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What is the abortion pill, the next issue in the war on Roe v. Wade?

With more states across the country passing laws that attempt to challenge Roe v. Wade, the United States has become an increasingly difficult place to live for people seeking abortion care. As access to clinics grows more difficult, a less discussed method of abortion, known as the abortion pill (also referred to as medication for abortion), is gaining in popularity, with many people getting it prescribed by doctors and others using it to self-induce abortion. Still, there's a lot of important information about the pill that isn't yet common knowledge. Here's everything to know about the abortion pill.

How it works

Approved by the FDA in 2000, the abortion pill is routinely prescribed by healthcare providers, and is "a very safe and effective method" of abortion, says Dr. Daniel Grossman, who's researched the abortion pill for years and published multiple studies about its use. The pill most commonly prescribed is Mifeprex, a medication that involves two different pills: mifepristone and misoprostol, the latter of which is taken 24 to 48 hours after the former. Mifeprex is approved by the Food and Drug Administration, and has a 95-98 percent success rate within the first 10 weeks of pregnancy. It also has fewer side effects than other abortion pills, and is the recommended method for first trimester abortions by the American College of Obstetricians and Gynecologists (ACOG).

Misoprostol is less effective on its own (80-85 percent) than when combined with mifepristone — a steroid that blocks the production of progesterone, thus inducing an abortion — but it's still safe to use alone, and is even endorsed by the World Health Organization as an alternative when mifepristone is not available. It is not common or advised for people to take mifepristone alone, however.

Unlike emergency contraception designed to reduce the risk of pregnancy within 120 hours of unprotected intercourse (commonly referred to as Plan B), the abortion pill induces abortion and can be taken up to 70 days after the first day of the last menstrual period.

Where to get it

Physicians recommend obtaining the pill through a licensed medical provider, but that's not always possible. Access to both mifepristone and misoprostol is severely restricted in the United States, and even in areas where it's attainable, the process can take many steps. According to the Guttmacher Institute, 34 states require that the person who administers the abortion pill is a licensed physician, despite the FDA determining that physician assistants and advanced nurses can also prescribe the pill. Additionally, 17 states require the provider to be physically present during the procedure, prohibiting the possibility of telemedicine, i.e. when a physician prescribes medication remotely.

The Guttmacher Institute.

Because it can be difficult to access abortion care in clinics, some individuals choose to buy pills online to self-administer their abortions. Plan C, a non-profit organization that works to educate people about the abortion pill, has a thorough breakdown on its website of how to access the pill via the internet, as well as a "report card" that rates sites selling the pill based on price, shipping time, product quality, and physician oversight. Purchasing the pill online for a self-managed abortion can cost anywhere from $95 to $360, depending on the site, while at a clinic, the price for an abortion can be anywhere from $300 to $800, according to Planned Parenthood. All self-managed abortions should be followed with a visit to a healthcare provider.

Elisa Wells, a co-founder of Plan C, tells Mic that the abortion pill needs to be de-stigmatized in the United States so that it is easier to obtain. While self-administering abortions has historically been seen as a dangerous and unregulated practice, "the difference now is that we have various very safe and effective way for people to do that," explains Wells. "In the past, people have used unsafe ways of self-managing their abortions. But what is remarkable now is that we have the technology to enable people to do it safely and effectively."

What happens after you take the pill

Physically, the effects of taking the abortion pill are typically minor; most people experience cramps and bleeding for a few hours, according to the ACOG. Yet legally, things can get complicated. Jill E. Adams, J.D., the executive director of the nonprofit If/When/How: Lawyering for Reproductive Justice, tells Mic that there are a variety of state laws — part of the wider trend of criminalizing abortion in the U.S. — that can be used to punish people who administer their own abortions. According to the Guttmacher Institute, seven states have laws that directly criminalize self-managed abortions, 10 states have have fetal harm laws that exist without exceptions for pregnant people, and 15 states have laws that could be used to criminalize self-managed abortion.

"We know of at least 21 people throughout the United States who have been arrested and some even imprisoned for ending their own pregnancy or for helping someone else do so," explains Adams. "Abortion is a right protected by the US Constitution and many state constitutions. However, it's not an unfettered right. And some people have been criminalized for self-managing their own abortion."

The Guttmacher Institute

On its website, Plan C notes that groups already vulnerable to excessive policing (people of color, the LGBTQ+ community, people living below the poverty line, and immigrants) may face additional legal risks when self-administering abortions. However, there is no way for a provider to be able to determine whether or not you took the pill, because a spontaneous abortion (most widely known as a miscarriage) looks the same, medically, as an elective abortion. And if you choose to have an abortion through this method, you are not obligated to tell anyone.

"We have people all the time tell us that this is what they would prefer to do, to have the convenience and confidentiality and control that self-managed abortion offers," Wells says. "And I think it's particularly true now in the United States with the climate around abortion."

Why it's becoming more widely used

"The news that these ultra conservative bills are passing in legislatures in our country is fueling interest in self-managed abortion," Wells says. "We have certainly seen our website traffic jump dramatically." But even before the recent spate of anti-abortion legislation, the abortion pill was a common alternative for people who had restricted access to reproductive care (90 percent of U.S. counties don't have an abortion provider). According to the Guttmacher Institute, the use of the abortion pill increased from 6 percent in early 2001 to 31 percent in 2014, and in 2014, medication-caused abortions made up 43 percent of all pregnancy terminations.

"The reality for many people already is that they don't have access to abortion services," Wells explains. "There are many reasons why abortion is already inaccessible to many in this country, and people are looking for alternatives."

Now that there is more anti-abortion legislature happening nationwide, though, the abortion pill will likely become even more widely used. Wells says that Plan C sees self-managed abortion as "a method that needs to become a part of the mainstream options available to those who need an abortion."

Adds Adams, "As long as someone has access to accurate information, reliable methods, and confidential backup medical care in the event it's needed, people can end their own pregnancies at home safely and effectively."

To learn more about the abortion pill visit plancpills.org.