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In the United States, abortion is legal in every state. Although aspiration, also known as surgical abortion, is the most common method of abortion, many clinics that provide abortion care also offer the option of an abortion with pills if a person is less than 10 weeks pregnant.
Many people in the United States receiving abortion care do so from medical professionals in clinical settings. Others, especially around the world, self-administer abortion pills to end their own pregnancies for various reasons. The practice of self-administering abortion pills is often referred to as self-induced abortion.
Click the titles below for additional information.
The laws regulating the practice of self-administering abortion pills or other methods of ending a pregnancy are complex. Tragically, throughout the United States, a small number of people have been arrested—and some even jailed—for ending their own pregnancies. Additionally, since people who end their own pregnancies often turn to friends, family members, midwives, doulas, indigenous healers, herbalists, curanderas, or others in their community for information on how to safely and effectively end a pregnancy, or for abortion pills, there have also been arrests of those supporting someone who ends their own pregnancy. Courts reviewing such prosecutions have generally sided with people who end their own pregnancies. However, some prosecutors are politically motivated to punish people who have abortions and those who assist them. As such, even though abortion itself is legal, those who end their own pregnancies may risk unjustified arrest and imprisonment under laws that limit abortion provision to licensed health care workers and that criminalize self-induced abortion. Such laws vary from state-to-state. There are lawyers—who can be found here—who are developing ways to respond to and prevent these arrests.
The World Health Organization Guidance outlines two methods of medical abortion:
- The use of Mifepristone and Misoprostol. This is the most effective method and is 95-99% effective in the first 10 weeks of pregnancy. It is provided at abortion clinics in the United States up to 10 weeks.
- The use of Misoprostol alone. Misoprostol alone is 75-85% effective in the first 12 weeks of pregnancy.
Both methods have been used by millions of people around the world for early abortion. Misoprostol, with or without mifepristone, will cause a miscarriage if used early in the pregnancy, or trigger labor if used later in a pregnancy. If misoprostol is used correctly, the uterus will cramp and push out the pregnancy, creating cramping and prolonged menstrual-like bleeding. Common side effects from misoprostol include nausea, fever, vomiting and diarrhea, which pass after a few hours. The risk of serious complication is very low. Some people find these side effects are reduced if misoprostol is used with mifepristone, as noted above.
It is important to note that emergency contraceptives, such as Plan B, are not the same as abortion pills. Emergency contraceptives cannot be used to end a pregnancy.
Mifepristone blocks the hormone progesterone, which is required to sustain a pregnancy. Without this hormone, the attachment of a fertilized egg to the uterine wall is disrupted, and the uterus contracts. Under the World Health Organization’s technical and policy guidance for safe abortion, a person would swallow one mifepristone tablet to start the process. Usually there are no side effects from mifepristone. Then, under the WHO Guidance, after 24 hours, a person would use misoprostol, 800 mcg (micrograms), usually four (4) 200 mcg tablets, every three hours for no more than 12 hours. The misoprostol can be put in the cheeks between the teeth and gums, without swallowing the pill, and left for 30 minutes to dissolve. Misoprostol causes contractions of the uterus. As a consequence, the uterus pushes out the pregnancy.
According to the WHO Guidance, a safe medical abortion can be completed with misoprostol only, however, it requires more misoprostol than if the abortion were completed with mifepristone. A person would take 800 mcg either by dissolving under the tongue or inside the vagina every four hours for no more than 12 hours.
The experience and risks of an abortion using these medicines are similar to those of a spontaneous miscarriage. Miscarriage happens spontaneously in 15-20% of all pregnancies. In other words, the risks of a complication after a spontaneous miscarriage or a miscarriage caused by abortion pills are the same.
Anyone who has decided to end their pregnancy with medication should understand how medication abortion works and how to use the medicines correctly. It is best to discuss the directions with a friend or clinician to review and clearly understand all medication information instructions. Information about how one would use pills for safe abortion are available from Women Help Women and Women on Web. Both are members of the National Network of Abortion Funds. It is important to visit these sites to learn exactly how one would use the medicines correctly.
Though a person may feel obligated to report when someone has used abortion medication to end their own pregnancy, they are generally not required to do so nor should feel pressure to. It is important to remember that some people in the United States have been arrested or jailed for ending their own pregnancies.
Misoprostol is used to prevent ulcers in people with conditions like arthritis that require them to take non-steroidal anti-inflammatory (NSAID) medication long-term. It is used by veterinarians to treat dogs for the same reason.
In Mexico and other countries in Latin America, prescriptions are not required for most medicines available in pharmacies. Therefore it is possible for people to buy misoprostol over the counter. (With the exception of Mexico, Mifepristone is not available in pharmacies anywhere in Latin America.) In many cases, the pharmacist will not ask why a person wants to buy the medicine. If the pharmacist asks, some people say it’s for their a family member’s ulcer or arthritis. If a pharmacy will not sell the misoprostol to a person, they might try a different pharmacy. For more information, visit Women on Waves.
Immigrant communities in the U.S. often rely upon local stores to help them secure medications they were used to taking in their home country, which may have instructions in the language they are most comfortable with or dosages they understand. Some local stores that import directly from places where misoprostol is available over-the-counter may carry misoprostol, often sold under generic names like Cytotec. If a person does seek abortion medication, it is very important to get genuine pills. The medication should be in its original packaging, as loose pills are unsafe. Click here to see a picture of misoprostol.
It is also very important to note that there are many websites that claim to sell misoprostol or mifepristone to people in the United States. Some of these website send genuine medicines, however, many of these websites are scams and do not send real medication. Unfortunately, new scam websites are posted on the Internet every week to exploit people who are desperate to end a pregnancy, and there is no listing of websites that are trustworthy.
These medicines have been used by millions of people in the United States and around the world for early abortion. Complications are very rare and can be treated in any hospital because the complications from abortion are exactly the same as complications from miscarriage. Spontaneous miscarriage occurs in 15-20% of all pregnancies, so all emergency rooms and doctors working in them know how to handle a complication from miscarriage. According to the WHO Guidance, abortion pills are not appropriate for everyone, including those with a history of previous ectopic pregnancy or pelvic inflammatory disease, those with a current IUD, or those who might currently be experiencing pelvic pain. Anyone considering taking abortion pills who has any of these health issues may want to reach out to a medical professional first.
According to the WHO Guidance, the following are signs of complication requiring follow up care with a medical professional:
- If there is heavy bleeding that lasts for more than two hours and soaks more than two sanitary pads per hour (if the stream of blood is like a stream of water in the open faucet). Feeling dizzy or light-headed can be a sign of too much blood loss, and dangerous to a person’s health (very rare; less than 1%).
- If there is severe pain that does not go away a few days after taking the medicines.
- If there is vaginal discharge that smells bad.
- If a person has a fever of over 100o Fahrenheit for more than 24 hours, or a fever of more than 102o F degrees at any point.
If there is a complication, a person can always go to the hospital or any doctor and say they had a miscarriage. The doctor will treat them as if they had a spontaneous miscarriage. There is no blood test in the United States to determine if a person has ingested abortion pills, as such there will be no way that the doctor can know they have taken medicines unless the patient discloses or has the pills on or in their body (in their mouth or vagina). The treatment is more misoprostol or a vacuum curettage with manual or electric suction or a D&C (dilation and curettage), during which a doctor empties the uterus by scraping. The treatment of miscarriage is widespread, routine, and safe.