Covering abortion pills with scientific evidence

This guide distills how journalists can use scientific research and expertise to anchor reporting about abortion pill use and related policies.

By McKenna Oxenden

The 2022 U.S. Supreme Court Dobbs decision allowing individual states to ban abortion has shifted the debate about abortion access, with an increased focus on medication abortion and access to the drugs mifepristone and misoprostol. Research shows that the number of pills being obtained has risen dramatically since that court ruling. When covering court battles, legislative efforts, and political rhetoric, journalists can turn to a strong body of independent, evidence-based research and scientific expertise to provide context and a deeper understanding of the issue, from how medications induce abortions to research tracking the effects of policy changes and data on abortion pill use in each state.

There are several factors driving the significance of the topic:

• States that have enacted near-total bans on abortion are fighting to limit access to abortion pills. Among other states’ legal challenges, Louisiana sued the Food and Drug Administration to try to stop mifepristone from being prescribed via telemedicine and then being sent through the mail to patients. The FDA first began allowing this practice in 2021 amid the pandemic. A review of research showed it was safe for patients to take the medication without seeing a healthcare provider in person, according to the FDA. An appeals court decision temporarily halted telemedicine abortion and sending pills by mail, but then the U.S. Supreme Court issued two brief orders to pause that decision and kicked the case back to the lower courts, ordering that there be no change in mifepristone access while the courts continue to review the case. The case is likely to end up back to the Supreme Court, said Mary Ruth Ziegler, a law professor at the University of California, Davis, School of Law.
• Medication abortions account for 63% of clinician-provided abortions in states without total bans, according to the Guttmacher Institute, a research and policy organization that aims to advance reproductive health and rights.
• Research from the University of California, Berkeley School of Public Health found that many top-ranking search results for “abortion pill” offer low-quality information. And false claims about abortion pills crop up often.

This guide is designed to help journalists access, understand, and incorporate research-based evidence and scientific expertise about medication-induced abortions into their work. It provides baseline information about what abortion pills are and research about their safety and effectiveness, who accesses them, and the impact of policy changes related to access.

A medication abortion, which is commonly known as the “abortion pill,” generally includes two drugs taken in combination to end a pregnancy: mifepristone and misoprostol.

The combination of the two medications is currently approved by the FDA to end a pregnancy through 10 weeks of gestation.

Mifepristone, which is taken first, blocks the body’s own progesterone, a hormone that is essential for the embryo to grow. That thins the uterine lining, which leads to the pregnancy detaching.

The second medication, misoprostol, can be taken right away or up to 48 hours later, according to Cleveland Clinic. It can cause cramping and bleeding as the uterus contracts, expelling the pregnancy. Misoprostol is usually dissolved under the tongue or inside the cheeks. Occasionally, it is inserted in the vagina.

A medication abortion using mifepristone and misoprostol dissolved in the cheek is 96.7% effective in pregnancies up to nine weeks, according to a review of evidence. Medication abortion is considered a safe and effective abortion method by the American College of Obstetricians and Gynecologists.

A medication abortion can also be done with just misoprostol. However, medical professionals say using both medications tends to be more effective. ACOG recommends using mifepristone and misoprostol in a combined regimen when possible rather than using misoprostol alone.

Misoprostol is around 80% effective, research shows, depending upon when and how it is taken. It can also cause more side effects when taken by itself versus with mifepristone.

Medication abortions made up 63% of U.S. clinician-provided abortions in 2023, which is up from 53% in 2020, according to the Guttmacher Institute.

About four decades of peer-reviewed research have found medication abortions to be safe, according to Johns Hopkins University experts. Less than 1% of people encounter a complication with a medication abortion.

Mifepristone was developed in France in the 1980s and approved by the FDA in 2000, and it’s currently authorized for use in around 100 countries.

The risk of maternal death during childbirth is about 14 times higher than the risk associated with abortion, the American College of Obstetricians and Gynecologists says.

Buying an abortion pill isn’t generally illegal, even in states with abortion bans, but specific state policies vary.

There are numerous routes to obtain abortion pills. Many people may opt for a “self-managed” abortion, which can be referred to as “self-induced” or an “at-home abortion.” All that means is that the person is ending a pregnancy outside the confines of a medical care setting, generally at home, by ordering abortion pills online. People may go this route because of state bans, clinic access barriers, cost, transportation, time limitations, or privacy, according to KFF.

Some companies providing these drugs have a clinician review a customer’s medical information before filling the medication and might even require a telehealth visit, KFF reported. Other companies, like AidAccess, are based outside the U.S. and will mail pills to an individual without a visit. People can also access pills through community networks.

A study published in the Journal of the American Medical Association found a sharp increase in AidAcess requests after the federal right to an abortion was overturned. The requests for medication went from an average of 82.6 daily requests to 213.7, with the largest increases in states that have banned abortion.

While it is not generally illegal for people to access self-managed abortions, there are documented instances of people facing criminal charges for self-managing an abortion. If/When/How, a reproductive justice group, has some data in this area.

Some states have also begun imposing criminal penalties on clinicians who help someone obtain abortion services.

In response to that legal threat, 23 states and the District of Columbia enacted “shield laws” to help protect providers from possible litigation, according to University of California, Los Angeles Law’s state-by-state map.

These policies can differ from each state and some were implemented through executive orders rather than legislation. The Guttmacher Institute has data around this topic, including research about medication abortion access inside and outside the formal healthcare system.

Numerous organizations and news outlets keep track of ongoing efforts to change abortion access across the country.

Rachel Jones, a principal research scientist at Guttmacher Institute, said that the legal case surrounding mifepristone is creating significant confusion for people.

“There are some people who are hearing this news and all they hear is telemedicine access for abortions may not be available, and then they just assume they can’t get an abortion at all,” Jones said.

That’s why writing about abortion pills in a way that incorporates detailed, accurate data, is even more important, Jones said, so that it helps people understand what is actually at stake and happening. These sources offer state-specific data:

• The Society of Family Planning regularly releases new data from each state and month, called #WeCount, in an effort to “capture national shifts in abortion volume.” The data is downloadable and includes report data tables, summary slides with national and state-level findings, and a narrative report. The organization also publishes the volume of abortions and its fluctuations by state.
• Guttmacher Institute has a monthly abortion provision study that allows people to filter by state and years or months. It collects data on procedural and medication abortions provided at brick-and-mortar health facilities, as well as medication abortions provided via U.S. telehealth and virtual providers.
• The Center for Reproductive Rights, an advocacy organization, offers state-by-state maps showing U.S. abortion laws and what state constitutions say about abortion rights.
• Plan C has a database of each state’s policy, a list of providers that can assist with abortion access, and information about the legality of abortion and how individuals choose a provider.

The UCLA School of Law has a “Mifepristone Litigation Tracker” and “Mifepristone Federal Action Tracker” that provide “timely, regularly updated information on the current status of litigation and federal administrative actions that could shape regulation of and access to mifepristone.” The site includes the number of cases, how many of them are active, and recaps of the latest litigation with background.

Ziegler, the law professor, said reporters should keep an eye out for lawsuits related to abortion pill access filed by their state’s attorney general—especially in Florida, Idaho, Kansas, Missouri, and Texas. Many states are challenging access to telehealth medication abortions.

Reporters can also search for wrongful death lawsuits, which often target doctors who have provided abortion-related medication.

Even reporters who are in a state where abortion access isn’t restricted should keep an eye out for jurisdictions battling one another to extradite a doctor for criminal proceedings, Ziegler said. That is currently playing out between Texas and New York, she said.

When there’s not a court case in the news, stories about medication abortion sometimes fall to the wayside, but people continue to access abortion pills via telehealth or community support networks.

Sources distributing medication for abortion include:

• Local Planned Parenthood health centers
• AbortionFinder
• INeedAnA
• Plan C

There are several ways people get pills sent by mail, even in states that have total bans on abortion care. Some community networks will send pills for free, and many people travel to areas where medication is available. Others use websites that sell pills, including some based outside the U.S.

McKenna Oxenden is an award-winning freelance journalist focused on covering women’s and reproductive health. Her work has appeared in national and regional publications, including The New York Times, Straight Arrow News, The Baltimore Sun, The Tampa Bay Times, and Houston Landing.