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the findings of studies conducted under the auspices of the World Health Organization (WHO)—says this protocol is outdated.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 August 26, 2019)
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-four 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.
Eighteen 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.
Three states (North Dakota, Ohio, and Texas) require mifepristone to be provided in accordance with the outdated FDA protocol, although Texas permits providers to use the medication levels that ACOG recommends. Arkansas, and Oklahoma 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 |
Jan 9, 2012 |
Blocked/Enjoined |
Texas Omnibus Abortion Bill (HB 2)
|
HB 2 |
Texas |
Jun 28, 2013 |
Current |
Texas Telemedicine Ban (SB 9)
|
SB 9 |
Texas |
Jun 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 |
Nov 12, 2012 |
Failed to Pass |
Texas Omnibus Abortion Bill (SB 5)
|
SB 5 |
Texas |
Jun 11, 2013 |
Failed to Pass |
Texas Omnibus Abortion Bill (HB 60)
|
HB 60 |
Texas |
Jun 12, 2013 |
Failed to Pass |
Texas Omnibus Abortion Bill (SB 1)
|
SB 1 |
Texas |
Jul 1, 2013 |
Failed to Pass |
Arizona Bill to Remove Medication Abortion FDA Protocols Compliance Requirements (HB 2596)
|
HB 2596 |
Arizona |
Feb 13, 2013 |
Failed to Pass |
Arizona Bill to Remove Restrictions on Medication Abortion (HB 2649)
|
HB 2649 |
Arizona |
Feb 13, 2013 |
Failed to Pass |
Arizona Bill to Remove Medication Abortion FDA Protocols Compliance Requirements (HB 2575)
|
HB 2575 |
Arizona |
Feb 4, 2014 |
Failed to Pass |
Arizona Bill to Remove Restrictions on Medication Abortion (HB 2371)
|
HB 2371 |
Arizona |
Jan 16, 2014 |
Failed to Pass |
Florida for Life Act 2014 (HB 545)
|
HB 545 |
Florida |
Jan 9, 2014 |
Failed to Pass |
Missouri Telemedicine Ban (HB 400)
|
HB 400 |
Missouri |
Jan 31, 2013 |
Current |
Missouri Abortion-Inducing Drug Safety Act (HB 177)
|
HB 177 |
Missouri |
Jan 16, 2013 |
Failed to Pass |
Missouri Telemedicine Ban (SB 175)
|
SB 175 |
Missouri |
Jan 17, 2013 |
Failed to Pass |
Oklahoma Bill Regarding Medication Abortion Restrictions (HB 2684)
|
HB 2684 |
Oklahoma |
Feb 3, 2014 |
Blocked/Enjoined |
Louisiana Omnibus Abortion Bill (HB 388)
|
HB 388 |
Louisiana |
Feb 25, 2014 |
Blocked/Enjoined |
Arkansas Telemedicine Ban (SB 913)
|
SB 913 |
Arkansas |
Mar 8, 2013 |
Failed to Pass |
Kansas Law Regarding Licensing Regulations of Abortion Clinics (SB 36)
|
SB 36 |
Kansas |
Jan 19, 2011 |
Current-Partially Blocked |
Mississippi Women’s Health Defense Act of 2013 (HB 897)
|
HB 897 |
Mississippi |
Feb 5, 2013 |
Failed to Pass |
Mississippi Women’s Health Defense Act of 2013 (SB 2795)
|
SB 2795 |
Mississippi |
Jan 21, 2013 |
Current |
Idaho Omnibus Bill Including Medication Abortion Restrictions (SB 1193)
|
S 1193 |
Idaho |
Mar 22, 2013 |
Failed to Pass |
Indiana Omnibus Abortion Bill (SB 371)
|
SB 371 |
Indiana |
Jan 8, 2013 |
Blocked/Enjoined |
Indiana Telemedicine Ban (HB 1533)
|
HB 1533 |
Indiana |
Jan 22, 2013 |
Failed to Pass |
Iowa Bill Regarding Medication Abortion Restrictions (SF 14)
|
SF 14 |
Iowa |
Jan 16, 2013 |
Failed to Pass |
Iowa Bill Regarding Medication Abortion Restrictions (HF 173)
|
HF 173 |
Iowa |
Feb 7, 2013 |
Failed to Pass |
Kentucky Bill Regarding Physical Exam Prior to Induced Abortion (HB 163)
|
HB 163 |
Kentucky |
Jan 8, 2014 |
Failed to Pass |
South Carolina Bill Regarding Medication Abortion Restrictions (S 34)
|
S 34 |
South Carolina |
Dec 3, 2014 |
Failed to Pass |
Iowa Bill Regarding Medication Abortion Restrictions (SF 11)
|
SF 11 |
Iowa |
Jan 2, 2015 |
Failed to Pass |
Florida for Life Act 2015 (HB 247)
|
HB 247 |
Florida |
Jan 13, 2015 |
Failed to Pass |
Arkansas Telemedicine Ban (HB 1076)
|
HB 1076 |
Arkansas |
Jan 15, 2015 |
Current |
Arkansas Telemedicine Ban (SB 53)
|
SB 53 |
Arkansas |
Jan 15, 2015 |
Current |
Arizona Omnibus Bill (SB 1318)
|
SB 1318 |
Arizona |
Feb 2, 2015 |
Blocked/Enjoined |
Texas Bill Regarding Exceptions From Penalties for an Abortion Provider’s Professional Judgment (HB 1210)
|
HB 1210 |
Texas |
Feb 9, 2015 |
Failed to Pass |
Idaho Physician Physical Presence and Women Protection Act (H 88)
|
H 88 |
Idaho |
Feb 5, 2015 |
Failed to Pass |
Arkansas Abortion-Inducing Drug Safety Act (HB 1394)
|
HB 1394 |
Arkansas |
Feb 17, 2015 |
Blocked/Enjoined |
Idaho Telehealth Access Act (H 98)
|
H 98 |
Idaho |
Feb 10, 2015 |
Failed to Pass |
Idaho Physician Physical Presence and Women Protection Act (H 154)
|
H 154 |
Idaho |
Feb 18, 2015 |
Current |
Minnesota Telemedicine Ban (HF 734)
|
HF 734 |
Minnesota |
Feb 12, 2015 |
Failed to Pass |
Minnesota Telemedicine Ban ( SF 727)
|
SF 727 |
Minnesota |
Feb 12, 2015 |
Failed to Pass |
Montana Telemedicine Ban (HB 587)
|
HB 587 |
Montana |
Feb 20, 2015 |
Vetoed |
Minnesota Telemedicine Ban (SF 2957)
|
SF 2957 |
Minnesota |
Apr 4, 2014 |
Failed to Pass |
Minnesota Telemedicine Ban (HF 3361)
|
HF 3361 |
Minnesota |
Apr 28, 2014 |
Failed to Pass |
Florida For Life Act 2015 (SB 1502)
|
S 1502 |
Florida |
Feb 26, 2015 |
Failed to Pass |
Kansas Bill Amending Telemedicine Ban (HB 2228)
|
HB 2228 |
Kansas |
Feb 4, 2015 |
Blocked/Enjoined |
Ohio Bill Regarding Medication Abortion Restrictions (HB 255)
|
HB 255 |
Ohio |
Jun 10, 2015 |
Failed to Pass |
Rhode Island Bill Prohibiting Insurance Coverage for Induced Abortions (H 8045)
|
H 8045 |
Rhode Island |
Apr 10, 2014 |
Failed to Pass |
Rhode Island Bill Prohibiting Insurance Coverage for Induced Abortions (H 7403)
|
H 7403 |
Rhode Island |
Feb 12, 2015 |
Failed to Pass |
Florida for Life Act 2016 (SB 1718)
|
SB 1718 |
Florida |
Jan 11, 2016 |
Failed to Pass |
New Hampshire Abortion-Inducing Drugs Safety Act (HB 1662)
|
HB 1662 |
New Hampshire |
Jan 27, 2016 |
Failed to Pass |
South Dakota Bill Regarding Informed Consent and Reversing Medication Abortions (HB 1157)
|
HB 1157 |
South Dakota |
Jan 28, 2016 |
Current |
Arizona Bill Restricting Medication Abortions (SB 1324)
|
SB 1324 |
Arizona |
Jan 27, 2016 |
Current |
California Abortion Pill Reversal Notice for Clinics (AB 2134)
|
AB 2134 |
California |
Feb 17, 2016 |
Failed to Pass |
Iowa Bill Regarding Medication Abortion Restrictions (HF 2084)
|
HF 2084 |
Iowa |
Jan 22, 2016 |
Failed to Pass |
Indiana Bill Regarding Telemedicine Prescriptions (HB 1263)
|
HB 1263 |
Indiana |
Jan 11, 2016 |
Current |
Louisiana Bill Prohibiting Harvesting of Aborted Fetal Remains (HB 815)
|
HB 815 |
Louisiana |
Mar 4, 2016 |
Signed into Law |
South Carolina Telemedicine Act (H 5162)
|
H 5162 |
South Carolina |
Mar 23, 2016 |
Failed to Pass |
Utah Telehealth Revisions Bill (HB 340)
|
HB 340 |
Utah |
Feb 16, 2016 |
Failed to Pass |
North Dakota Abortion Law Amendments (HB 1297)
|
HB 1297 |
North Dakota |
Jan 10, 2011 |
Current |
Arkansas Insurance Coverage for Contraception Refusal Clause
|
Ark. Code Ann. §§ 23-79-1101 to -1104 |
Arkansas |
|
Current |
Arizona Abortion and Contraception Refusal Clause
|
Ariz. Rev. Stat. § 36-2154 |
Arizona |
|
Current |
Arkansas Contraception Refusal Clause
|
Ark. Code Ann. § 20-16-304 |
Arkansas |
|
Current |
Indiana Bill Requiring Abortion Pill Reversal Notification (HB 1128)
|
HB 1128 |
Indiana |
Jan 5, 2017 |
Failed to Pass |
Colorado Abortion Pill Reversal Information Act (HB 1086)
|
HB 1086 |
Colorado |
Jan 18, 2017 |
Failed to Pass |
Mississippi Bill Prohibiting Abortion (HB 1197)
|
HB 1197 |
Mississippi |
Jan 16, 2017 |
Failed to Pass |
Utah ‘Unborn Child Protection Amendments’ (HB 141)
|
HB 141 |
Utah |
Jan 23, 2017 |
Current |
Oklahoma Bill Regarding Drug-Induced Abortion Violations (SB 764)
|
SB 764 |
Oklahoma |
Feb 6, 2017 |
Failed to Pass |
Utah Telehealth Amendments (HB 154)
|
HB 154 |
Utah |
Jan 23, 2017 |
Current |
North Carolina ‘Woman’s Right to Know Addition’ (HB 62)
|
HB 62 |
North Carolina |
Feb 8, 2017 |
Failed to Pass |
Georgia Bill Requiring Abortion Pill Reversal Information (SB 239)
|
SB 239 |
Georgia |
Feb 22, 2017 |
Failed to Pass |
Georgia Bill Regarding Admitting Privileges and Abortion-Inducing Drugs (SB 230)
|
SB 230 |
Georgia |
Feb 21, 2017 |
Failed to Pass |
Idaho Bill Regarding Abortion Reversal Information (S 1131)
|
S 1131 |
Idaho |
Mar 2, 2017 |
Failed to Pass |
Arkansas Bill to Place Limitations and Safety Guards on the Mifepristone Prescription for Abortion (HB 2071)
|
HB 2071 |
Arkansas |
Mar 6, 2017 |
Failed to Pass |
North Carolina Bill Requiring Information on Abortion Pill Reversal (HB 575)
|
HB 575 |
North Carolina |
Apr 5, 2017 |
Failed to Pass |
Colorado Women’s Reproductive Information Guarantee for Health and Transparency (RIGHT) Act (SB 284)
|
SB 284 |
Colorado |
Apr 3, 2017 |
Failed to Pass |
West Virginia Bill Relating to the Practice of Telemedicine (HB 2509)
|
HB 250 |
West Virginia |
Feb 16, 2017 |
Current |
Missouri TRAP Bill (HB 6)
|
HB 6 |
Missouri |
Jun 12, 2017 |
Failed to Pass |
Missouri TRAP Bill (HB 3)
|
HB 3 |
Missouri |
Jun 12, 2017 |
Failed to Pass |
Mississippi Bill Prohibiting Abortion (HB 45)
|
HB 45 |
Mississippi |
Jan 2, 2018 |
Failed to Pass |
Kentucky Medication Abortion Reporting Requirements Bill (HB 115)
|
HB 115 |
Kentucky |
Jan 3, 2018 |
Failed to Pass |
Colorado Women’s Reproductive Information Guarantee for Health and Transparency (RIGHT) Act (HB 1082)
|
HB 1082 |
Colorado |
Jan 17, 2018 |
Failed to Pass |
Idaho Bill Requiring Abortion Reversal Information (S 1243)
|
S 1243 |
Idaho |
Jan 29, 2018 |
Current |
Indiana Regulation of Abortion Bill (SB 340)
|
SB 340 |
Indiana |
Jan 4, 2018 |
Blocked/Enjoined |
Utah Abortion Law Amendments (SB 118)
|
SB 118 |
Utah |
Jan 26, 2018 |
Current |
Michigan Telemedicine Abortion Ban (SB 1198)
|
SB 1198 |
Michigan |
Nov 8, 2018 |
Vetoed |
Kentucky Bill Regarding Medication Abortion (SB 50)
|
SB 50 |
Kentucky |
Jan 8, 2019 |
Current |
North Dakota Bill Requiring Abortion Reversal Information (HB 1336)
|
HB 1336 |
North Dakota |
Jan 9, 2019 |
Blocked/Enjoined |
Nebraska Bill Requiring Abortion ‘Reversal’ Information (LB 209)
|
LB 209 |
Nebraska |
Jan 11, 2019 |
Current |
Oklahoma Bill Requiring Abortion Reversal Information (SB 614)
|
SB 614 |
Oklahoma |
Feb 4, 2019 |
Blocked/Enjoined |
Mississippi Total Abortion Ban (HB 1061)
|
HB 1061 |
Mississippi |
Jan 21, 2019 |
Failed to Pass |
North Carolina ‘Women’s Right to Know Addition’ (HB 22)
|
HB 22 |
North Carolina |
Feb 5, 2019 |
Proposed |
Kansas Bill Requiring Abortion Reversal Information (HB 2274)
|
HB 2274 |
Kansas |
Feb 12, 2019 |
Proposed |
Kansas Bill Requiring Abortion Reversal Information (SB 167)
|
SB 167 |
Kansas |
Feb 13, 2019 |
Proposed |
North Carolina ‘A Second Chance for LIFE’ Act (HB 53)
|
HB 53 |
North Carolina |
Feb 12, 2019 |
Proposed |
North Carolina ‘A Second Chance for LIFE’ Act (SB 52)
|
SB 52 |
North Carolina |
Feb 12, 2019 |
Proposed |
Arkansas Abortion Reversal Information Bill (SB 341)
|
SB 341 |
Arkansas |
Feb 14, 2019 |
Current |
Georgia Bill Requiring Abortion Pill ‘Reversal’ Information (SB 169)
|
SB 169 |
Georgia |
Feb 22, 2019 |
Proposed |
Texas Bill Relating to Abortion Safety and Penalties (HB 4213)
|
HB 4213 |
Texas |
Mar 8, 2019 |
Failed to Pass |
Maryland Bill Regarding the Administration of Mifepristone (HB 1101)
|
HB 1101 |
Maryland |
Feb 8, 2019 |
Failed to Pass |
Kansas Bill Requiring Abortion Reversal Information (SB 67)
|
SB 67 |
Kansas |
Jan 31, 2019 |
Vetoed |
Wisconsin Bill Regarding Abortion-Inducing Drugs (AB 180)
|
AB 180 |
Wisconsin |
Apr 19, 2019 |
Vetoed |
Wisconsin Bill Regarding Abortion-Inducing Drugs (SB 174)
|
SB 174 |
Wisconsin |
Apr 22, 2019 |
Proposed |
Alaska Abolition of Abortion Act of 2019 (HB 178)
|
HB 178 |
Alaska |
May 15, 2019 |
Proposed |
Ohio Medication Abortion ‘Reversal’ Bill (SB 155)
|
SB 155 |
Ohio |
May 28, 2019 |
Proposed |
Second Chance at Life Act of 2019 (H.R. 2010)
|
H.R. 2010 |
Federal |
Apr 1, 2019 |
Proposed |
Support and Value Expectant (SAVE) Moms and Babies Act of 2019 (H.R. 4399)
|
H.R. 4399 |
Federal |
Sep 19, 2019 |
Proposed |
Iowa Medication Abortion Reversal Bill (HF 2316)
|
HF 2316 |
Iowa |
Feb 10, 2020 |
Proposed |