Mifepristone, when paired with misoprostol, forms the cornerstone of medication-induced abortion. This duo effectively terminates a pregnancy by first blocking the hormone progesterone through mifepristone, which is essential for the pregnancy’s progression. Subsequently, misoprostol induces uterine contractions, mirroring the process of a miscarriage, to expel the pregnancy.
Research conducted in the United States has demonstrated that this combination successfully completes an abortion in over 99% of cases, showcasing a safety profile comparable to surgical abortions performed in clinical settings. Extensive studies have underscored the low incidence of adverse effects associated with medication abortions, and a notable publication in The Lancet last year highlighted the general satisfaction among patients who opted for this method.
International evidence further supports the safety of abortion pills, even in scenarios where medical guidance is not directly accessible.
Although the FDA endorses the use of both mifepristone and misoprostol for terminating a pregnancy, misoprostol alone can also achieve this outcome. Despite being slightly less effective—around 80%—misoprostol can terminate a pregnancy on its own, sometimes requiring multiple doses. It’s also used for treating ulcers and is readily available over the counter in several countries, including Mexico, without being impacted by any legal decisions regarding mifepristone.
The FDA has sanctioned the use of medication abortion up to the 10th week of pregnancy. However, the World Health Organization extends this recommendation to 12 weeks for at-home use and beyond 12 weeks under medical supervision. It’s noteworthy that the majority of abortions occur within the 12-week mark.
In recent years, particularly during the Covid-19 pandemic, medication abortion has seen a surge in preference in the United States, accounting for more than half of all legal abortions—a figure that rises to three-quarters in Europe. The pandemic-driven shift towards telemedicine and adjustments in federal regulations facilitated easier access to these medications, allowing patients to avoid in-person clinic visits.
Following the Supreme Court’s Dobbs decision, which led to abortion bans or restrictions in nearly two dozen states, many women in affected areas have sought out mail-order abortion pills as an alternative. Healthcare providers in various states have started dispatching these pills to states with restrictions, supported by protective shield laws. Additionally, international non-profits and entrepreneurs have begun supplying women in the U.S. with pills from abroad, a practice unaffected by U.S. legal constraints and ensuring continued access despite potential restrictions on mifepristone.