Abortion pill mifepristone: An explainer and research roundup about its history, safety and future

This piece aims to help inform the narrative on medication abortion with scientific evidence. Medication abortion is also known as abortion with pills or medical abortion. The legal future of mifepristone had hung in the balance for several months, but journalistic coverage of the topic has never been more crucial.

The Legal Landscape and Supreme Court Decision

On June 13, the Supreme Court justices in a unanimous decision preserved access to mifepristone, a medication that’s used for the safe termination of early pregnancy. The justices wrote that “federal courts are the wrong forum for addressing the plaintiffs’ concerns about FDA’s actions.” This piece was updated on June 13, 2024 to reflect the recent Supreme Court decision about access to mifepristone, and to highlight new research on medication abortion. Previously, in August 2023, the 5th U.S. Circuit Court of Appeals ruled that mifepristone should not be prescribed past the seventh week of pregnancy, prescribed via telemedicine, or shipped to patients through the mail.

How Medication Abortion Works

The abortion pill was approved by the FDA in 2000. Another name for the abortion pill is a medical or chemical abortion. The pill is actually two drugs and it’s taken in two separate doses. Mifepristone inhibits progesterone, a hormone essential for maintaining pregnancy, causing the thinning of the uterus lining and releasing the embryo. Misoprostol is taken within 24 to 40 hours, causing the uterus to contract and triggers uterine contractions to remove the pregnancy tissue.

Clinical Guidelines and Gestational Limits

• The Food and Drug Administration has approved medication abortion for up to 10 weeks of pregnancy.
• The World Health Organization authorizes its use for up to 12 weeks.
• The abortion pill is usually taken between 4-6 weeks but can be taken up to 11 weeks in most cases.
• The gestational limit for pill usage is sanctioned up to 9 weeks (63 days) in India after your last menstrual period (LMP) begins.

Safety, Fertility, and Research Findings

In India and worldwide, correctly used abortion pills are safe for future fertility and pregnancies. However, rare but serious side effects can occur with its use, emphasising the need for medical guidance. According to figures from the National Institutes of Health (NIH), 82.7% of women linked to unsupervised medication abortions experienced complications such as incomplete abortions. It is important to first get an ultrasound to determine if the pregnancy is viable and to rule out an ectopic pregnancy. This occurs when the fertilized egg does not correctly move into the uterus and can be a life-threatening condition that would need immediate action.

Key Facts About Medication Abortion

• Differentiation: The abortion pill is not the same as the emergency contraceptive, The Morning After Pill or Plan B One Step.
• Medical History: Medication abortion is not an option for people with certain medical conditions.
• Reversal: Reversal is possible if action is taken after the first dose.
• Incomplete Abortion: Risks include incomplete abortion, which may need to be followed by surgical abortion.

Comparison of Medication Abortion Standards

• Standard Approach: A combination called mifepristone followed by misoprostol.
• FDA Approved Limit: 10 weeks.
• WHO Approved Limit: 12 weeks.
• Indian sanctioned limit: 9 weeks.
• Common Kit Names: Unwanted Kit or Mifegest Kit.