The FDA had previously required that one of the medications used in Plan C pills (also known as at-home abortion pills), mifepristone, be dispensed in person. But now, that requirement has been permanently lifted, paving the way for telehealth platforms to arrange easier access to abortion care, delivering the pills by mail to those in all 50 states.
After the Supreme Court case heard arguments on the Mississippi law challenging Roe v. Wade in November 2021, many experts are under the impression that the landmark 1973 case upholding a woman's right to an abortion is at risk of being overturned.
When healthcare providers are barred from providing access to safe abortions, many women will be forced to resort to unsafe measures to end an unwanted pregnancy. But that’s where improved access to a medication abortion, known as Plan C, can help.
According to The American College of Obstetricians and Gynecologists (ACOG), 1 in 4 women in the U.S. will have an abortion in their lifetime, and approximately 21 million women worldwide obtain unsafe, illegal abortions each year. Women may choose to end a pregnancy for a number of reasons, including but not limited to: contraceptive failure, barriers to contraceptive use and access, rape, incest, intimate partner violence, fetal anomalies, illness during pregnancy, and exposure to medications that may harm the fetus. Complications from unsafe, self-managed abortions account for approximately 13% of all maternal deaths, which equates to nearly 50,000 annually.
What is Plan C?
Plan A is birth control to prevent pregnancy, Plan B is emergency contraception (to prevent pregnancy after sex) and Plan C is abortion pills.
Also called a medication abortion, Plan C is an option for safely and effectively ending a pregnancy. The medication used is a combination of mifepristone and misoprostol (or misoprostol may be used solo, if mifepristone is not available). The entire process can be self-managed at home.
According to ACOG, a medication abortion is most effective if used before 10 weeks of pregnancy, up to 70 days from the first day of your last normal period.
Is a medication abortion safe?
Yes. The protocol of taking mifepristone first (which blocks progesterone, a hormone needed to maintain pregnancy viability), followed by misoprostol 24 to 48 hours later (which causes your uterus to cramp and contract, emptying its contents) is approved by the Food and Drug Administration (FDA). The protocol is also recommended by ACOG and Planned Parenthood.
This method of medication abortion is low risk (less than 1% of women who have used medication abortion have reported serious adverse side effects such as infection or hemorrhage), highly effective (95% to 98% of abortions are successful), and it has the fewest side effects.
Studies show that abortion with Plan C pills tends to take longer and require you to monitor yourself at home, as compared to a surgical abortion, known as uterine aspiration, which is typically performed by a clinician in one office visit. Though no medical procedure is without risk, the risks of a medication abortion are most serious if you have an IUD or an ectopic pregnancy.
Plan C pills make abortions more accessible
In 2017, medication abortion comprised 39% of all abortions in the U.S. In some European countries, such as Finland, medication abortions account for up to 90% of all abortion procedures. Many healthcare providers recommend medication abortions to their patients seeking this type of care—as it may be preferable over a uterine aspiration in some cases.
Add to that, Plan C pills offer additional benefits: they’re more accessible, much more affordable (pills can cost $40-$105; uterine aspiration typically costs upwards of $500) and can be self-managed. That self-management factor is hugely important, considering states have enacted no fewer than 106 bills restricting abortions this year, the most in one year since 1973, The Atlantic reports. Access to in-clinic abortion is becoming more and more tenuous.
Resources for finding Plan C
Resources for finding abortion pills in your state are available via Planned Parenthood, Choix Health (which offers virtual clinician services for California, Illinois and Colorado) and Plan C, where you can enter your location and determine the best method of getting access to the medication, whether that’s clinician-supported or self-managed. In some states, you can visit a clinic or seek support from an online clinician then take the pills at home, in other cases, you can order the pills for delivery to your home without consulting a healthcare provider. Plan C also has a list of online resources, such as The M+A Hotline, that are available for additional support.
A small 2021 cohort study examined the safety record of medication abortion care administered by telehealth, and found it to be “feasible, safe and efficacious.”
Though the pills are legal to take in all 50 states, plus Washington D.C. and some U.S. territories, certain states have more restrictive laws than others. A law recently signed into effect in Texas limits medication abortion access to just the first 7 weeks of pregnancy, narrowing the window for which medication abortion can be given by a clinician without legal consequence.
Abortion care is healthcare. “Like all patients, women obtaining abortion are entitled to privacy, dignity, respect, and support,” writes The American College of Obstetricians and Gynecologists (ACOG). Plan C offers them just that.
A version of this post was originally published on Dec. 3, 2021. It has been updated.