This version of the fact sheet was written by Kimya Forouzan. It was edited by Ian Lague.
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 is currently approved through 10 weeks gestational duration, although it is commonly, safely and legally used later in pregnancy on an off-label basis. 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, both when provided in person and via telehealth. In 2023, medication abortion accounted for 63% of all clinician-provided abortions 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In the wake of Dobbs v. Jackson Women’s Health Organization, the 2022 US Supreme Court decision that rescinded Americans’ constitutional right to abortion, states across the country instituted total or early gestational duration abortion bans that prohibit both procedural and medication abortion. Many of the states that are not enforcing total bans have imposed unnecessary restrictions on medication abortion that increase barriers to care. For example, some states explicitly prohibit the use of telemedicine to prescribe medication abortion pills, despite clinical evidence that this practice is appropriate and safe. Other ways that states effectively prohibit telemedicine provision 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 providers from mailing abortion pills to patients.
Even before the Dobbs decision, many states have impeded medication abortion provision in ways that disregard scientific evidence and best medical practice. In some states, providers are required to give patients medically inaccurate information on the possibility of “reversing” a medication abortion after starting the regimen. In other states, patients may be required to make an in-person visit after completing a medication abortion, necessitating another trip to the clinic. Several states also impose a gestational limit on the use of medication abortion that is earlier than the FDA’s approved timeframe. Additionally, half of all states limit medication abortion provision solely to physicians. This policy contradicts findings from the World Health Organization and other researchers that advanced practice clinicians, such as physician assistants and nurse practitioners, can safely provide medication abortion.
In recent years, states have begun imposing new types of restrictions on medication abortion provision. For example, some states explicitly prohibit the sale, purchase or distribution of medication abortion pills. Others have classified these pills as controlled substances. These newer restrictions are part of a new wave of attacks on telemedicine abortion care, particularly care provided by out-of-state providers under the legal protection of reproductive health shield laws.