Happy Birthday To The Abortion Pill

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Ten years after the FDA approval of mifepristone for medication abortions, it's a good moment to think about what its availability has changed — and what it hasn't.


It's been a long, slow road for mifepristone, sometimes known as RU-486. The first successful results with the pill were in 1982; first approved usage in France was 1988, after a battle in which the French government intervened. ("I could not permit the abortion debate to deprive women of a product that represents medical progress. From the moment Government approval for the drug was granted, RU-486 became the moral property of women, not just the property of a drug company," said the health minister at the time.) In France, the percentage of medical abortions is far higher — almost 50 percent in 2007.)

This Time cover is from 1993. The FDA approved mifepristone (known on the market by the oh-so-catchy Mifeprex) in 2000. By 2007, 21 percent of abortions conducted in the US before nine weeks were medical, and the number is growing. The drug's has also meant that a higher proportion of abortions are taking place earlier; as Jodi Jacobson notes,

The earlier in an unintended pregnancy an abortion occurs, the safer and less costly it is. Medication abortion is only appropriate for unintended and untenable pregnancies up to nine weeks. Availability of medication abortion has meant that an increasing share of abortions are early, and an increasing share of early abortions are done before six weeks or before nine weeks.

But the key hope that the drug would increase access for poor or geographically-disadvantaged women has not yet been realized, according to a Guttmacher study from last year:

"Instead, almost a decade later, we find that women in areas that already had access to abortion now have the choice between a medication or a surgical abortion. But for most women who were not easily able to access an abortion provider before mifepristone became available, services remain difficult to obtain.

That could change if more medical providers adopt the telemedicine program that Planned Parenthood of the Heartland has piloted in Iowa:

Women seeking the pill can go to one of 16 clinics, have an ultrasound, be examined by a nurse, then talk to a doctor by a secure Internet connection. The doctor has the woman's medical records and, if no complications are detected, can remotely open a container to provide the pill.


Almost 2,000 women have benefited from the program. Another advantage of the program: it decentralizes operations, making it that much hard for anti-abortion activists to try to intimidate the patient or the doctor.

But medical abortion isn't for everyone, as the CEO of Reproductive Health Technologies Project told USA Today. While it's helped beef up offerings at Planned Parenthoods that used to only be able to offer family planning, she said, "abortion is a really individual experience."

Women who favor an abortion via medication prefer "being able to experience an abortion in the comfort of their own home and surroundings," she says. But "if you're a mom with two young kids at home and a boyfriend who's not that helpful," you might prefer a surgical abortion.
"Increasingly, though," Moore says, "if you do go to an abortion provider, you're going to have options when you get there, and that's always a good thing."



Thanks to Medication Abortion, An Increasing Share of Abortions Take Place By or Before Nine Weeks [RH Reality Check]
The Impact of Medication Abortion 10 Years After FDA Approval [Guttmacher]
Decade After Abortion Pill's OK, It's Not Used As Often As Expected [USAT]
Ten years After Abortion Pill Approved By FDA, New Controversies Still Loom [AP]


Flackette Knits A Lot

Sadly, access to mifepristone can sometimes be blocked by jackass pharmacists. My understanding is that mifepristone is sometimes prescribed to women who have had early miscarriages, to empty the uterus. I read a personal account by a woman who had miscarried a wanted pregnancy, and had to take her Rx for mifepristone and a painkiller to the pharmacy, her toddler daughter in tow.

The asshole pharmacist asked her why she was filling "this abortion pill" and gave her a hard time in front of her daughter. Finally the woman said "I've had a miscarriage, please give me the medicine."

She ended up later having to explain to her toddler what a miscarriage was. Never mind that if anyone overheard what he was saying, that was a gross violation of patient privacy.

Oh, and she had just lost a much-wanted pregnancy, and he was basically publicly berating her. Nice.

So, even if you aren't seeking an abortion, unfettered access to mifepristone is important!