Medication Abortion Is Key to the Future of Abortion Access

Regardless of income, ZIP code, or status, you should be able to decide what kind of care fits your needs without fear, shame, and unnecessary restrictions.

[Photo: Orange boxes of Mifeprex (mifepristone) lie on top of one another on a table.]
With pills from reliable sources, accurate information, and back-up care in the rare circumstances it's needed, people can self-manage abortions—empowering individuals to make autonomous choices about their own reproductive health. Robin Marty/Flickr

In 2019, abortion opponents doubled down on their efforts to restrict access to abortion care. Lawmakers in 17 states enacted more than 50 arbitrary restrictions that closed reproductive health clinics, jeopardized patient care, and made abortion less accessible.

Across the country, the anti-abortion movement continues to shame, pressure, and punish people who understand that abortion is a human right.

At this moment, it’s difficult to believe that the government or the courts will protect our freedom to obtain an abortion. In this political climate, and recently at the request of over 200 lawmakers, it’s easy to imagine a future without the federal protections that Roe v. Wade guarantees.

The future of abortion won’t look like it did before that seminal decision. That’s because, contrary to the prominent coat-hanger imagery associated with self-managed abortion, safe and effective options for ending a pregnancy now exist, including self-managed abortion with pills.

For nearly two decades, nearly 3 million people have ended their pregnancy with medication abortion. Self-managing an abortion consists of two sets of pills to be taken at or under ten weeks after the first day of a person’s last period: The first, mifepristone, blocks the hormone essential to advancing pregnancy. In the following 24 to 48 hours, the person takes the second medication, misoprostol, to empty the uterus.

This method has proven to be extremely safe. In an analysis by Advancing New Standards in Reproductive Health, there was just a 0.3 percent risk of major complications for medication abortions.

Since its inception, however, the method has been met with protest and seen outdated and medically unnecessary restrictions based on politics, not science. These laws prevent health-care providers from prescribing medication abortion like any other prescription drug, which the patient can fill at a local pharmacy.

Research demonstrates that with pills from reliable sources, accurate information, and backup care in the rare circumstances it is needed, pregnant people can self-manage their abortion—empowering individuals to make autonomous choices about their own reproductive health and increasing access to safe, effective abortion care options that fit their personal circumstances.

That’s why advocates like us are talking to communities, in-person and online, about the potential of self-managed medication abortion. Medication abortion does not need to be a backup plan when restrictive abortion policies result in clinic closures or raised costs. It can and should be an option for whatever reason for anyone who wants it—whether they can’t get to a clinic or simply want more privacy or need the flexibility to balance work and childcare.

People seeking reproductive care will always need clinic access, and every person should have the option of going to a clinic if they choose. However, as of 2017, the most recent year data is available, 60 percent of early abortions in clinical settings were with pills, a 25 percent increase from 2014. But current policies on medication abortion make this reliable, safe care extremely hard to access. There are laws in place that have the potential to deter physicians and patients from requesting and offering medication abortion as an option. According to the Guttmacher Institute, 34 states require that only a physician can perform a medication abortion, and 18 states require the provider to be in the same room with the patient when they offer the medication abortion pill, which effectively bans telemedicine abortion.

Meanwhile, many other medications that carry greater risks are available over the counter.

We created videos to raise awareness of self-managed abortion, the opportunities it presents, and the obstacles to access. One video, titled “Times Have Changed,” demonstrates why we need to take another look at our misperceptions of self-managed abortion because of its strong safety record. “Home” speaks to the reality that we want control over our personal health-care decisions, and a medication abortion can give us that option to make the most personal decision in our own space. And “An Abortion on 16th Street” and “Abortion on Ocean Drive” force us to question the common misconceptions of abortion as a complex procedure and show that each person can take control. These videos recognize the progress of the past five decades and demonstrate the medical possibilities of today and tomorrow.

The biggest risk to people who self-manage their abortions using medication abortion is not a threat to their health or safety from the abortion itself, but the threat of prosecution as a result of over-policing in communities, systemic racism, and outdated laws. Whether the laws potentially criminalizing self-managed abortion are decades old—in 2019, Nevada decriminalized self-managed abortion and New York codified Roe v. Wade into state law, or recently introduced like the laws in Georgia and Alabama, criminalization continues to be a threat. Indeed, since 1973, at least 21 people in the United States have been arrested, investigated, and jailed for ending their own pregnancies. Instead of prosecuting people and providers, our communities should be ensuring that anyone who needs or wants to, can end their pregnancy safely, effectively, with dignity and respect.

Although our home states of Florida and Colorado vary greatly, threats to abortion care continue to grow within and along the borders of both. We both know education is key: Sharing information about what is and what should be available is the key to advocate for a world where everyone, regardless of where they live, can access an abortion on their own terms.

It’s time to make our voices heard and center communities that are disproportionately impacted by barriers to abortion access. We must pressure the U.S. Food and Drug Administration to get rid of the medically unnecessary regulations that make it hard for people to access medication abortion pills. And we must hold our lawmakers accountable and demand they repeal laws that could be used to criminalize people who self-manage their abortions.

Everyone, regardless of income, zip code, and status, should be able to decide what kind of care best fits their needs without fear, shame, and unnecessary restrictions. Times are changing. With the potential of the upcoming U.S. Supreme Court case, June Medical Services v. Gee, to put abortion further out of reach for Americans, it is time to realize the potential of medication abortion to transform the future of abortion care and empower anyone who chooses this option to end their pregnancy safely, effectively, privately—on their own terms.