Medication Abortion

Last updated: March 18, 2016

Medication abortion, commonly known as the abortion pill or RU-486, is a non-surgical procedure by which pregnancy is terminated through the use of two drugs. The first drug, mifepristone, works by blocking the hormone progesterone, which causes the lining of the uterus to break down so that the pregnancy cannot continue. The second drug, misoprostol, which causes cramps and heavy bleeding that usually lasts for a few hours, induces contractions and ends the pregnancy.

According to Planned Parenthood, women choose medication abortion because they believe that it is a more natural way to terminate a pregnancy, because it can be done at the earliest stages of pregnancy, and because the abortion process can be completed in the privacy of their own home.

Medication abortion has been used around the world for nearly three decades. It was first approved for use in France and China in 1988, then in Great Britain in 1991, in Sweden in 1992, and throughout Europe in the 1990s. The Food and Drug Administration (FDA) finally approved medication abortion for use in the United States in 2000.

Since then, anti-choice advocates have targeted medication abortion in their efforts to wind back access to safe abortion care. In particular, groups such as Americans United for Life have drafted model bills specifically tailored to render medication abortion inaccessible. These model bills force doctors to administer medication abortion in a manner that contravenes research-driven guidelines published by the most trusted professional and scientific organizations like the World Health Organization, the American College of Obstetrics and Gynecology, and the American Medical Association.

When the FDA first approved medication abortion, it adopted the regimen that had been developed by researchers in France in 1988, which required three visits to a physician: first for counseling and to obtain a 600 mg oral dose of mifepristone; a second visit two days later to obtain a 400 mg oral dose of misoprostol; and finally a follow-up visit 14 days after the first visit.

However, current medical consensus—including the findings of studies conducted under the auspices of the World Health Organization (WHO)—says this protocol is outdated.

For example, WHO research demonstrates that the dosage of mifepristone can be reduced to 200 mg, instead of the 600 mg that is still required under the FDA rules. In addition, the original mifepristone/misoprostol regimen specified that medication abortion is effective only up to seven weeks, but researchers found that it was effective up to 63 days’ gestation, or about nine weeks. Finally, the FDA protocol requires multiple trips to a physician despite the fact that researchers found that women could self-administer the misoprostol at home, thus obviating the need for the second visit to the physician to obtain the drug.

In order to account for developments in medication abortion research, the National Abortion Federation (NAF) publishes Clinical Policy Guidelines (CPGs) that reflect the FDA-approved labeling for mifepristone, and also includes evidence-based alternatives to the FDA-approved regimen. The CPGs set the standards for abortion care in North America. They were first published in 1996 and are reviewed and reissued annually. Before mifepristone was approved by the FDA in 2000, NAF and PPFA were jointly conducting education and training programs, which included evidence-based regimens.

NAF does not require its members to use the FDA protocol and only requires members to use evidence-based regimens in keeping with the medical practices in the U.S. and Canada. Indeed, as far back as 2001, 83% of abortion providers in the United States were no longer adhering to the FDA protocol. While it may seem odd for clinicians to adhere to guidelines that contravene FDA-approved guidelines, according to the National Abortion Federation, the FDA explicitly permits the evidence-based use of approved medications in ways that are different from the package labeling (“off-label” use) as long as clinicians receive informed consent from the patient, and are guided by accepted medical practice when determining whether to use drugs in alternative regimens rather than FDA-specified regimens.

Examples of Medication Abortion Restrictions (last updated October 9, 2015)

As reported by the Guttmacher Institute, medication abortion restrictions generally fall into three categories: (1) requiring licensed physicians to perform medication abortions; (2) requiring the abortion provider to be physically present during the procedure and counseling session; (3) and requiring strict adherence to the outdated FDA protocol.

Thirty-nine states prohibit any clinician aside from a licensed physician from performing medication abortions, even though the World Health Organization, the American College of Obstetricians and Gynecologists (ACOG), American Public Health Association and American Medical Women’s Association all support training non-physician providers (such as nurse practitioners and physician assistants) to administer medication abortion.

Fourteen states require that the medication abortion provider be physically present during the procedure. These laws effectively ban “telemedicine,” where physicians use a remote-controlled system to see patients and dispense abortion medication. Bans on telemedicine are particularly detrimental to women who live in rural areas and may find it difficult to make multiple trips to a healthcare provider for medical abortion. Telemedicine bans also harm low-income women due to transportation costs, child care, and lost wages that result from multiple trips to an abortion provider.

Two states (Ohio and Texas) require mifepristone to be provided in accordance with the outdated FDA protocol. A third state, Arizona, is set to implement regulations requiring the use of the FDA protocol beginning in April 2014, although a lawsuit challenging the regulation was filed in early March 2014. Two additional states, North Dakota and Oklahoma have enacted laws requiring the use of the FDA protocol, but the laws have been blocked by courts and are currently not in effect. Anti-choice legislators have advocated these types of laws, which require medication abortion to follow the FDA protocols, claiming that such restrictions are in the interest of the health and safety of women. In reality, however, such restrictions are an attempt to ban outright, legislate the administration of, or interfere in the delivery of medication abortion. These restrictions have also resulted in the arrest and prosecution of women who buy or are suspected of buying abortion pills online.

The American Medical Association and ACOG have spoken out against the efforts in Texas and elsewhere to dictate medical practice by forcing physicians who prescribe medication abortions to follow the FDA protocol. In an amicus brief filed before the Fifth Circuit Court of Appeals in Planned Parenthood v. Abbott, ACOG stated its opposition to the medication abortion restrictions set forth in Texas’s omnibus abortion bill, HB 2. “Legislators should not block advances in medical care by prohibiting physicians from incorporating the best, and most current, scientific evidence into their patient care,” the ACOG brief in opposition to the Texas restrictions notes:

“Requiring physicians to follow a protocol that is scientifically proven to be inferior to other regimens is an unwarranted intrusion in the physician-patient relationship. The practice of medicine should be based on the latest scientific research and medical advances.”

ACOG and the Society of Family Planning reiterated this point in new guidelines on medication abortion issued in February 2014 writing that, “Based on efficacy and adverse effect profile, evidence-based protocols for medical abortion are superior to the FDA-approved regimen.”

Laws

Title Number State Proposed Status
Arizona Omnibus Abortion Bill (HB 2036) HB 2036 Arizona January 9, 2012 Blocked/Enjoined
Texas Omnibus Abortion Bill (HB 2) HB 2 Texas June 28, 2013 Current
Texas Telemedicine Ban (SB 9) SB 9 Texas June 28, 2013 Failed to Pass
Texas Telemedicine Ban (SB 18) SB 18 Texas May 29, 2013 Failed to Pass
Texas Telemedicine Ban (SB 97) SB 97 Texas November 12, 2012 Failed to Pass
Texas Omnibus Abortion Bill (SB 5) SB 5 Texas June 11, 2013 Failed to Pass
Texas Omnibus Abortion Bill (HB 60) HB 60 Texas June 12, 2013 Failed to Pass
Texas Omnibus Abortion Bill (SB 1) SB 1 Texas July 1, 2013 Failed to Pass
Arizona Bill to Remove Medication Abortion FDA Protocols Compliance Requirements (HB 2596) HB 2596 Arizona February 13, 2013 Failed to Pass
Arizona Bill to Remove Restrictions on Medication Abortion (HB 2649) HB 2649 Arizona February 13, 2013 Failed to Pass
Arizona Bill to Remove Medication Abortion FDA Protocols Compliance Requirements (HB 2575) HB 2575 Arizona February 4, 2014 Failed to Pass
Arizona Bill to Remove Restrictions on Medication Abortion (HB 2371) HB 2371 Arizona January 16, 2014 Failed to Pass
Florida for Life Act 2014 (HB 545) HB 545 Florida January 9, 2014 Failed to Pass
Missouri Telemedicine Ban (HB 400) HB 400 Missouri January 31, 2013 Current
Missouri Abortion-Inducing Drug Safety Act (HB 177) HB 177 Missouri January 16, 2013 Failed to Pass
Missouri Telemedicine Ban (SB 175) SB 175 Missouri January 17, 2013 Failed to Pass
Oklahoma Bill Regarding Medication Abortion Restrictions (HB 2684) HB 2684 Oklahoma February 3, 2014 Blocked/Enjoined
Louisiana Omnibus Abortion Bill (HB 388) HB 388 Louisiana February 25, 2014 Blocked/Enjoined
Arkansas Telemedicine Ban (SB 913) SB 913 Arkansas March 8, 2013 Failed to Pass
Kansas Law Regarding Licensing Regulations of Abortion Clinics (SB 36) SB 36 Kansas January 19, 2011 Current
Mississippi Women’s Health Defense Act of 2013 (HB 897) HB 897 Mississippi February 5, 2013 Failed to Pass
Mississippi Women’s Health Defense Act of 2013 (SB 2795) SB 2795 Mississippi January 21, 2013 Current
Idaho Omnibus Bill Including Medication Abortion Restrictions (SB 1193) S 1193 Idaho March 22, 2013 Failed to Pass
Indiana Omnibus Abortion Bill (SB 371) SB 371 Indiana January 8, 2013 Blocked/Enjoined
Indiana Telemedicine Ban (HB 1533) HB 1533 Indiana January 22, 2013 Failed to Pass
Iowa Bill Regarding Medication Abortion Restrictions (SF 14) SF 14 Iowa January 16, 2013 Failed to Pass
Iowa Bill Regarding Medication Abortion Restrictions (HF 173) HF 173 Iowa February 7, 2013 Failed to Pass
Kentucky Bill Regarding Physical Exam Prior to Induced Abortion (HB 163) HB 163 Kentucky January 8, 2014 Failed to Pass
South Carolina Bill Regarding Medication Abortion Restrictions (S 34) S 34 South Carolina December 3, 2014 Proposed
Iowa Bill Regarding Medication Abortion Restrictions (SF 11) SF 11 Iowa January 2, 2015 Failed to Pass
Florida for Life Act 2015 (HB 247) HB 247 Florida January 13, 2015 Failed to Pass
Arkansas Telemedicine Ban (HB 1076) HB 1076 Arkansas January 15, 2015 Current
Arkansas Telemedicine Ban (SB 53) SB 53 Arkansas January 15, 2015 Current
Arizona Omnibus Bill (SB 1318) SB 1318 Arizona February 2, 2015 Current
Texas Bill Regarding Exceptions From Penalties for an Abortion Provider’s Professional Judgment (HB 1210) HB 1210 Texas February 9, 2015 Failed to Pass
Idaho Physician Physical Presence and Women Protection Act (H 88) H 88 Idaho February 5, 2015 Failed to Pass
Arkansas Abortion-Inducing Drug Safety Act (HB 1394) HB 1394 Arkansas February 17, 2015 Current
Idaho Telehealth Access Act (H 98) H 98 Idaho February 10, 2015 Failed to Pass
Idaho Physician Physical Presence and Women Protection Act (H 154) H 154 Idaho February 18, 2015 Current
Minnesota Telemedicine Ban (HF 734) HF 734 Minnesota February 12, 2015 Failed to Pass
Minnesota Telemedicine Ban ( SF 727) SF 727 Minnesota February 12, 2015 Failed to Pass
Montana Telemedicine Ban (HB 587) HB 587 Montana February 20, 2015 Failed to Pass
Minnesota Telemedicine Ban (SF 2957) SF 2957 Minnesota April 4, 2014 Failed to Pass
Minnesota Telemedicine Ban (HF 3361) HF 3361 Minnesota April 28, 2014 Failed to Pass
Florida For Life Act 2015 (SB 1502) S 1502 Florida February 26, 2015 Failed to Pass
Kansas Bill Amending Telemedicine Ban (HB 2228) HB 2228 Kansas February 4, 2015 Current
Ohio Bill Regarding Medication Abortion Restrictions (HB 255) HB 255 Ohio June 10, 2015 Proposed
Rhode Island Bill Prohibiting Insurance Coverage for Induced Abortions (H 8045) H 8045 Rhode Island April 10, 2014 Failed to Pass
Rhode Island Bill Prohibiting Insurance Coverage for Induced Abortions (H 7403) H 7403 Rhode Island February 12, 2015 Failed to Pass
Florida for Life Act 2016 (SB 1718) SB 1718 Florida January 11, 2016 Failed to Pass
New Hampshire Abortion-Inducing Drugs Safety Act (HB 1662) HB 1662 New Hampshire January 27, 2016 Failed to Pass
South Dakota Bill Regarding Informed Consent and Reversing Medication Abortions (HB 1157) HB 1157 South Dakota January 28, 2016 Proposed
Arizona Bill Restricting Medication Abortions (SB 1324) SB 1324 Arizona January 27, 2016 Current
California Abortion Pill Reversal Notice for Clinics (AB 2134) AB 2134 California February 17, 2016 Failed to Pass
Iowa Bill Regarding Medication Abortion Restrictions (HF 2084) HF 2084 Iowa January 22, 2016 Failed to Pass
Indiana Bill Regarding Telemedicine Prescriptions (HB 1263) HB 1263 Indiana January 11, 2016 Current
Louisiana Bill Prohibiting Harvesting of Aborted Fetal Remains (HB 815) HB 815 Louisiana March 4, 2016 Signed into Law
South Carolina Telemedicine Act (H 5162) H 5162 South Carolina March 23, 2016 Failed to Pass
Utah Telehealth Revisions Bill (HB 340) HB 340 Utah February 16, 2016 Failed to Pass