managed with over-the-counter medication such as ibuprofen, says Felice Gersh, MD, an ob-gyn and the director of Integrative Medical Group of Irvine in California.

The pills can be taken immediately after someone discovers they’re pregnant. Still, the process becomes “less effective and more complicated, in terms of the amount of bleeding and tissue that has to be expelled, up to 11 weeks after the first day of your last period,” says Dr. Gersh.

Is the Abortion Pill Safe?

Proponents for self-managed abortions, including Lux Alptraum, stress that abortion pills can be incredibly safe and effective. For this reason, she believes the medication should be made available over the counter without a prescription. However, the abortion pill is not appropriate for patients with an IUD or certain bleeding disorders, those who suspect that they may have an ectopic pregnancy, or people taking blood-thinning medications. For patients unable to safely undergo this type of abortion, surgical abortion, where a provider surgically remove the tissues in the uterus, could be a better option.

Buying Abortion Pills Online Safely

Gersh cautions buyers who purchase their medicine online to ensure that the pills are obtained through legitimate telehealth providers. Patients should have consultations with board-certified providers who issue a prescription that the service fills and mails directly.

Because the changing landscape for contraceptive access has created an opportunity for rogue online pharmacies to sell counterfeit or substandard abortion pills, buyers must purchase their medication from verified sources to ensure they’re safe. While pregnant people can buy pills from online pharmacies without a prescription — called self-managed abortion — it’s vital to ensure these pharmacies sell the proper medication. Fake abortion pills can be ineffective (sold without the correct active ingredients), expired, or potentially dangerous due to contaminants or improper medications, according to the U.S. Food and Drug Administration.

RELATED: How to Buy Abortion Pills Online: A Step-by-Step Guide

Resources like Plan C can connect you with vetted pharmacies that ship abortion pills to the United States. The nonprofit Partners for Reproductive Justice provide links to global partners and information on what to look for to ensure the medicine you purchase is legitimate. However, the legal repercussions of purchasing medications for self-managed abortion will vary from state to state and are changing rapidly.

Risks of Self-Managed Abortion With the Abortion Pill

Complications from a medication abortion are exceedingly rare. A report (PDF) published by Advancing New Standards in Reproductive Health found that the rate of mortality from medication abortion was 0.35 deaths per 100,000 medication abortions. However, in the rare event of a medical emergency, Gersh says that patients should ideally be within one hour of the nearest hospital to seek medical care immediately.

“There has to always be some kind of backup solution,” she says, “because nothing is foolproof or completely free of potential side effects.” According to Gersh, complications that would warrant a trip to the hospital include soaking through two pads an hour for more than two hours, a high-grade fever above 100.4 degrees F, vomiting for more than 24 hours, or experiencing extreme pain.

Given the current risk of criminalization, it’s important for women to know that they’re under no obligation to tell healthcare practitioners or hospital staff whether they took abortion pills. Induced miscarriage (medication abortion) and spontaneous miscarriage look identical, says Gersh. “Any person (since they don’t do lie detector tests) could walk into an emergency room and simply say, ‘I believe I’m having a miscarriage,’ and there’s no way for anyone to know otherwise. There will be no telltale signs whatsoever,” she says.

Access to the Abortion Pill Is Vital

In our post-Roe reality, access to legal abortion is not guaranteed for everyone. However, medication abortion provides a very safe and convenient option for most women, whether they simply want to terminate their pregnancy at home, or they have no other safe choice.

To that end, purchasing abortion pills online is an optimal way for women to self-direct their access to abortion by mail — provided they educate themselves about the potential risks and buy the proper medication, by consulting reputable resources offered by sexual and reproductive healthcare organizations on the web, such as Planned Parenthood and Plan C.

“Plan C offers research-based information about how people are accessing abortion pills for a medically safe self-managed abortion, even in states that restrict access,” said a representative from the organization. “We want people to know there are ways to access pills by mail in all 50 states, as well as free medical and legal support to help people navigate the changing access landscape.”

Speaking out about experiences of self-managed abortion (as long as it wouldn’t put you in legal jeopardy) is an integral step toward enacting change, says Lux Alptraum. “The more we talk about self-managed [abortion], the more we are fundamentally reclaiming our reproductive autonomy because, for many decades, abortion has been gatekept. … It’s something where we’re taught only doctors can do this. … And it’s really not true.”

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