Today is the 15th anniversary of the abortion pill’s approval in the US

Today marks the 15th anniversary of when the FDA approved mifepristone — aka RU-486, aka “the abortion pill” — for use in the United States. But anti-choice restrictions have prevented us from realizing its full potential. 

A medication abortion — which actually usually involves two drugs, mifepristone followed by misoprostol — essentially induces a miscarriage and is very safe and effective up until about nine weeks of pregnancy. More than 2 million patients in the US have used the method since 2000, and today, about a quarter of those ending an early pregnancy choose the abortion pill over a surgical abortion. Many appreciate the convience and privacy of being able to end their pregnancy in their own home, having a greater sense of control over the process, and not having to undergo a surgical procedure.

When it comes to ensuring access to abortion for all those who need it, the abortion pill is a potential game-changer too. You don’t need to be a physician to safely prescribe the pills and instruct the patient on how to take them — nurses, midwives, and other providers could just as easily do it. In fact, you don’t need to physically be in the room with a patient at all. Telemedicine abortion programs in Iowa and Minnesota have allowed women in rural areas far from clinics that offer surgical abortion to get safe medication abortions remotely, thereby avoiding a long drive and a costly overnight stay.

But, of course, the anti-choice movement has been quick to recognize that the abortion pill has the potentional to seriously undermine their efforts at chipping away at access. They’ve worked hard to ensure that medication abortions are restricted by just as many unnessary regulations as surgical abortions are — and in many states, they’ve succeeded. In 38 states, only doctors can provide the abortion pill. In 18 states, the doctor must be present in the room with the patient so telemedicine is not an option. In three states, doctors are forced to use an out-dated protocol that is less effective, more expensive, and causes more side effects. In another three, clinics that offer only medication abortions must nonetheless meet the standards of ambulatory surgical centers. As Chloe Murtagh explores in a post on the Community site, the laws restricting the abortion pill reflect the anti-choice movement’s views toward women and dedication to making abortion “as intimidating, arduous, shameful, invasive, and expensive as possible.”

Such medically unnessary, politically motivated restrictions are, of course, par for the course when it comes to abortion in the US. But it’s worth remembering, now and then, what it would be like if the regulation of abortion was based solely on science, patient safety, and public health — not politics. The discovery of mifepristone was an incredible advance in medicine technology — offering a way to safely and effectively have an abortion by taking a pill, instead of undergoing an invasive surgical procedure. In theory, it should have made ending an unwanted pregnacy as easy as seeing any health care provider, asking them to write you a prescription for the two drugs, picking them up from the pharmacy, taking the pills according to the instructions, and following up if you have any problems. (Or alternately, having a telephone consulation with a provider and having the pills mailed to you, which is now an option in Australia.)

The fact that the approval of mifepristone 15 years ago has not had that effect just goes to show how thoroughly the regulation of abortion has become excluded from the realm of evidence-based medicine, governed largely by anti-choice laws whose sole purpose is to reduce access to the procedure.