All About The Abortion Pill At The Heart Of A New Supreme Court Case
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On Tuesday, March 26, The Supreme Court started hearing oral arguments in FDA v. Alliance for Hippocratic Medicine. This case centers around allegations that the FDA overlooked potential safety issues when it made mifepristone—a drug commonly used in medication abortion—more easily accessible to the public in 2016 and in 2021. If The Supreme Court rules against the FDA, future mifepristone access could be impacted. (An official ruling decision is expected in June 2024.)
There are two major issues at stake with the latest court case, says Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. “If the Supreme Court denies access to mifepristone, this sets a precedent that every single FDA-approved drug is at risk based not on science, but on the whims of politicians,” she says. “This has nothing to do with safety, efficacy and need, which is how the FDA makes decisions regarding approval.”
The other is that mifepristone access may be limited or even unavailable going forward. “This would be an unprecedented blow to women’s health,” Dr. Streicher says. “Mifepristone is a scientifically proven safe and effective approach to pregnancy termination. If unavailable, women will have to resort to surgical abortions, illegal abortions or carrying pregnancies to term.”
Fourteen states now ban abortion, so it’s only natural for cases like FDA vs. Alliance for Hippocratic Medicine to make you wonder what this means for access to birth control, IUDs, and emergency contraception—including Plan B. But is Plan B the same thing as an abortion pill? Ahead, medical experts set the record straight on this common misconception, explain the differences, and answer your burning questions.
Meet the experts: Jennifer Lincoln, MD, is an ob-gyn and author of Let's Talk About Down There. Jessica Shepherd, MD, is an ob-gyn based in Texas. Lauren Streicher, MD, is a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine.
What is Plan B?
Plan B One-Step, frequently referred to as the morning after pill, is a type of emergency contraceptive that you can purchase over the counter at a pharmacy for around $50. It's one pill (taken orally) that contains 1.5 milligrams of levonorgestrel, a synthetic form of the hormone progesterone, according to the FDA.
Plan B was the first oral emergency contraception product approved by the FDA in 1999, according to the Kaiser Family Foundation (KFF). Since then, more emergency contraception drugs have been FDA approved, but people tend to refer to emergency contraception as “Plan B,” even when they’re talking about other products.
The purpose of Plan B is to stop you from getting pregnant after having unprotected sex or after you think your contraception has failed. It prevents pregnancy by delaying ovulation, and it can also prevent a fertilized egg from implanting in the uterus.
In 2021, a study showed that 24 percent of women ages 22 to 49 years old had used emergency contraception in their lifetime, per the Centers for Disease Control and Prevention (CDC). But experts warn that it shouldn't be your main way of preventing pregnancy. "Emergency contraception should not be used as a regular method of birth control," says Jessica Shepherd, MD, an ob-gyn and director of Minimally Invasive Gynecology at the University of Illinois at Chicago.
Is Plan B the abortion pill?
No, Plan B is not the abortion pill. “This confusion has been present for decades,” Dr. Streicher says. “Plan B is not an abortion pill. It prevents pregnancy and does not disrupt an established pregnancy.”
Medication abortion usually involves two drugs—mifepristone and misoprostol. These are collectively referred to as “the abortion pill” even though it technically involves two different medications.
Plan B is a medication used to prevent pregnancy by delaying ovulation and preventing a fertilized egg (if there is one) from attaching to the uterus, per the FDA. If you’re already pregnant, though, Plan B (or similar emergency contraception medications) won’t stop the pregnancy from progressing, the FDA says.
Is taking Plan B the same thing as an abortion?
No, Plan B is not the same as abortion—taking it prevents pregnancy by delaying ovulation. And if fertilization does occur, Plan B may prevent a fertilized egg from attaching to the uterus, per the FDA. However, if a fertilized egg is implanted prior to taking Plan B, the drug will not work and pregnancy proceeds normally. The CDC defines abortion as the termination of an established pregnancy.
What is the abortion pill and how does it work?
If you opt for a medication abortion, you'll actually take two different pills: mifepristone and misoprostol. On day one, you'll take mifepristone, per Planned Parenthood. Mifepristone blocks the body’s progesterone, a hormone that is needed to continue a pregnancy in its early stages. It causes the pregnancy to stop progressing, says Dr. Shepherd.
On day two or three, you will usually take four misoprostol pills. This medication softens the cervix and causes the uterus to contract, says Dr. Shepherd. This will expel the embryo from the uterus.
Why do people confuse Plan B and the abortion pill?
One of the main reasons why people think that Plan B is the same thing as abortion is because the packaging states it could prevent the implantation of an embryo, says Dr. Lincoln. However, "this is a hypothetical that has never been proven," she says. Plus, some people believe that pregnancy begins at fertilization—not at implantation, she adds.
But organizations such as the National Institutes of Health (NIH) Trusted Source and the American College of Obstetricians and Gynecologists (ACOG) says that pregnancy occurs only after a fertilized egg is implanted in the uterus, per Healthline.
"Implantation at the beginning of pregnancy happens about a week after fertilization," says Dr. Shepherd. The blastocyst—a tiny group of cells that will later become the fetus—embeds itself into the wall of the uterus. And that's when experts say you're technically pregnant.
Is Plan B going to be illegal?
As of right now, no states have banned Plan B or made it illegal. However, there have been talks among lawmakers who are considering putting stricter measures in place. It all comes down to how the law is interpreted and whether or not it can be expanded to include the pill or other forms of emergency contraception.
Thirteen states currently have trigger bans that can go into effect now that Roe is overturned. But these bans do not include emergency contraceptives or in vitro fertilization (IVF).
Brent Crane, the House State Affairs Committee Chairman, has said that he would hold hearing about banning emergency contraception due to reports of “complications” causing “health concerns for the mom,” according to the Idaho Statesman.
Meanwhile, Justice Clarence Thomas hinted that a woman's right to birth control (protected under Griswold v. Connecticut) could be under threat next. “In future cases, we should reconsider all of this Court’s substantive due process precedents, including Griswold, Lawrence, and Obergefell,"he wrote.
When should I take Plan B?
"Plan B should be taken by 3 days or 72 hours of unprotected sex," says Dr. Lincoln. "But it works better the sooner you take it."
How long is Plan B's shelf life?
Plan B has a shelf life of about four years if it's stored properly, per Plan B One Step. Regardless, it's always good practice to check the box for the expiration date before purchase.
What if I can't find Plan B?
If you can't get your hands on a Plan B, consider other options that could buy you more time and might be even more effective. For example, Ella, another form of emergency contraception, is especially helpful for women with a higher BMI. Ella is effective for people with a BMI of up to 35, instead of Plan B's 26, per Healthline. But it requires a prescription, so it might not be the best option if you're running short on time.
"Ella is better in that you have up to 5 days or 120 hours after unprotected sex to take it," says Dr. Lincoln. Ella may prevent pregnancy even before ovulation begins, adds Dr. Shepherd. You can also get a copper IUD inserted into your uterus as a form of emergency contraception, Dr. Shepherd says.
Here are some stats to help you weigh your options:
Ella: 97.9 to 99.1% effective (per Ella's website)
Copper IUD: < 99% effective (per Cleveland Clinic)
What are the side effects of Plan B compared to the abortion pill?
Some common but temporary side effects of taking Plan B include nausea, dizziness, fatigue, headaches, breast tenderness, bleeding between periods or heavier menstrual bleeding, and lower abdominal pain or cramps, per Mayo Clinic. But if you vomit within two hours after taking Plan B, consult with your doctor to see if you should take another dose.
The "side effects" are slightly different from the abortion pill. You can expect bleeding and cramping, which is normal to expel the pregnancy, according to Dr. Lincoln. You might also experience nausea, chills, and fever for a short period, per Planned Parenthood.
Does emergency contraception affect future fertility?
Emergency contraception does not impact your chances of getting pregnant in the future. "There is no risk to future fertility when using birth control long term or using ECP and data has substantiated this now repeatedly," explains Dr. Shepherd. There is also no evidence that taking emergency contraception raises your risk of breast cancer.
Plan B One-Step Emergency Contraceptive, 1.5 Mg (1 Tablet)
amazon.com
$46.87
COURTESYWhere can I buy Plan B?
Plan B can be purchased over-the-counter at your local drugstore or pharmacy.
But if you're looking to purchase Ella, you'll have to ask your doctor for a prescription. Still, both Ella and Plan B can be sent to you from mail-order birth control companies, says Dr. Lincoln. "It's best to have them on-hand before you need them, so there are no barriers to you taking them ASAP," she suggests.
Should I stockpile Plan B?
Now that Roe v. Wade has been overturned, many women wonder if they should be buying Plan B in bulk just in case they need it in the future.
"It's unnecessary to stock up in bulk like people did with toilet paper back in 2020. This will lead to lack of access when people need it most," cautions Dr. Lincoln. "Instead, get yourself one or two so you have them if you or a friend needs them. But don't go overboard."
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