Confusion Over Morning-After Pill's Legality Persists Amid Abortion Restrictions

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The morning-after pill is legal throughout the United States, including in states with the most restrictive abortion laws. However, many Americans are unaware of this, often due to confusion stemming from the belief that the pill is a form of abortion medication.

A 2023 survey by the health policy nonprofit KFF revealed that nearly one-third of American adults are uncertain about the legality of emergency contraception in their state, with 5% wrongly thinking it is illegal. A separate survey by emergency contraception provider Cadence OTC, shared with The Hill, found even greater confusion. Just 40% of participants correctly knew that the morning-after pill is legal nationwide.

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This misunderstanding is largely driven by the misconception that the morning-after pill is the same as the abortion pill. According to Samantha Miller, co-founder of Cadence OTC, many people mistakenly believe that the pill ends early pregnancies and thus think it is banned in abortion-restricted states. She emphasized that many do not fully understand the pill’s active ingredient and how it works.

The over-the-counter morning-after pill contains levonorgestrel, a hormone that prevents ovulation. Most effective when taken within three days of unprotected sex, it can delay ovulation for up to five days, the amount of time sperm can survive in the body. This mechanism prevents pregnancy from occurring, rather than terminating an existing one like abortion medications do.

The over-the-counter morning-after pill, such as Plan B One-Step, can be purchased without an ID or age restriction, according to a representative from its manufacturer, Foundation Consumer Healthcare.

Another type of emergency contraception, Ella, also known as the morning-after pill, requires a prescription. Like levonorgestrel, Ella prevents pregnancy by delaying ovulation, but its active ingredient is ulipristal acetate. Ella can be effective up to five days after unprotected sex.

Both types of morning-after pills are most effective when taken as soon as possible after unprotected sex. Once ovulation has occurred, the pill is no longer effective in preventing pregnancy. Experts like Clayton Alfonso, an assistant professor of obstetrics and gynecology at Duke University, stress that neither the over-the-counter pill nor Ella can harm an existing pregnancy.

Jayme Trevino of the American College of Obstetricians and Gynecologists also clarified that emergency contraception does not cause an abortion. “It is only effective in preventing pregnancy,” Trevino stated, noting that abortion medication, such as mifepristone and misoprostol, is used to terminate an existing pregnancy. These drugs are not available over-the-counter and must be administered at a health clinic or via telehealth.

Since the Supreme Court overturned Roe v. Wade in 2022, medication abortions have been banned or restricted in several states, while the morning-after pill remains legal. Despite this, many Americans fail to recognize the distinction between the two, contributing to confusion about the legality of emergency contraception.

A recent survey by Foundation Consumer Healthcare found that half of women aged 18-44 believed the morning-after pill worked like the abortion pill or were unsure how it works. This confusion has persisted for years and has only intensified after the Roe v. Wade ruling.

Ashley Kirzinger, a polling expert at KFF, noted that after the ruling, many Americans became more focused on medication abortion and its legality. However, misconceptions about the “abortion pill” and the morning-after pill being the same have likely led some to assume that the latter is also restricted in some states. “People conflate the two,” Kirzinger explained. “They think that if medication abortion isn’t available, the morning-after pill must not be either.”