What happened to the abortion pill revolution we were promised?

On September 28, 2000, the FDA approved mifepristone. The New York Times headline the next day predicted mife “could reshape debate” around abortion in the US. Fifteen years later, I’ve yet to find even a feminist friend of mine who has heard of it. What happened to the revolution we were promised?

Mifepristone has never had an easy time. Its FDA approval process was grueling, and took 54 months compared to the average of 15.6. When it was finally approved, it was slapped with a set of regulations reserved for only the most “risky” drugs, when there was no evidence to support that classification. After a rigorous approval process, plus the last fifteen years’ worth of experience and research, we now know that mifepristone is extremely safe – much safer than actually having a baby. Given this proven lack of risk, why does mifepristone have these unique regulations – barriers that make mifepristone virtually impossible to access for some women? Why is it that physicians, let alone potential users, know so little about this option?

The medical abortion process works in two steps: first, the patient takes a mifepristone pill to end the pregnancy, then 24-48 hours later takes misoprostol tablets to expel the tissue. This process, if unrestricted, has transformative potential because it is demedicalized compared to more invasive types of abortion – a pregnant person could take one pill, then the other, and never actually need to be physically in a physician’s care. Because of this, many more women could access abortion than with only an in-clinic option. The pills could be taken at home, at a time that is convenient. There would be no need for travel or hotels, or for arranging child or eldercare. These elements allow a greater number of women to access abortion, even if they can’t access a clinic. This could be a powerful tool to expand access to those who have historically been denied abortion care, including poor women, rural women, young women, women of color. Perhaps even more revolutionary, however, mifepristone medical abortion allows all women to administer, plan and handle their abortion themselves. Mifepristone allows a woman even greater control of her own body – which is why it’s not surprise that access to mifepristone is fought so furiously.

The restrictions on medical abortion directly reflect how society feels about women. The restrictions specific to medical abortion enhance the paternalistic sentiment even more than the typical anti-abortion rhetoric that proposes a women loses all right to her body when pregnant. Medical abortion is completely at odds with conservative philosophy because it’s private, autonomous, and convenient. Given the restrictions anti-abortion politicians have enacted, it appears that if abortion’s going to be legal, it should be as intimidating, arduous, shameful, invasive and expensive as possible. These specific restrictions give us a glimpse at a much larger conservative, anti-woman ideology.

There are laws requiring women take the pill in the clinic – instead of safely in their homes at a convenient time – which illustrate a belief that women cannot be trusted to take safe, easy-to-administer medication. Laws requiring a physician to hand this pill to patients and watch them swallow it strips the autonomy and decision-making power patients feasibly and safely could have had. The convenience, comfort, and privacy of taking the pill at home is apparently considered an undeserved luxury, not a healthcare-related right. This seems to fit with conservative sentiment that pregnancy is a consequence of women’s moral failings and abortion, even more so.

Laws in several states forcing women to take three times the dose needed of mifepristone, risking greater side effects and guaranteeing higher costs, unnecessarily imposes additional stress on women’s bodies. These laws seem to say that we should be made to suffer, to pay, for our immorality.

Politicians have enacted laws that require physicians to perform an ultrasound – an extra visit and an extra cost – to date the pregnancy, when data tells us that women are extremely capable of doing so themselves based on their own menstrual history. Again this illustrates that women should be considered untrustworthy and incapable.

Conservatives have passed laws specifically barring the use of telemedicine for abortion – when it’s safely used for countless other prescriptions – and laws that require physicians to provide maliciously incorrect information about the capability to reverse a medical abortion despite any actually scientific evidence supporting that information, when the existence of valid scientific evidence is our standard for all other healthcare. These laws specifically and intentionally reducing the quality of care illustrates the sentiment that women deserve only subpar health care. These laws tell us that it is not unethical to use women’s lives and bodily integrity to prove political points. It reminds us again that women’s bodies are often not their own.

The approval of mifepristone fifteen years ago, along with the potential for a private, autonomous, empowering abortion, was a tremendous step forward for US women. Unfortunately, those against female autonomy have recognized mifepristone for the revolutionary force that it is, and have thrown themselves into restricting, demonizing and misrepresenting it. Let’s take this opportunity – mifepristone’s fifteenth anniversary – to celebrate the safety, efficacy and revolutionary empowerment afforded by mifepristone. On mifepristone’s fifteenth birthday, let’s renew our commitment to fighting for access for all women.

I recognize that women are not the only people who need access to mifepristone for abortion, but I am writing about the intersection between social attitudes towards women, specifically, and restricted access to mifepristone. Because of this, I speak specifically about women and not all people who can become pregnant.