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Access Denied

The Medication Abortion Revolution Is Here

SCOTUS is poised to gut Roe v. Wade this year, making abortion illegal in more than half the country. But expanded access to abortion pills may be one way to save pregnant people's lives.

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Inside the Supreme Court on December 1, 2021, the die appeared to be cast for abortion rights. During oral arguments for Dobbs v. Jackson Women’s Health Organization, the Court’s conservatives made clear what abortion-rights supporters have long known: They intend to gut Roe v. Wade and they intend to do it now. By the end of 2022, abortion could very well be illegal in more than half the states in the country

Outside the Court, however, we saw a very different scene unfold when a handful of activists with the group Shout Your Abortion gathered together, dressed all in black. Bullhorn in hand and banner unfurled, this wasn’t a funeral procession for abortion. It was a coming out party. 

“Abortion. Pills. Forever!” they chanted. Finally, in coordinated motion, four of the activists popped a pill—mifepristone—and washed it down with water. They had taken the abortion pill, right in front of the Supreme Court. None of them was pregnant, but nonetheless, it was a defiant display of the power and promise of medication abortion.

“These pills are about to make abortion potentially more accessible than it’s ever been early in pregnancy,” said Amelia Bonow, co-founder of Shout Your Abortion. “We’re here to stand in this spot, in front of this Court, and take some mifepristone because this Court will never stop us from having abortions, and having safe abortions.”

Medication abortion, often called “the abortion pill,” isn’t new. Mifepristone was approved by the FDA for pregnancy termination in 2000. Today, it’s typically combined with misoprostol and is a safe and effective way to end a pregnancy up to ten weeks. Until recently, patients have been required to go to a clinic in order to access medication abortion, an onerous requirement that made access harder for the 90 percent of U.S. counties without an abortion provider. Just last month, the FDA announced that it will permanently allow abortion pills by mail, access to this safe medication will likely improve. Now, upon receiving a prescription from an abortion provider, pregnant people can safely and privately terminate a pregnancy at home. 

Before Roe, it was exceptionally difficult to have a safe abortion. Abortion was criminalized in every state until 1967, and by the time Roe was decided, it was only legally available in a handful of states. Having a safe abortion required the ability to travel to states like New York or Hawaii, or, quite simply, luck. Groups like “the Jane Collective” and other underground cohorts facilitated safe, illegal abortions in cities like Chicago and Los Angeles, but they couldn’t serve everyone. People still needed abortions, and they were often willing to risk their lives to have one, even if it meant taking matters into their own hands with whatever they could find that might induce an abortion, possibly using a wire coat hanger or whatever chemicals they could find. Once abortion became legal nationwide, it became safe, commonplace, and easy to provide. Now, not only is having an abortion is 14 times safer than childbirth, but medication abortion exists. A procedure isn’t even required to have an abortion early in pregnancy anymore.

Self-managing an abortion with pills is actually very safe; so safe, in fact, that the World Health Organization lauds it as “empowering for individuals” and provides guidance on how to do it. In countries where abortion is heavily restricted or even banned, self-managed abortion through pills may be patients’ only means of safely accessing abortion care at all. Now that the Supreme Court seems determined to dismantle Roe and federal protections for abortion rights, huge swaths of the U.S. may soon function in much the same way. 

But just how do you get medication abortion delivered to your home? The FDA certainly made it easier to access medication abortion through the mail, but that only applies to states where telehealth abortion provision is legal. Some states, like Texas, have already banned telehealth for abortions. If you live in one of those states, the FDA’s new policy doesn’t help you. Then what?

There are other ways to procure medication abortion than through a nearby clinic; simply type in ShareSafeAbortion.info into your browser and you are presented with a variety of options. Dr. Rebecca Gomperts, who became renowned for sailing her boat to countries where abortion was illegal and providing safe abortions to patients past the maritime border, has a new, U.S.-focused venture called Women on Web, which will ship medication abortion and guidance on how to safely self-manage an abortion directly to your home, no questions asked. Plan C also offers information on how to access medication abortion so that folks can safely self-manage an abortion at home, as well.

That doesn’t mean self-managed abortion with pills is without risk. While it’s safe medically, it can be more risky legally, particularly for women of color who have already been criminalized for their pregnancy outcomes, some for searching online for medication abortion or even discussing it with a friend. Abortion has been legal nationwide for nearly 50 years and women of color have still been charged and prosecuted for having a miscarriage or stillbirth, let alone self-managing an abortion. The end of Roe will likely lead to more policing and criminalization for already-marginalized communities. 

That’s why what Amelia Bonow and her Shout Your Abortion compatriots did is so powerful. The more people with privilege purchase medication abortion online, the harder it will be to track and target the more marginalized among us. Even if you’re not currently pregnant, it’s still good to have access to medication abortion (Women on Web provides medication abortion for folks who aren’t currently pregnant, as well as those who are). Medication abortion can be a revolution if we make it one, and that requires all of us, particularly those with the most privilege, being willing to step up and support that effort.

“​​Self-managed abortion with pills has the potential to undermine the long-term solvency of the antiabortion movement in a way few things can, because they simply can’t stop it,” said Erin Matson, Executive Director of Reproaction. “They’ve been promising for so long that they can abolish abortion, and make it illegal and go away. They can’t put the pills back in the bottle.”

Technically, the Supreme Court can erode our rights and send us whirling back in time by more than half a century. But as much as the Court may wish it to be, 2022 isn’t 1973. Then, activists found a way to support safe, underground abortion. Now, we will do the same. The self-managed-abortion-through-pills revolution is coming. All you have to do is open your mailbox.

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