Published by the Katharine Dexter McCormick Library
Planned Parenthood Federation of America
434 West 33rd Street, New York, NY 10001
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 anti-choice groups. The morning-after pill, also known as emergency contraception, helps prevent pregnancy; the abortion pill, 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 College 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 pill, 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 pill? What is the abortion pill?
Also known as emergency contraception, the
Also known as medication abortion, the abortion pill
morning-after pill contains medication that reduces
contains medication called mifepristone to induce
the risk of pregnancy if started within 120 hours (five
abortion. Mifepristone (Mifeprex®) can be taken
days) of unprotected intercourse. Two brands —
under supervision up to 63 days after the first day of
Next Choice® and Plan B One Step® — contain the
the last menstrual period. It is used in conjunction
hormone progestin and are currently available over
with misoprostol, which is taken later to complete the
the counter to individuals who are 17 or older. They
abortion (Creinin & Aubény, 1999; Middleton et al.,
are also available by prescription, as is ella®, which
contain ulipristal acetate (UPA), and certain brands
of oral contraception taken in increased doses for
Pharmaceuticals, 2006; Glasier, 2010; RHTP, 2009;
Rodrigues et al., 2001; Van Look & Stewart, 1998).
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 pill, the U.S.
Mifepristone ends pregnancy by blocking the
Food and Drug Administration (FDA) delcared,
hormones necessary for maintaining a pregnancy.
“Emergency contraceptives act by delaying or
Misoprostol causes the uterus to contract and empty
inhibiting ovulation and/or altering tubal transport of
sperm and/or ova (thereby inhibiting implantation)”
(FDA, 1997). More recently, studies suggested that
progestin-only morning-after pills 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
How effective is the morning-after pill? How effective is the abortion pill?
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 120
96–97 percent of women who choose mifepristone.
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 pills
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
(Ellertson 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 following
unprotected intercourse (Fine et al., 2010; Glasier et
How safe is the morning-after pill? How safe is the abortion pill?
The morning-after pill is safe for nearly all women —
The abortion pill is safe for most women — millions
millions of women around the world have used it
of women around the world have used it safely.
safely (Guillebaud, 1998; Van Look & Stewart,
There are risks associated with all medical
procedures, including abortion. And, in extremely
rare cases, death is possible from serious
complications of the abortion pill, but it remains safer
than carrying a pregnancy to term (ARHP, 2008).
THE MORNING-AFTER PILL THE ABORTION PILL Does the morning-after pill cause an abortion? Can the medicines used in the abortion pill also
The morning-after pill will not induce an abortion in a
be used for emergency contraception?
woman who is already pregnant, nor will it affect the
Although some studies show that mifepristone could
developing pre-embryo or embryo (Van Look &
be used in very low doses to reduce the risk of
Stewart, 1998). Emergency contraception prevents
pregnancy as a method of emergency contraception
pregnancy and helps a woman prevent the need for
within five 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,
Why might a woman choose the morning-after Why might a woman choose the abortion pill?
Women might choose the abortion pill as a way to
Women may choose emergency contraception as a
end pregnancy because it is a noninvasive
way to prevent pregnancy after unprotected
procedure and does not require anesthesia. It is
intercourse — in cases of unanticipated sexual
free from the risk of injury to the cervix or uterus and
activity, contraceptive failure, or sexual assault.
the possible complications caused by the use of
Nearly half of America’s 6.7 million annual
anesthesia used for other abortion procedures
pregnancies are unintended (Finer & Zolna, 2011).
(Aguillaume & Tyrer, 1995). Women who chose
medication abortion also reported that they felt it
was a more “natural” way to end a pregnancy
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 following medication
only and UPA pills than using combined hormone
abortion are similar to those of a miscarriage —
pills. 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).
How long does the process of using the How long does the process of the abortion pill morning-after pill take?
Combined hormone pills are taken in two doses, 12
It begins immediately after taking the mifepristone.
hours apart. Progestin-only pills can be taken in one
Some women may begin spotting before taking the
dose. UPA is taken in one dose. Side effects
misoprostol, the second medication. For most, the
associated with emergency contraception pills
bleeding and cramping associated with medication
generally subside within 48 hours. They affect the
abortion begin after taking it. More than 50 percent
timing of the menstrual cycle in 10–15 percent of
of women who use mifepristone abort within four or
women. Changes in the menstrual cycle are seen
five hours after taking the misoprostol. Heavy
with combined hormone, progestin-only, and UPA
bleeding may continue for about 13 days. Spotting
pills. If the next menstrual cycle is more than one
can last for a few weeks. About 92 percent of
week late, a woman should visit her clinician for a
mifepristone abortions are completed within a week
pregnancy test (Fine et al., 2010; Van Look &
(ACOG, 2001; el-Refaey et al., 1995; Newhall &
Stewart, 1998; von Hertzen et al., 2002).
Winikoff, 2000; Peyron et al., 1993; Wiebe et al.,
THE MORNING-AFTER PILL THE ABORTION PILL 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 users
An overwhelming majority of women who choose
are satisfied with it. One study found that 97 percent
medication abortion were satisfied with it. A recent
of users would recommend it to friends and family
study found that 97 percent of women who had a
(Harvey et al., 1999). Another study found that 92
medication abortion would recommend it to a friend.
Additionally, 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 (Hollander, 2000).
Where can I get the morning-after pill? Where can I get the abortion pill?
Plan B One Step and Next Choice are currently
Contact your nearest Planned Parenthood health
available over the counter to women and men who
are 17 and older. They and other forms of
www.plannedparenthood.org, another women’s
emergency contraception, including UPA are also
health care center, or your private clinician. Planned
available by prescription for all women. If you need
Parenthood health centers that do not provide
a prescription for emergency contraception, you can
medication abortion can refer you to a provider who
contact your nearest Planned Parenthood health
How much does the morning-after pill cost? How much does the abortion pill cost?
Nationwide, the price of EC ranges from $10–$70
Nationwide, the price of medication abortion ranges
(PPFA, 2012b). 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, 2012a).
Contact your nearest Planned Parenthood health
Costs vary from community to community, based on
www.plannedparenthood.org, another women’s
health care center, or your private clinician.
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Lead Author — Jennifer Johnson, MPH Revised by — Jon Knowles
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