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 abortion in a two-drug regimen with misoprostol. Mifepristone was first approved for use through seven weeks’ gestational duration and is currently approved through 10 weeks. It is also used safely off-label later in pregnancy. Unlike procedural abortion, medication abortion does not have to take place in a clinical setting—the pills can be taken in one’s own home. Decades of studies have shown that medication abortion is safe and effective. In 2023, medication abortion accounted for 63% of all abortions provided by clinicians in the United States, up from 53% in 2020 and 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 instituted total or early gestational duration abortion bans that prohibit both procedural and medication abortion.
In January 2023, the FDA lifted restrictions that prevented patients from obtaining medication abortion pills at 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 total abortion ban.
Many of the states that allow abortion have imposed unnecessary restrictions on medication abortion that increase barriers to care. For example, half of all 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 registered nurses, can safely provide medication abortion.
Some states explicitly prohibit the use of telemedicine to provide medication abortion, despite clinical evidence that this practice is appropriate and safe. Other ways to prevent telemedicine provision in practice include requiring an in-person exam before the medications are provided, requiring a provider and patient to be in the same room when the medications are dispensed, and requiring that a provider observe a patient taking the first dose. A few states prohibit a provider from mailing abortion pills to a patient.
In some states, providers are required to give patients medically inaccurate information on the possibility of “reversing” a medication abortion after starting the regimen. Patients may be required to make an in-person visit after taking the course of medication abortion, necessitating another trip to the provider. Several states specify a cut-off for use of medication abortion that is earlier than the FDA’s approved timeframe.