The Difference Between The Morning After Pill and Abortion Pill

Out of the millions of pregnancies every year in the United States, around 46% are unintended. In an effort to reduce the number of unplanned pregnancies, we have access to various types of birth control—from oral contraceptives to condoms to IUDs to shots. Still, accidents happen, which is why we have emergency contraception (commonly known as “the morning after pill”) and, depending on which state you live in and how many weeks pregnant you are, the combination of the two medications, mifepristone and misoprostol (the two-step medication, commonly known as the “abortion pill”). While these medications are intended to address unintended pregnancy, the ways in which they do that are very different.

“There are, unfortunately, numerous misconceptions about emergency contraception and the abortion pill, when in fact, they are two distinct medications,” says Cordelia Nwankwo, MD, FACOG, an OB-GYN practicing in Washington D.C., and medical advisor for Julie, a brand of emergency contraception. “In light of recent attacks on reproductive rights both at the state and federal levels, it’s especially important for people to have access to medically accurate information that empowers them to make informed decisions about their sexual and reproductive health,” she adds.

With so many conflicting headlines and misinformation swirling around about reproductive health care right now, simply learning about your options can be daunting. To help simplify your research, we spoke with Dr. Nwankwo and Lauren Demosthenes, MD, an OB-GYN and senior medical director with Babyscripts, to help us deliver the “must knows” about the morning after pill and the abortion pill.

What Is the Difference Between the Morning After Pill and the Abortion Pill?

Dr. Demosthenes puts it very simply: abortion pills end a pregnancy, morning after pills prevent a pregnancy from occurring. Period. They are different medications that do completely different things in the body.

Dr. Nwankwo further explains, “Emergency contraception prevents pregnancy before it occurs by preventing or delaying ovulation … emergency contraception is used after unprotected penetrative vaginal sex. It is FDA-approved and legal in all 50 U.S. states.”

The morning after pill isn’t actually a brand of emergency contraception but rather a catchall for the various brands that are available. In addition to Julie, the brand Dr. Nwankwo works with, other options include Plan B One-Step, Take Action, My Way, Option 2, Preventeza, AfterPill, My Choice, Aftera, and EContra, according to Planned Parenthood. All of these options use levonorgestrel, a synthetic progestin.

Another emergency contraceptive brand is called ella, and while it still comes in the form of a pill, it uses ulipristal acetate rather than levonorgestrel, which has a longer window of effectiveness. Though not considered a morning after pill, there are also certain IUDs that can act as emergency contraception as long as they are put in within five days of unprotected sex.

“The abortion pill, or medication abortion, is used to end a pregnancy,” says Dr. Nwankwo. “Medication abortion can be a two-drug regimen of mifepristone and misoprostol or a one-drug regimen of only misoprostol.”

Mifepristone blocks progesterone, the hormone that is needed for pregnancy to progress. According to Planned Parenthood, misoprostol “causes cramping and bleeding that empties your uterus,” which results in “pregnancy tissue [coming] out through your vagina—it’s like having an early miscarriage or a really heavy period.” In 2020, 53% of all abortions in the United States were medication abortions.

Medication abortions using both mifepristone and misoprostol are effective between 87-99% of the time, and misoprostol-only abortions are effective between 85-95% of the time. Ideally, a medication abortion uses both drugs, but with the current legal attacks on the FDA for its approval of mifepristone (all the way back in 2000), it’s comforting to know that if the pill is no longer available, medical professionals are prepared to continue to provide patients with medication abortions using just misoprostol.

Does the Morning After Pill Cause a Miscarriage or Abortion?

Even for those not in a position to take on the responsibilities of an unintended pregnancy, there may be hesitation to take emergency contraception after failed birth control due to the fear that the morning after pill will trigger a miscarriage or an abortion. If this is your concern, then we have some reassuring news for you.

“The morning after pill does not cause a miscarriage or abortion,” emphasizes Dr. Demosthenes, “[emergency contraceptions work] by preventing ovulation, and they only work if you are not already pregnant.”

Everyone should have the freedom to choose what’s best for them when it comes to reproductive health—that’s what being pro-choice means. It’s perfectly reasonable if termination isn’t the right option for you, but understand that emergency contraception is intended to prevent unintended pregnancy so that you aren’t faced with having to make a choice at all.

When Should You Take These Medications?

Dr. Nwankwo and Dr. Demosthenes stress the importance of timing when it comes to the morning after pill and the abortion pill. In both cases, you have a short window of time in order for the medications to be effective.

“Emergency contraception is most effective when taken as soon as possible after unprotected sex,” says Dr. Nwankwo. “Emergency contraception [that uses levonorgestrel], like Julie, can be taken within a 72-hour window.” The other morning after pill, ella, can be taken within 120 hours (five days) after unprotected sex but is also most effective when taken as soon as possible.

Medication abortions can be effective up to 77 days (11 weeks) after the first day of your last period, which is important given the bans and restrictive laws states are passing across the country. If you’re taking both mifepristone and misoprostol, the process may take a couple of days, depending on how your provider instructs you to take the medication. According to Dr. Demosthenes, patients first take mifepristone, then take misoprostol one to two days later (though some providers may have you take both at once). You can expect to experience bleeding between one to four hours after taking the misoprostol.

Do You Need a Prescription for the Morning After Pill or the Abortion Pill?

Both abortion pills require a prescription, as they should only be taken under the care of a health care provider. Morning after pills that use levonorgestrel can be purchased over the counter at pharmacies, big-box retailers (like Target and Walmart), and through several online platforms. The other morning after pill, ella, requires a prescription (which you can get in person or through some online platforms). There are no age restrictions for morning after pills or abortion pills.

What Are the Most Important Things To Know About The Morning After Pill and the Abortion Pill?

When asked what they believe are the most important things to know about emergency contraception and medication abortions, Dr. Nwankwo and Dr. Demosthenes said:

• Both pills are very safe; “long-term harm from the morning after or abortion pill is less than pregnancy itself … [patients] may have some nausea and cramps as short-term side effects,” says Dr. Demosthenes.
• The morning after pill is a great choice, but it must be taken as soon as possible.
• You can take emergency contraception if you’ve been drinking without decreasing its efficacy.
• The only known antibiotic that may reduce the morning after pill’s efficacy is rifampin, which is primarily used to treat tuberculosis.
• There is no harm in taking the morning after pill on more than one occasion, and it doesn’t change its efficacy.
• Some studies have shown decreased effectiveness of the morning after pill in people who have a BMI over 25; we do know that effectiveness decreases as BMI increases, but the morning after pill can still be safe and effective regardless of your BMI. (Note: Planned Parenthood’s guidelines say that if you weigh over 165 lbs., levonorgestrel morning after pills may not work as well, and if you weigh over 195 lbs., ella may not work as well.)

Both of these medications are essential to reproductive health in the United States, and given the recent attacks on bodily autonomy since the overturning of Roe v. Wade last year, it’s more important than ever that we understand what these medications do and don’t do. Equipped with factual information, you will be better able to make informed decisions for yourself and help educate the people around you who may misunderstand how these medications work.