Evidence You Can Use: Medication Abortion is designed to give advocates, service providers and policymakers the data and resources they need to engage in ongoing policy discussions in their states. It includes information on state laws and policies, a synthesis of the relevant research, information on states in which the issue has been debated in the past three years and links to state-specific data. The toolkit provides the evidence base for understanding regulations and restrictions related to medication abortion.

BACKGROUND

A safe and effective option at early gestations, medication abortion accounted for more than one-third (39%) of all abortions in the United States in 2017. Medication abortion is as safe as surgical abortion, but is noninvasive and can be completed in a patient’s chosen setting, such as at home.

Medication abortion using a combination of mifepristone and misoprostol was first approved by the U.S. Food and Drug Administration (FDA) in 2000. In 2016, on the basis of scientific studies, the FDA updated its protocol to a regimen that is just as effective but uses less medication, has fewer side effects, has a longer time span for use (up to 70 days after a patient’s last menstrual period) and requires fewer visits to the provider. By the time the protocol was updated, this evidence-based regimen was already in widespread use. Decades of clinical evidence suggest that medication abortion can even be provided without laboratory tests or ultrasound prior to administration, opening up further possibilities for service delivery.

However, abortion restrictions continue to hamper the delivery of medication abortion. Since 2004, states have enacted several types of restrictions targeting medication abortion. Most of the laws take one of two approaches: limiting provision to the FDA protocol or requiring in-person administration. By limiting providers to the current FDA protocol, states may preclude providers from taking advantage of future evidence-based changes in the administration of medication abortion. And by requiring in-person administration, states prevent providers from using telemedicine to administer medication abortion. In doing so, they reduce access to abortion in rural areas. In addition, a few states require providers to share with patients the medically unsupported claim that medication abortion can be reversed.

STATE LAWS AND POLICIES

For a chart of current laws and policies in each state related to medication abortion, see Medication Abortion.

For information on state laws and policies related to other sexual and reproductive health and rights issues, see State Laws and Policies, issue-by-issue fact sheets updated monthly by the Guttmacher Institute’s policy analysts to reflect the most recent legislative, administrative and judicial actions.

RELEVANT DATA AND ANALYSIS

Administration of Medication Abortion

The protocol for administering medication abortion is based on decades of research showing that it is safe and effective.

The administration of medication abortion is more heavily regulated than necessary. The medication abortion regimen is low risk and easy to follow, and the process can be safely managed by patients and providers. Despite this, the FDA imposes restrictions on medication abortion that hinder access for potential patients and do not reflect its long record of safe use.

Expanding Abortion Access Using Medication Abortion

Medication abortion can be safely offered in diverse settings and by a range of health care providers.

Counseling About Medication Abortion Reversal

Some states require that abortion counseling include the unverified claim that medication abortion can be “reversed” by giving a patient a high dose of progesterone to stop the abortion after they take mifepristone. There is no medical evidence to support this assertion, and there are no data on the safety of this unproven treatment. In 2015, Arkansas became the first state to implement mandatory abortion reversal counseling; Arizona and South Dakota subsequently adopted similar laws.

RECENT STATE ACTION ON THIS ISSUE

States that have addressed this issue over the past three years are listed below.

EState enacted a relevant measure

V: State vetoed measure

A: State adopted measure in at least one chamber

 

States that require counseling on medication abortion “reversal”

Arkansas (2019)

E

Idaho (2018)

E

Kansas (2019)

V

Kentucky (2019)

E

Nebraska (2019)

E

North Dakota (2019)

E

Oklahoma (2019)

E

Tennessee (2020)

E

Wisconsin (2019)

V

REFERENCES

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2. National Abortion Federation, 2020 Clinical Policy Guidelines for Abortion Care, Washington, DC: National Abortion Federation, 2020, https://prochoice.org/providers/quality-standards/.

3. Jones R and Boonstra H, The public health implications of the FDA’s update to the medication abortion label, Health Affairs Blog, 2016, http://healthaffairs.org/blog/2016/06/30/the-public-health-implications-of-the-fdas-update-to-the-medication-abortion-label/.

4. FDA, Questions and answers on Mifeprex, 2019, https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex.

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11. National Academies of Sciences, Engineering and Medicine, The Safety and Quality of Abortion Care in the United States, Washington, DC: National Academies Press, 2018.

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14. Donovan M, Improving access to abortion via telehealth, Guttmacher Policy Review, 2019, 22:23–28, https://www.guttmacher.org/gpr/2019/05/improving-access-abortion-telehealth.

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16. Kvedar J, Joel Coye M and Everett W, Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth, Health Affairs, 2014, 33(2):194–199, https://www.healthaffairs.org/doi/10.1377/hlthaff.2013.0992.

17. American Medical Association, Council on Medical Service, Coverage of and payment for telemedicine, Report 7-A-14, 2014, http://www.modernhealthcare.com/assets/pdf/CH95086612.PDF.

18. Lawrence HC, Testimony of the American Congress of Obstetricians and Gynecologists (ACOG), submitted to U.S. Senate Committee on the Judiciary, S. 1696, The Women’s Health Protection Act hearing, July 15, 2014, https://www.actforwomen.org/wp-content/uploads/2015/09/ACOG-Testimony-Womens-Health-Protection-Act.pdf.

19. Jones RK and Jerman J, Time to Appointment and Delays in Accessing Care Among U.S. Abortion Patients, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/delays-in-accessing-care-among-us-abortion-patients.

20. Raymond EG et al., Commentary: no-test medication abortion: a sample protocol for increasing access during a pandemic and beyond, Contraception, 2020, 101(6):361–366, https://www.contraceptionjournal.org/article/S0010-7824(20)30108-6/fulltext.

21. D’Almeida K, Telemedicine abortion care is coming to Maine, Rewire.News, Feb. 29, 2016, https://rewire.news/article/2016/02/29/telemedicine-abortion-care-coming-maine/.

22. Kohn JE et al., Medication abortion provided through telemedicine in four U.S. states, Obstetrics & Gynecology, 2019, 134(2):343–350, doi:10.1097/AOG.0000000000003357.

23. Boonstra HD and Nash E, A surge of state abortion restrictions puts providers—and the women they serve—in the crosshairs, Guttmacher Policy Review, 2014, 17(1):9–15, https://www.guttmacher.org/gpr/2014/03/surge-state-abortion-restrictions-puts-providers-and-women-they-serve-crosshairs.

24. Raymond E et al., TelAbortion: evaluation of a direct to patient telemedicine abortion service in the United States, Contraception, 2019, 100(3):173–177, https://www.contraceptionjournal.org/article/S0010-7824(19)30176-3/abstract.

25. Grossman D and Grindlay K, Safety of medical abortion provided through telemedicine compared with in person, Obstetrics & Gynecology, 2017, 130(4):778–782, https://journals.lww.com/greenjournal/Fulltext/2017/10000/Safety_of_Medical_Abortion_Provided_Through.16.aspx.

26. Jerman J, Onda T and Jones RK, “What are people looking for when they Google ‘self-abortion’?”, Contraception, 2018, 97(6):510–514, https://www.contraceptionjournal.org/article/S0010-7824(18)30068-4/fulltext.

27. Kapp N et al., A research agenda for moving early medical pregnancy termination over the counter, BJOG, 2017, 124(11):1646–1652, http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14646/full.

28. Graham R, A new front in the war over reproductive rights: “abortion-pill reversal,” New York Times Magazine, July 18, 2017, https://www.nytimes.com/2017/07/18/magazine/a-new-front-in-the-war-over-reproductive-rights-abortion-pill-reversal.html.

29. Delgado G and Davenport ML, Progesterone use to reverse the effects of mifepristone, Annals of Pharmacotherapy, 2012, 46(12):1723.

30. Grossman D et al., Continuing pregnancy after mifepristone and “reversal” of first-trimester medical abortion: a systematic review, Contraception, 2015, 92(3):206–211.

31. ACOG, Facts are important: Medication abortion “reversal” is not supported by science, 2017, https://www.acog.org/advocacy/facts-are-important/medication-abortion-reversal-is-not-supported-by-science .

32. Delgado G et al., A case series detailing the successful reversal of the effects of mifepristone using progesterone, Issues in Law & Medicine, 2018, 33(1):3–14.

33. Creinin MD et al., Mifepristone antagonization with progesterone to prevent medical abortion: a randomized controlled trial, Obstetrics and Gynecology, 2019, 135(1):158–165, https://journals.lww.com/greenjournal/Citation/2020/01000/Mifepristone_Antagonization_With_Progesterone_to.21.aspx.

34. Louisiana Department of Public Health, Legislative Report on 2016 House Concurrent Resolution 87, 2017, http://www.dhh.louisiana.gov/assets/docs/LegisReports/HCR87RS20161.pdf.