What to Expect When You Stop Expecting: Demystifying Miscarriage and Medication Abortion 

Anti-abortion zealots have sought to criminalize miscarriage and charge women for “endangering” their pregnancies. Here’s what you need to know.

In response to the confirmation of two hard-right Supreme Court justices and an increasingly hostile judiciary that threatens women’s access to clinic-based abortion, the National Women’s Health Network (NWHN) has been working hard to demystify medication abortion for the public and push back against medically unnecessary restrictions imposed by states and the Food and Drug Administration (FDA).

We want everyone to know that medication abortion (abortion induced by taking FDA-approved pills) is physiologically indistinguishable from a miscarriage that occurs on its own. While everyone will feel differently about their experience, there is no right or wrong way to feel. The physical process, symptoms, risks, warning signs, complications, and treatments are the same. Additionally, abortion pills are often used to help treat incomplete miscarriages. 

Knowledge really is power, and knowing that medication abortion and spontaneous miscarriage are the same physical process is key to combating anti-abortion fear-mongering and correctly placing medication abortion in the context of normal human reproduction. It also allows women to seek medical care as needed in states or hospitals hostile to abortion rights without revealing to medical staff whether their miscarriage was induced or spontaneous. It makes clear that attempts to criminalize abortion will also criminalize miscarriage, forcing women to prove to potentially hostile law enforcement entities that they didn’t do anything to ‘endanger’ their pregnancies.

The NWHN works to demystify medication abortion and place it in the context of a very normal part of human reproduction. However, it has become clear that we need to demystify miscarriage itself.

Earlier this winter, CNN Business ran an article titled, “Miscarriages are common. But at work, a culture of silence keeps women quiet.” In the piece, a woman recalls: “[W]hat’s so crazy is through having my miscarriage, I found out how many people I knew had miscarriages. And I’m like, ‘I wish you would have told me.'” 

CNN identified fear of discrimination in the workplace as one reason women may be reluctant to speak openly about their pregnancies, highlighting research that shows women pay a “motherhood” penalty in lost income and status as soon as they’re seen being on the “mommy track.” But the anti-abortion movement has also played a key role, aggressively working to confuse women about the science of miscarriage and to punish them when one occurs.

Fake women’s health clinics (sometimes referred to as “crisis pregnancy centers” or “pregnancy resource centers”) have been known to significantly exaggerate the likelihood of miscarriage to dissuade pregnant people from seeking desired abortions.

Anti-choice zealots have also used a combination of decades-old laws and radical new “personhood” measures to criminalize miscarriage and charge women for “endangering” their pregnancies. In overturning one woman’s manslaughter conviction, the New York Court of Appeals cautioned in 2015 that, under the prosecutors’ approach, “one could find it ‘reckless’ for a pregnant woman to disregard her obstetrician’s specific orders concerning bed rest; take prescription and/or illicit drugs; shovel a walkway; engage in a contact sport; carry groceries; or disregard dietary restrictions.”

The stigma surrounding miscarriage leads women to blame themselves for the situation and question what they could have done differently. Health historian Shannon Withycombe stated in an interview with The Cut that “[o]nce you miscarry, especially if you haven’t heard the statistics about how common it is, it’s easy to think it’s your fault, or that you did something wrong.” This misunderstanding only encourages more women to stay silent about their miscarriage experiences.

Here’s what you should know:

• A medication abortion is an abortion that is induced by FDA-approved abortion pills-most often a combination of mifepristone (brand name Mifeprex) and misoprostol (brand name Cytotec, among others)-usually within the first ten weeks of pregnancy.
• A miscarriage (or “spontaneous abortion”) occurs when an early pregnancy (less than 20 weeks of gestation) ends on its own. The American College of Obstetricians and Gynecologists estimates that 10 percent or more of known pregnancies end in miscarriage.
• Miscarriages are almost never directly related to the actions of the pregnant person. Rather, they are often the result of chromosomal abnormalities that naturally occur during early embryonic development.
• And whether an early pregnancy ends spontaneously or as a result of intervention with pills doesn’t impact someone’s ability to become pregnant again. Having one miscarriage does not change the likelihood that a person will be able to get pregnant again if she wants to, and there is no evidence that an abortion impacts future fertility.

To combat bad and confusing information and to encourage women to talk more openly about their experiences, we created a FACT SHEET explaining medication abortion and miscarriage, outlining what to expect when experiencing either and what to watch out for.

Sarah Christopherson, MA, is the Legislative Director for the social justice campaign, Americans for Tax Fairness, and the NWHN’s former Policy Advocacy Director. Her 10 years working for Congress and her deep knowledge of health policy and consumer protection make her the NWHN’s issue area expert on federal health reform implementation and defense, drug and device safety and efficacy, and sexual and reproductive health.