What to Know About Self-Managed Abortions

  • Medication abortions using the pills misoprostol and mifepristone are increasingly common.
  • It involves taking the two pills at home to induce a “miscarriage” over a few days, gynecologist Dr. Mary Jane Minkin told Insider.
  • Self-managed abortions can be done for up to 11 weeks since your last menstrual cycle.
  • Visit Insider’s homepage for more stories.

Since the FDA approved the abortion pill mifepristone in 2000, self-managed at-home abortions — which can be done in the first 11 weeks of pregnancy — have become increasingly common in the US.

It is likely to become especially sought-after given the recent challenges to abortion access across the US, Carole Joffe, sociologist and co-author of “Obstacle Course: The Everyday Struggle to Get an Abortion in America,” told Insider.

Texas has implemented a ban on abortions after six weeks, which effectively bans all abortions. Many states have barely any abortion clinics. Soon, the Supreme Court will hear a case from the state of Mississippi, asking to overturn Roe v. Wade, the precedent that makes abortion legal in the US. 

Medication abortions have also been under threat.

In January, the Supreme Court made it illegal to get abortion-inducing pills by mail — the only medication barred from mail-order prescriptions during the pandemic. (President Joe Biden reversed the ban in April.)

However, these pills are now being eyed as a lifeline for people in Texas, who can no longer get an abortion after six weeks without breaking the law.

Here’s everything you need to know about abortion pills.

First, consult with a doctor

The first stage in any abortion should be a consultation with a healthcare provider.

They will explain your abortion options, and can carry out lab tests to ensure you’re a good candidate for medication abortion.

If you decide to go the route of a medication abortion, you’ll be prescribed mifepristone and misoprostol.

That prescription comes with directions on how to use the pills, and a number to call if you need assistance during or after the abortion.

Two pills are used to induce a miscarriage

Self-managed abortions are done using two pills together: mifepristone and misoprostol.

First, you’ll take the mifepristone, which blocks the production progesterone, a hormone needed to sustain a pregnancy.

Right after or up to two days later, depending on your doctor’s instructions, you’ll take misoprostol, a drug that causes the uterus to contract and pushes the embryo or fetus out of your body.

“You will be experiencing, in a sense, a miscarriage,” Yale University gynecologist Dr. Mary Jane Minkin told Insider.

Misoprostol normally causes cramping and bleeding one to four hours after a patient takes it, according to Planned Parenthood.

Sometimes a self-managed abortion is only done with mifepristone, but research has shown that using both drugs in tandem leads to better outcomes because it prevents the potential need for surgery to remove the fetus.

Afterwards, you’ll have a follow-up appointment with a doctor to make sure the abortion is complete.

You can use the abortion pill until 11 weeks after your last period

If you are pregnant and it has been more than 11 weeks since your last period, you’ll have to explore other options, Minkin said. 

The effectiveness of the abortion pill changes depending on close you get to the 11-week cutoff.

For example, the pill is effective between 94% and 98% effective for people who are less than eight weeks pregnant. But for people who are nine to 10 weeks pregnant, the pill is effective 91% to 93% of the time, the Planned Parenthood website says.

Sometimes doctors will prescribe an extra dose of medicine for patients who are closer to the 11-week threshold, which can increase effectiveness, according to Planned Parenthood.

In-person and online healthcare providers offer the abortion pill

To get the drugs you need for a self-medicated abortion, you’ll need to see a gynecologist who’s trained and licensed to give you the pills. You can call and ask ahead of time to be sure.

If you can’t access a gynecologist in your area, you can order the pill online.

Carafem, a reproductive healthcare provider in Maryland, Georgia, Tennessee, Washington DC, and Illinois, offers both in-person and telemedicine medicated abortion services.

People who don’t live within driving distance of a brick-and-mortar provider can set up an encrypted video meeting with a physician and then they’ll be sent the pills in the mail, according to chief operating officer Melissa Grant.

Grant said Carafem in-person clinics are located in close proximity to states that don’t have easy abortion access. Over the summer, Carafem found 30% of their clients drove more than 100 miles to get to their clinics in DC, Nashville, Chicago, and Atlanta, Grant said.

The abortion pill may be covered by insurance, but not always

Minkin said medicated abortion is typically less expensive than in-clinic, but cost varies based on your location and insurance coverage.

According to Planned Parenthood, the pill can cost up to $1,000 without insurance.

If you have Medicaid and need an abortion due to rape, incest, or life endangerment due to carrying a pregnancy, all states cover the cost of the pill, according to the Kaiser Family Foundation.

Due to a piece of legislation called The Hyde Amendment, 16 other states use their own funds to cover abortions, including the pill.

Some people aren’t eligible for a medication abortion

People with IUDs, bleeding disorders, a suspected

ectopic pregnancy
, or who are allergic to the pills can’t get medication abortions, according to the Mayo Clinic.

Rare complications include excessive bleeding, blood clots, and infection

Though rare, there are complications that can occur after a self-managed abortion, including excessive bleeding, blood clots, and infection.

If you have any of these symptoms, contact your healthcare provider right away and go to the hospital.

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