How safe are abortion pills?

Recently, a fellow health care worker asked me about safeguards for a self-managed abortion with pills. I was confused by the question - "safeguards" as in a trusted companion to support someone through the process, or care for them through potential discomfort or pain? As in a plan to seek followup care if needed? "Well," they asked me, "what are the dangers?"

The use of abortion pills is not only safer than childbirth, it is also safer than using antibioticspenicillin or Viagra. In fact, taking the pills that will end an early pregnancy is safer than taking Tylenol, a drug you can buy over the counter in any store. So why don't we talk about it as such? Even health care providers, it turns out, may have some misconceptions about the safety and efficacy of a medication abortion - whether it takes place in a clinical setting or in the privacy of your home. 

Medication abortion within the first trimester (12 weeks) of pregnancy is >98% effective. It is simple and straightforward, with very few risks of complications. It carries the same risks as a natural miscarriage would, and any potential complications can easily be treated by a doctor. In the very rare case that further medical care is needed, this care consists of a very simple vacuum aspiration or another dose of medication - that's it!

My colleague was shocked to learn these facts, and that the restrictions on Mifepristone and Misoprostol, the abortion pills, is just political--not based on data, science, or medical facts. 

"Have you heard of any injury or death?" they asked me, knowing that I've worked with patients using abortion pills for years. The answer: No! 

The risk of mortality from a medication abortion is less than 1 in 100,000.

Medication abortion with Mifepristone and Misoprostol is used in most European countries. In France alone, more than 2.000.000 abortions have been done with Mifepristone and Misoprostol since 1992, and 0 deaths have occurred. Mifepristone and Misoprostol are so common, safe, and effective, in fact, that they are included in the World Health Organization's Core Model List of Essential Medicines.

Increasingly, people are choosing to take the abortion pills outside of a clinic. Once a doctor prescribes you the medication, which can be done online through services like Women on Web, you can follow the instructions to induce your abortion safely, on your own. Women on Web alone has helped over 100,000 women and pregnant people to self-manage their abortions and they've seen an increase in people seeking medical terminations done in the privacy and comfort of their homes.

According to the WHO, individuals can safely and effectively self-manage their abortions within 12 weeks at home without the direct support of a healthcare provider. WHO Guidelines on Self-Care Interventions: Self-Management of Medical Abortion suggests that “Self-management can be appealing for several practical reasons including lower costs, ease of scheduling, reduced transport needs, ability to manage stigma, and quicker termination of pregnancy. Individuals also value the sense of control over the abortion process and the ability to maximize comfort and support.

In fact, researchers have recently found that most medication abortions around the world actually take place at home (or otherwise outside of clinical settings), and are just as safe when they are self-managed

So not only are abortion pills incredibly safe, I told my co-worker, they are also common, popular, essential, widely available, and wonderful

Blog post by Hannah Matthews, Hannah (she/her) is a reproductive health care worker, abortion doula, and writer based in the U.S. Her writing on abortion care has been published by ELLE, Esquire, Teen Vogue, and other outlets, and her book about community abortion care and support work, YOU OR SOMEONE YOU LOVE, is forthcoming from Atria Books in 2023.