Emergency contraception doesn’t work like that! Warning: Some spoilers ahead!
"Maybe in this dystopian future, EC will be something else. But currently, EC is not something that can induce an abortion," Dr. Daniel Grossman, professor of obstetrics and gynecology at the University of California, San Francisco, tells BuzzFeed Health. "It has no effect if you take it once the pregnancy is already established."
EC pills, Plan B One-Step and Ella, are meant to be taken immediately following unprotected sex (for Plan B, no more than 72 hours afterward). They work by delaying ovulation, which prevents the sperm and egg from meeting. "The woman won't get pregnant because the sperm won't hang around for that long," says Grossman.
EC pills are only one medicine — either levonorgestrel or ulipristal acetate. Earlier forms of emergency contraception were in fact regular birth control pills, but at higher doses. (One thing Black Mirror does get right? Emergency contraception can cause nausea, although vomiting is less likely than in the past.) The abortion pill, on the other hand, is actually two medicines (mifepristone and misoprostol) that are taken in a sequence, 24 to 48 hours apart, Grossman says.
The "abortion pill" also works differently. Mifepristone works to block progesterone activity, which the body needs to continue pregnancy, and misoprostol works to actually terminate the pregnancy by emptying the uterus — causing cramps, bleeding, and nausea.
It's also worth noting that you can get EC pills from most pharmacies, either over-the-counter or with a doctor's prescription, but you CAN'T get the abortion pill as easily. "A doctor can't even write a prescription for medication abortion so that it can be dispensed at a pharmacy," Grossman says, noting that you'd have to go see a doctor for an abortion.
Actually, conflating the two drugs is just one of the tropes about abortion that end up on TV all the time, Gretchen Sisson, tells BuzzFeed Health. Sisson is a research sociologist who's looked into the portrayal of abortion on TV for UCSF's research group, ANSIRH. Another common plot device — one that's appeared in Law & Order and Veronica Mars — is the "coercive or secretive application of abortion medication," she says, noting that these plotlines usually involve parents or partners. "So Black Mirror kind of had a little bit of both of those elements."
By using incorrect information, Grossman says the entertainment industry misses an opportunity to set the record straight when it comes to emergency contraception. "I think for this particular idea that EC causes abortion, a lot of people believe that to be true because they don't understand the mechanics of how the medications work differently and the impact they have," Sisson adds. She also noted that the storytellers could have diverged from contemporary medical and technological constraints altogether, and reimagined abortion as something completely different in the way it's administered.
As we mentioned above, there are two totally different ways to get the EC pill and the abortion pill, and and it should be that way, Sisson says. "When you confuse them enough in the public understanding, people might not understand why EC can be safely available over-the-counter," she says. "If they think that it's causing abortion, then they will rightly think that it should have more control — or gatekeepers who control access to it — when they can actually safely administer it themselves." In other words, all the confusion can impact how people think it should be regulated, how it should be accessed, how it can be safely used, and who can make that choice, she says.
"There's so much information out there from the anti-abortion movement saying that EC causes abortions when it doesn't," Sisson says. "So that's not just a question of medical understanding, it's also a political talking point, and it's inaccurate."