Now nearly two years into the covid pandemic, we’ve seen fundamental shifts in how people are accessing health care, including abortion. In the US, medication abortion through mifepristone and misoprostol pills accounted for 54% of all abortions in the US in 2020, up from 39% just five years ago, according to new research from Guttmacher. Medication abortions have more than doubled since 2011, when they accounted for 24% of abortions. And these stats notably don’t include the medication abortions of those who purchased abortion pills online, through websites like Aid Access and Women on Web.
Given this sharp increase in demand for medication abortion, which is extremely safe—notably safer than even Tylenol—and effective through the first 10 weeks of pregnancy, it’s not surprising that anti-abortion state lawmakers are cracking down on abortion pills as a way to decimate access. As of this week, one South Dakota lawmaker is trying to enact a total ban on medication abortion, while Georgia’s legislature is trying to ban telemedicine access to the medication. Last fall, Texas enacted a law that makes use of abortion pills after seven weeks a felony. Anti-abortion lawmakers know what they’re doing: They’re trying to ban and even criminalize an option that’s become crucial to the future of abortion access.
Even before the pandemic, use of medication abortion, which was approved by the FDA in 2000, was steadily on the rise. Abortion pills can be taken from the comfort and safety of one’s home and can be ordered online in all 50 states—now, even before you’re pregnant. While access to the medication has increased in recent years, the availability of physical clinics has continued to decline: 90% of US counties lack an abortion provider, and since 2016, 113 independent abortion clinics—which provide the majority of abortions in the US—have closed.
The pandemic only created greater strain on patients’ ability to get to abortion clinics. Early in 2020, dozens of states rushed to ban supposedly “elective,” “non-essential” health services like abortion, as if being pregnant against your will is somehow a non-urgent health condition. Covid also resulted in more restrictions on travel, not to mention greater risk of exposure associated with traveling out-of-state to get abortion care and greater costs, as the pandemic fueled an economic recession that disproportionately impacted women of color. For many people seeking abortion care during the pandemic, obtaining medication abortion via telemedicine consultations and receiving the pills in the mail became the safest or only option available to them.
Since September, the rise of laws like Texas’ near-total abortion ban, which is enforced through citizen surveillance and the threat of costly lawsuits, has likely worsened pregnant people’s anxieties about privacy in seeking reproductive care like abortion. As Texas-like laws spread across the country, having a medication abortion from the privacy and comfort of one’s own home could become the preferred way to end a pregnancy for more people. Still, even as abortion through pills accounts for more than half of all abortions in the US today, in-person abortion clinics will never become obsolete: Many are the sole providers of sexual and reproductive health services in their communities. Independent clinics, in particular, account for 64 percent of abortion providers for pregnancies at or after 16 weeks.
It should be noted that while medication abortion is highly convenient and medically safe, advocates and legal experts have long warned of legal risks associated with buying and taking the pills. Amid the ongoing surge in abortion bans and restrictions across the US, criminal charges for miscarriages, stillbirths, and self-managed abortions, including with pills, have tripled in recent years, and people of color—particularly Black and Indigenous people—are more likely to face criminalization for the outcomes of their pregnancies. In several cases, people who have lost their pregnancies have faced criminal charges for “fetal homicide,” and their search histories or text conversations about seeking abortion pills were used as evidence against them.
A handful of states have also enacted laws that require abortion providers to tell patients about a medically unproven and unsafe option to “reverse” a medication abortion that’s underway, putting patients at risk, and further stigmatizing self-managed abortion with pills.
Medication abortion isn’t without barriers, and even concerning legal risks that are a consequence of anti-abortion politics and cultural stigma. But abortion pills are nonetheless crucial to the future of abortion access. When Roe v. Wade and abortion rights are inevitably gutted by the Supreme Court and state legislatures across the country, we aren’t going back to the days of “back-alley” or “coat-hanger” abortions—not when FDA-approved abortion pills exist. There should no longer be shame or fear-mongering around self-managing your own abortion, done safely.