Medication Abortion

October 31, 2023

Laws and regulations on mifepristone are rapidly changing across the United States since the District Court for the Northern District of Texas ordered the Food and Drug Administration in April to revoke its approval of mifepristone, one of two pills used in medication abortions, in Alliance for Hippocratic Medicine v. US FDA. As a result, some information here may be out of date. Our team is working diligently to update this resource. Thank you for your patience.

Medication abortion has been available in the United States since 2000, when the US Food and Drug Administration (FDA) approved the use of mifepristone for early abortion. Unlike procedural abortion, medication abortion does not have to be done in a clinical setting; the pills—mifepristone, followed by misoprostol—can be taken in one’s own home. Decades of studies have shown that medication abortion is safe and effective. By 2020, medication abortion accounted for more than half of all abortions obtained in the United States, up from 39% in 2017.

In the wake of Dobbs v. Jackson Women’s Health Organization, the US Supreme Court decision in June 2022 that overturned the federal constitutional right to abortion, states across the country have banned the procedure. Near-total or early gestational age bans in those states have restricted both procedural and medication abortion.

In January 2023, the FDA lifted restrictions that prevented patients from obtaining medication abortion pills from a retail pharmacy. Pharmacies must complete a certification form from the manufacturer to dispense the pills. Individuals cannot obtain the medication at a pharmacy in states that have a near-total abortion ban.

Many of the states that allow abortion have imposed unnecessary restrictions on medication abortion that only serve to increase barriers to care; almost half of those states limit its provision solely to physicians. This policy contradicts findings from the World Health Organization and other health and medical organizations that advanced practice clinicians, such as physician assistants and advanced practice nurses, can safely provide medication abortion. Currently, medication abortion is approved by the FDA for use up to 10 weeks of gestational age and it is used safely off-label at later gestations.

Some states require a physician to be in the same room as the patient when administering the medications, effectively prohibiting telemedicine provision of medication abortion despite clinical evidence that this practice is appropriate and safe. Other ways to limit access to medication abortion are requiring that the provider observe the patient taking the first dose and prohibiting a provider from mailing the medications to a patient. Allowing use of telehealth would expand access to medication abortion, particularly for patients in rural areas and in areas with few abortion providers.

Highlights

14 states have a near-total ban on abortion in effect (Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia). All of these states have separate laws limiting the provision of medication abortion, although these are not currently applicable because providers have stopped offering all abortion care.
15 states restrict access to medication abortion.
- 15 states require that medication abortion be provided by a physician.
- 5 of these states require the patient to have an in-person visit with a physician.
- 1 state requires that the first of the two-drug regimen for medication abortion be taken in the presence of a physician.
- 1 state bans mailing pills for medication abortion to a patient.

Current Policy Status Table

Restrictions on Medication Abortion
State	Must be provided by physician	Patient must have in-person visit with physician	Gestational age limit for provision	Patient must take first dose in the presence of physician	Mailing of abortion pills banned
	Must be provided by physician	Patient must have in-person visit with physician	Gestational age limit for provision	Patient must take first dose in the presence of physician	Mailing of abortion pills banned
Alaska	X
Arizona	X	X			X
Florida	X
Georgia*	X
Iowa	X	▼
Kansas	X	▽		▽
Michigan	X
Minnesota	▽
Montana		▽	▽		▽
Nebraska	X	X
Nevada	X
North Carolina	X	X
Ohio	X	▽		▽
Pennsylvania	X
South Carolina*	X	X
Utah	X
Wisconsin	X	X		X
TOTAL^‡	15	5	0	1	1

Note: Fourteen states with restrictions are not included on the table because they have a near-total ban on abortion in effect that supersedes any other restrictions on medication abortion (Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia). ▼ Permanently blocked by court order; law not in effect. ▽ Temporarily blocked by court order; law not in effect. * State bans abortion at six weeks. ‡ Wyoming enacted a law that would have banned medication abortion beginning in July 2023; however, a judge temporarily blocked the law from taking effect while a case against it proceeds.