The morning-after pill is legal across the U.S., even in the states with the strictest abortion bans — but many Americans don’t know that, in part due to a mistaken belief that the pill is abortion medication.
Nearly a third of American adults are unsure if emergency contraception like the morning-after pill is legal in their state and 5 percent think it is illegal there, according to a 2023 survey from health policy nonprofit KFF.
A recent survey conducted by emergency contraception company Cadence OTC, whose results were shared with The Hill, found even more widespread confusion about the pill’s legality: Just 40 percent of participants knew that emergency contraception in the form of the morning-after pill is legal in all 50 states.
“It’s primarily a result of some people conflating the morning-after pill with the abortion pill, believing that the morning-after pill will end an early pregnancy and therefore is illegal in states with abortion bans,” Cadence OTC co-Founder Samantha Miller wrote to The Hill. “Many people do not understand the morning-after pill’s active ingredient and mechanism of action.”
The over-the-counter form of the morning-after pill is one dose of levonorgestrel — a hormone that is used to delay ovulation. The pill is most effective if taken within three days of unprotected sex but can delay ovulation for up to five days, the length of time sperm can survive in the vagina or uterus.
Delaying ovulation in this way can prevent an unwanted pregnancy from beginning, rather than terminating a pregnancy like abortion medication does.
People do not need an ID or to be of a certain age to purchase over-the-counter forms of the morning-after pill like Plan B One-Step, according to a spokesperson for Foundation Consumer Healthcare, the makers of Plan B One-Step.
There is another medication, called Ella, that is also referred to as the morning-after pill, but people need a prescription to access it. Ella also comes in the form of a single pill and works to prevent unwanted pregnancy by delaying ovulation, but the active ingredient is ulipristal acetate.
Ella can be taken up to five days after unprotected sex and still be effective at preventing pregnancy.
People need to take the morning-after pill as soon as they are able, however, because once ovulation has occurred, the medication does not provide any protection against an unwanted pregnancy, according to Clayton Alfonso, assistant professor of obstetrics and gynecology at the Duke University Health System.
Neither the over-the-counter form of the medication nor Ella will harm an existing pregnancy, according to Jayme Trevino, the Darney-Landy Fellow at the American College of Obstetricians and Gynecologists.
“Emergency contraception does not cause an abortion because it does not affect an already established pregnancy,” Trevino said. “Emergency contraception is only effective to prevent pregnancy.”
Abortion medication, in contrast, is used to terminate an existing pregnancy. Medication abortions are typically a two-step process involving the drugs mifepristone — sold under the brand name Mifeprex — and misoprostol, with the first being used to stop an embryo from growing and the second to empty the uterus. However, people can undergo a medication abortion just by using misoprostol as well, according to Planned Parenthood.
Neither mifepristone nor misoprostol is available over the counter and they both must be administered in a health clinic or via a telehealth service.
Medication abortion has also been banned or restricted in a number of states since the Supreme Court overturned Roe v. Wade in 2022, while the morning-after pill remains legal around the country.
A significant portion of Americans don’t understand the difference between the two or know the morning-after pill is not impacted by abortion bans, however, drawing emergency conception into the uncertainty surrounding the U.S.’s changing abortion landscape.
The company behind Plan B One-Step, Foundation Consumer Healthcare, decided this summer to check in on just how many Americans were confused about the two.
The online survey found that half of women between the ages of 18 and 44 believed that the drug works the same way as the abortion pill or did not understand how it works at all, according to the Foundation Consumer Healthcare spokesperson.
Confusion over the mechanics of the morning-after pill has existed for years and only added to further confusion about its legality after the overturning of Roe v. Wade, according to Ashley Kirzinger, a polling expert at KFF.
After the ruling, many Americans became interested in learning about medication abortion and whether it was legal in their state. However, existing misconceptions that the “abortion pill” and the morning-after pill are the same thing could have led some to mistakenly believe the latter is illegal in some parts of the country, she said.
“What you’re getting is people conflating the two,” Kirzinger said. “They think, ‘Oh, if medication abortion isn’t available to me in my state and that’s the same thing as the morning-after pill, and so that must also not be available.’”
