THE DIFFERENCE BETWEEN THE MORNING-AFTER PILL AND THE ABORTION PILL There has been considerable public confusion about the difference between the morning-after pill and the abortion pill because of misinformation disseminated by groups that oppose safe and legal abortion. The morning-after pil , also known as emergency contraception, helps prevent pregnancy; the abortion pil , also known as medication abortion, terminates pregnancy. According to the general medical definitions of pregnancy that have been endorsed by many organizations — including the American Col ege of Obstetricians and Gynecologists and the United States Department of Health and Human Services — pregnancy begins when a pre-embryo completes implantation into the lining of the uterus (ACOG, 1998; DHHS, 1978; Hughes, 1972; “Make the Distinction …, “ 2001). Hormonal methods of contraception, including the morning-after pil , prevent pregnancy by inhibiting ovulation and fertilization (ACOG, 1998). The abortion pill terminates a pregnancy without using instruments. By helping women terminate unwanted pregnancies up to 63 days after their last menstruation, the abortion pill is a safe and effective option. THE MORNING-AFTER PILL THE ABORTION PILL What is the morning after pil ? What is the abortion pil ?
Also known as emergency contraception, the
Also known as medication abortion, the abortion pill
morning-after pill contains medication that reduces
contains medication cal ed mifepristone to induce
the risk of pregnancy if started within 120 hours (five
abortion. Mifepristone (Mifeprex®) can be taken
days) of unprotected intercourse. Plan B One-Step® under supervision up to 63 days after the first day of
contains the hormone progestin and are currently
the last menstrual period. It is used in conjunction
available over the counter in the family planning
with misoprostol, which is taken later to complete the
aisle of drug stores with no age requirement. Other
abortion (Creinin & Aubény, 1999; Middleton et al.,
2005; Schaff et al., 2000; Schaff et al., 2001).
EC such as Next Choice® remain behind the counter
with pharmacists for purchase by anyone 17 or
older without a prescription, or anyone younger
than 17 with a prescription. el a®, which contains
ulipristal acetate (UPA), and certain brands of oral
contraception taken in increased doses for use as
emergency contraception require a prescription at
any age (Barr Pharmaceuticals, 2006; Glasier, 2010;
RHTP, 2009; Rodrigues et al., 2001; Van Look &
THE MORNING-AFTER PILL THE ABORTION PILL How does the morning-after pill work? How does the abortion pill work?
In its approval of the morning-after pil , the U.S. Food Mifepristone ends pregnancy by blocking the
and Drug Administration (FDA) declared, “Emergency hormones necessary for maintaining a pregnancy.
contraceptives act by delaying or inhibiting ovulation Misoprostol causes the uterus to contract and empty
and/or altering tubal transport of sperm and/or ova
(thereby inhibiting implantation)” (FDA, 1997). More
recently, studies suggested that progestin-only
morning-after pil s work only by preventing ovulation
or fertilization, and have no effect on implantation
(Croxatto et al., 2003; Novikova et al., 2007). In 2008, a
consortium of authorities declared that progestin-only
emergency contraception does not interfere with
implantation (ICEC-FIGO, 2008). UPA works only by
preventing ovulation (Glasier, 2010). How effective is the morning-after pil ? How effective is the abortion pil ?
The morning-after pill is very effective at reducing
The abortion pill is highly effective at ending very
the risk of pregnancy. Studies have shown that it
early pregnancies. Complete abortion will occur in
reduces the risk of pregnancy when taken up to
96–97 percent of women who choose mifepristone.
120 hours after unprotected intercourse. With the
In the small percentage of cases that medication
exception of UPA, the sooner the dosing begins, the
abortion fails, other abortion procedures are required
more effective the treatment. When taken within 72
to end the pregnancies (ACOG, 2001; Schaff et al.,
hours of unprotected intercourse, morning-after pil s 2000).
that contain both estrogen and progestin reduce
the risk of pregnancy by 75 percent. Within that
same time, progestin-only regimens, such as Plan
B One-Step and Next Choice, reduce the risk of
pregnancy by 89 percent. When initiated within 24
hours of unprotected intercourse, progestin-only
morning-after pill reduced the risk of pregnancy by
95 percent (El ertson et al., 2003; Rodrigues et al.,
2001; TFPMFR, 1998; Van Look & Stewart, 1998). The
effectiveness of UPA, however, does not diminish
over the course of the five days fol owing unprotected
intercourse (Fine et al., 2010; Glasier et al., 2010). THE MORNING-AFTER PILL THE ABORTION PILL How safe is the morning-after pil ? How safe is the abortion pil ?
The morning-after pill is safe for nearly all women
The abortion pill is safe for most women — mil ions of
— mil ions of women around the world have used it
women around the world have used it safely. There
safely (Guil ebaud, 1998; Van Look & Stewart, 1998).
are risks associated with all medical procedures,
including abortion. And, in extremely rare cases,
death is possible from serious complications of the
abortion pil , but it remains safer than carrying a
Does the morning-after pill cause an abortion? Can the medicines used in the abortion pill also be used for emergency contraception?
The morning-after pill will not induce an abortion in a
woman who is already pregnant, nor will it affect the
Although some studies show that mifepristone could be
developing pre-embryo or embryo (Van Look & Stewart, used in very low doses to reduce the risk of pregnancy
1998). Emergency contraception prevents pregnancy
as a method of emergency contraception within five
and helps a woman prevent the need for abortion.
days of unprotected intercourse, it is not approved for
use as emergency contraception in the United States at
this time (Ho et al., 2002: TFPMFR, 1999). Why might a woman choose the morning-after pil ? Why might a woman choose the abortion pil ? Women may choose emergency contraception
Women might choose the abortion pill as a way to
as a way to prevent pregnancy after unprotected
end pregnancy because it is a noninvasive procedure
intercourse — in cases of unanticipated sexual
and does not require anesthesia. It is free from the
activity, contraceptive failure, or sexual assault.
risk of injury to the cervix or uterus and the possible
Nearly half of America’s 6.7 mil ion annual
complications caused by the use of anesthesia used
pregnancies are unintended (Finer & Zolna, 2011).
for other abortion procedures (Aguil aume & Tyrer,
1995). Women who chose medication abortion also
reported that they felt it was a more “natural” way to
Does the morning-after pill have side effects? Does the abortion pill have side effects?
Side effects are far less common using progestin-
The most common side effects fol owing medication
only and UPA pil s than using combined hormone
abortion are similar to those of a miscarriage
pil s. The most common side effects include nausea — abdominal pain, bleeding, changes in body
and vomiting. Abdominal pain, breast tenderness,
temperature, dizziness, fatigue, and gastrointestinal
dizziness, fatigue, headaches, and irregular bleeding distress (ACOG, 2005; Creinin & Aubény, 1999;
may also occur (Van Look & Stewart, 1998; OPR,
2011; TFPMFR, 1998; Trussell & Schwarz, 2011). THE MORNING-AFTER PILL THE ABORTION PILL How long does the process of using the How long does the process of the morning-after pill take? abortion pill take?
Combined hormone pil s are taken in two doses, 12
It begins immediately after taking the mifepristone.
hours apart. Progestin-only pil s can be taken in
Some women may begin spotting before taking the
one dose. UPA is taken in one dose. Side effects
misoprostol, the second medication. For most, the
associated with emergency contraception pil s
bleeding and cramping associated with medication
general y subside within 48 hours. They affect the
abortion begin after taking it. More than 50 percent of
timing of the menstrual cycle in 10–15 percent of
women who use mifepristone abort within four or five
women. Changes in the menstrual cycle are seen
hours after taking the misoprostol. Heavy bleeding
with combined hormone, progestin-only, and UPA
may continue for about 13 days. Spotting can last
pil s. If the next menstrual cycle is more than one
for a few weeks. About 92 percent of mifepristone
week late, a woman should visit her clinician for a
abortions are completed within a week (ACOG, 2001;
pregnancy test (Fine et al., 2010; Van Look & Stewart, el-Refaey et al., 1995; Newhall & Winikoff, 2000;
Peyron et al., 1993; Wiebe et al., 2002). Are women who have used the morning-after pill Are women who have used the abortion pill satisfied with it? satisfied with the method?
An overwhelming majority of morning-after pill
An overwhelming majority of women who choose
users are satisfied with it. One study found that 97
medication abortion were satisfied with it. A recent
percent of users would recommend it to friends and
study found that 97 percent of women who had a
family (Harvey et al., 1999). Another study found
medication abortion would recommend it to a friend.
that 92 percent of women who had used emergency Additional y, 91 percent of the women reported that
contraception would use it again in the case of a
they would choose medication abortion again if they
contraceptive emergency (Breitbart et al., 1998).
had to have another abortion (Hol ander, 2000). Where can I get the morning-after pil ? Where can I get the abortion pil ?
Plan B-One Step is now available over the counter in Contact your nearest Planned Parenthood
the family planning aisle of drug stores with no age
health center at 1-800-230-PLAN or www.
requirement. Other brands of levonorgestrel
plannedparenthood.org, another women’s health care
EC remain behind the counter with pharmacists
center, or your private clinician. Planned Parenthood
for purchase by anyone 17 or older without a
health centers that do not provide medication
prescription, or anyone younger than 17 with a
abortion can refer you to a provider who does.
prescription. el a requires a prescription at any
age. If you need a prescription for emergency
contraception, you can contact your nearest Planned
Parenthood health center at 1-800-230-PLAN or
How much does the morning-after pill cost? How much does the abortion pill cost?
Nationwide, the price of EC ranges from $30–$65
Nationwide, the price of medication abortion ranges
(PPFA, 2013b). Costs vary from community to
between $300 and $800. This includes two or three
community, based on regional and local expenses.
office visits, testing, and exams (PPFA, 2013a).
Costs vary from community to community, based on
health center at 1-800-230-PLAN or www.
plannedparenthood.org, another women’s health
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_____. (2001, April). “Medical Management of Abortion.” ACOG Practice Bul etin, 26, 1–13.
_____. (2005, October). “Medical Management of Abortion.” ACOG Practice Bul etin, 67, 1–12.
Aguil aume, Claude & Louise Tyrer. (1995). “Current Status and Future Projections on Use of RU-486.” Contemporary Ob/Gyn, 40(6), 23–40.
ARHP — Association of Reproductive Health professionals. (2008, April). What You Need to Know — Mifepristone Safety Overview. [Online]. http://www.arhp.org/upload/Docs/mifepristonefactsheet.pdf, accessed September 29, 2009.
Barr Pharmaceuticals, Inc. (2006, August 24). FDA Grants OTC Status to Barr’s Plan B® Emergency Contraceptive: Historic Dual Status Decision Provides OTC Access to Those 18 Years of Age and Older; Remains Prescription for Women 17 and Younger. [Online]. http://phx.corporate-ir.net/phoenix.zhtml?c=irol-newsArticle&ID=899120.
Breitbart, Vicki, et al. (1998). “The Impact of Patient Experience on Practice: The Acceptability of Emergency Contraceptive Pil s in Inner City Clinics.” Journal of the American Medical Women’s Association, 53(5 Supplement 2), 255–58.
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Croxatto, Horatio B., et al. (2003). “Mechanisms of Action of Emergency Contraception.” Steroids, 68, 1095–98.
DHHS — U.S. Department of Health and Human Services. (1978). Code of Federal Regulations. 45CFR46.203.
El ertson, Charlotte, et al. (2003). “Extending the Time Limit for Starting the Yuzpe Regimen of Emergency Contraception to 120 hours.” Obstetrics and Gynecology, 101, 1168–71.
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ICEC-FIGO — International Consortium for Emergency Contraception – International Federation of Gynecology & Obstetrics. (2008-October). “How do levonorgestrel-only emergency contraceptive pil s (LNG ECPs) prevent pregnancy?” [Online]. http://www.cecinfo.org/PDF/ICEC_MOA_10_14.pdf, accessed September 25, 2009.
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Newhal , Elizabeth Pirruccel o & Beverly Winikoff, (2000). “Abortion with Mifepristone and Misoprostol: Regimens, Efficacy, Acceptability and Future Directions.” American Journal of Obstetrics and Gynecology, 183(2), S44–53.
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TFPMFR — Task Force on Postovulatory Methods of Fertility Regulation. (1998). “Randomised Control ed Trial of Levonorgestrel Versus the Yuzpe Regimen of Combined Oral Contraceptives for Emergency Contraception.” The Lancet, 352(9126), 428–33.
_____. (1999). “Comparison of Three Single Doses of Mifepristone as Emergency Contraception: A Randomised Trial.” The Lancet, 353(9154), 697–702.
Trussel , James, and Eleanor Bimla Schwarz. (2011). “Emergency Contraception.” Pp. 113–145 in Robert A. Hatcher et al., eds., Contraceptive Technology — 20th Revised Edition. New York: Ardent Media, Inc.
Van Look, Paul & Felicia Stewart. (1998). “Emergency Contraception.” In Robert A. Hatcher et al., Eds, Contraceptive Technology — 17th Revised Edition. New York: Ardent Media.
von Hertzen, Helena, et al. (2002). “Low Dose Mifepristone and Two Regimens of Levonorgestrel for Emergency Contraception: A WHO Multicentre Randomised Trial.” The Lancet, 260, 1803–10.
Wiebe, El en, et al. (2002). “Comparison of Abortions Induced by Methotrexate or Mifepristone Fol owed by Misoprostol.” Obstetrics and Gynecology, 99(5), 813–9.
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