Medication Abortion in Global Context: Frequently Asked Questions
Get answers to frequently asked questions about medication abortion, which has transformed global abortion access.
Medication abortion is safe, effective, and essential to expanding access to abortion care across the world.
In recent years, global demand has surged for medication abortion, and in many countries, it is the most popular abortion method used. Medication abortion offers patients greater privacy and flexibility, while also expanding access for patients who live in areas without a local clinic or who have lower incomes.
The Center for Reproductive Rights is working to protect and promote access to medication abortion across the globe. Read more below for answers to some of the most frequently asked questions about medication abortion.
WHO Recommendations on Self-managed Abortion
The World Health Organization recommends that individuals up to 12 weeks pregnant can self-administer mifepristone and misoprostol medication without direct supervision of a health-care provider.
What is medication abortion?
Medication abortion, also referred to as “abortion with medication” or the “abortion pill,” is a safe and effective method for ending a pregnancy. The World Health Organization (WHO) recommends the use of two pills: mifepristone, which blocks the action of the hormone (progesterone) that supports the pregnancy, followed by misoprostol, which causes the cervix to dilate and the uterus to contract. However, the WHO recognizes that misoprostol alone can also induce abortion safely and effectively.
What advantages does medication abortion offer?
Medication abortion can be administered on an outpatient basis—and in many countries, by non-physician providers or via telemedicine—reaching people in areas where abortion services are otherwise difficult to access. Medication abortion also costs less on average than many other common forms of abortion care, making it more accessible for people with lower incomes. Moreover, medication abortion enables patients to terminate their pregnancies in their homes or other preferred locations, giving individuals more agency over their abortion care.
What do we know about the safety and efficacy of medication abortion?
Prominent public health and medical organizations have recognized the safety and efficacy of medication abortion. The WHO has identified mifepristone and misoprostol as essential medication, and it has recognized that individuals can safely self-administer the pills without being under the direct supervision of a health care worker.
Medication abortion is effective at ending pregnancy more than 95% of the time. In rare cases, pregnant people may require additional medication or an aspiration procedure to terminate the pregnancy successfully. Side effects of medication abortion are typically minor, and they may include bleeding or uterine cramping.
What have international bodies said about medication abortion?
Several international bodies have recognized medication abortion as critical to human rights. The United Nations Committee on Economic, Social, and Cultural Rights’ comment on the right to health recognizes state parties’ obligation to provide all medications under the WHO Model List of Essential Drugs, which includes drugs used for medication abortion. It released a subsequent comment in 2016, which specifically referenced “medicines for abortion” as essential medication.
The International Covenant on Economic, Social, and Cultural Rights also protects the “right of everyone: . . . (b) To enjoy the benefits of scientific progress and its applications…,” which has been interpreted to include pharmaceutical advancements such as medication abortion. In addition, the Maputo Protocol recognizes the right to medication abortion under certain circumstances, and the African Commission requires state parties to “ensure that the legal frameworks in place facilitate access to medical abortion…” when the woman’s life is at risk.
Does medication abortion require follow-up care?
According to WHO abortion care guidelines, there is no medical need for a routine follow-up visit after a typical medication abortion, though some providers may offer a follow-up visit shortly after the procedure.
Is there a maximum gestational limit in which medication abortion can be used?
According to WHO guidelines, medication abortion under the supervision of a trained provider can be used safely throughout pregnancy.
For those who self-manage their medication abortion, the WHO recommends that the individuals are less than 12 weeks pregnant and have a “source of accurate information and access to a health-care provider should they need or want it at any stage of the process.” (For more information on self-managed medication abortion, see the section below.)
Promoting Access to Self-Managed Abortion: Considerations for managing legal risk
A publication by the Center and Ipas about understanding and accessing the legal risks of self-managed abortion.
Self-Managed Medication Abortion
What is self-managed medication abortion?
Self-managed medication abortions are medication abortions that occur outside of a medical setting. This often includes self-sourcing abortion pills and taking them at home, without the supervision of a clinic or physician.
Why might people choose to self-manage their abortions?
People may choose to self-manage their abortions in contexts where abortion access is limited due to factors such as legal restrictions, procedural barriers, or a lack of local providers. Self-managing abortion care may also provide some individuals with a greater sense of control and agency in ending their pregnancies. Moreover, some people – especially those from historically marginalized groups – may feel more comfortable self-managing their abortions due to concerns about the formal healthcare system, such as fear of mistreatment by staff.
What legal risks are associated with self-managed abortion?
The reality of legal enforcement for restrictions on self-managed abortion varies widely. In particularly restrictive contexts, this may include strict enforcement of laws criminalizing abortion or intimidation campaigns that allow authorities to harass pregnant people and providers under the guise of the law. In some settings, pregnant people may risk arrest, police harassment, prosecution, and imprisonment for self-managing their abortions; in others, self-managed abortion may be illegal but fall outside of prosecutors’ jurisdiction. Legal risks thus vary greatly depending on the specific context.
Self-managed abortion is often restricted to a higher degree than other forms of abortion care. Even in contexts where medication abortion itself is legal, specific laws, policies, and guidelines may require the involvement of a healthcare professional for the abortion to be lawful. In countries such as Bolivia, Nepal, Rwanda, and the United States, there have been documented arrests of people who have self-managed their abortions, even though abortion was legal on certain grounds.
The Center’s Work on Medication and Self-Managed Abortion
Legal and Policy Barriers to Self-Managed Abortion
The Center’s legal framework and analysis of laws and policies on self-managed abortion in eight countries.
What work is the Center for Reproductive Rights doing to defend and expand the legality of medication abortion and self-managed abortion?
Even in countries with liberal abortion laws, it is necessary to guarantee access to medication abortion and enable individuals to self-manage abortion care. The Center for Reproductive Rights is working to develop an enabling legal framework that promotes patients’ autonomy by removing gatekeepers and other impediments from people’s ability to access care.
Such a legal framework would:
Not require a healthcare provider’s involvement in all abortions;
Ensure medication abortion is widely available;
Ensure that medication abortion pills can be obtained without a prescription, at least in the first 12 weeks of pregnancy;
Explicitly recognize that medication abortion can be carried out at least during the first 12 weeks of pregnancy;
Remove in-person requirements for medication abortion;
Enable individuals to terminate a pregnancy in the location of their choosing; and
Enable individuals seeking medication abortion to consult with a provider via telemedicine or other telehealth services.