I’ve been following reproductive rights issues long enough to remember when the drug for medical abortion, RU-486, or mifepristone, was first approved for use by doctors in the United States in 2000. At the time, there was quite a bit of excitement on the pro-choice side and outrage on the anti-choice side over it, in large part because most camps widely believed that this could create a real revolution in abortion care, making it cheaper and more private. Some pro-choicers hoped it would totally remake abortion care in the United States. Some anti-choicers worried it would make it impossible to know at which clinics they should show up and shame women. The New York Times even called medication abortion the “little white bombshell” that was a hassle-free, protester-free “shape of abortion to come.”
What actually happened was… not much. Women did start to use medication abortion—which generally involves taking RU-486 in conjunction with misoprostol—and this helped push the average gestational age of a pregnancy at time of abortion even earlier. Overall, though, the revolution wasn’t much of one. There’s been a slow uptick in the percentage of medication abortions every year. Still, they comprise less than a quarter of non-hospital abortions performed annually, according to the Guttmacher Institute. More distressingly, the availability of medication abortion didn’t do as much as hoped to dissuade protesters or make the experience more private. It did lower the cost somewhat, but abortion regulations—and a generally abortion-hostile culture—meant it was mostly available in the same clinics performing surgical abortions, and patients still had to go through the protester gauntlet in order to get it.
But now, 15 years after the FDA approved RU-486, the “little white bombshell” is legitimately becoming a cultural phenomenon worthy of the name, and it’s due in large part to pressure exerted by anti-choice forces. The privacy it offers, it appears, doesn’t make that much of a difference when abortion is legal and easy to get. But once legal abortion starts being snuffed out, the availability of a small, private pill—whether it’s mifepristone, misoprostol, or a combination of the two—becomes a way for desperate women with little access to take control over their own lives. No one wanted it to happen this way, but thanks to anti-choicers and their restrictions, the abortion pill revolution is under way.
Leave it to Women on Waves to plan a stunt showing how true this is. The organization, which made its name by offering women in countries where abortion is illegal an opportunity to climb on a boat and get it done in international waters, has now announced a plan to fly some drones into Poland and drop abortion pills into the arms of women who need them. Poland has a broad ban, with very few exceptions, on doctors performing abortion. However, according to Women on Waves’ Rebecca Gomperts, it’s not technically illegal for women to self-induce abortion—so the women who take the pills shouldn’t be in any legal danger.
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But even so, that’s the genius of the little white bombshell: Who can know who has taken it and who has not? There isn’t a blood test to determine if someone has taken abortion pills. As Women on Web, a sister organization to Women on Waves that helps send abortion pills to women through the mail, explains, the symptoms of a naturally occurring miscarriage and an abortion are exactly the same. If the medication is taken as the World Health Organization guidelines advise, there’s just no way to know.
The fact that abortion pills are easy to hide from authorities was never intended to be their main selling point, but anti-choice efforts have made the current situation inevitable. It certainly proves that pro-choicers were always right: If you take legal abortion away, it doesn’t make women embrace their unwanted pregnancies with open arms, as anti-choicers like to imagine happens. It often means they start resorting to quasi-legal or outright illegal methods in order to get the abortions they need.
So, congrats, anti-choicers. Your pressure has helped the abortion pill become the first thing women in many parts of the world think of when they want to terminate a pregnancy. In El Salvador, the illegal use of a form of the abortion pill has been credited, by Sofia Villalta Delgado of the Salvadoran Ministry of Health, with improving women’s health outcomes in the country by dramatically reducing the number of women who turn up in emergency rooms with sepsis from botched abortions. It’s hard to get numbers, but throughout much of Central and South America in countries where abortion is restricted, the use of the pill has become common knowledge. In Mexico, pharmacies sell a version of the pill, even though abortion is illegal in most of the country, under euphemistic language about bringing back your period.
“Worldwide, medication abortion (a technique using a combination of the drugs mifespristone and misoprostol, or misoprostol alone) has become more common in both legal and clandestine procedures,” Guttmacher’s fact sheet on abortion explains. “Increased use of medication abortion has likely contributed to declines in the proportion of clandestine abortions that result in severe morbidity and maternal death.”
As I said before, the frequency of medication abortion is slowly growing in the United States. But even though the procedure is supposed to be legal here, it’s increasingly hard to get—meaning that the exact same pressures that make abortion pills popular on the black market in El Salvador and Mexico appear to be making them popular here too. One expert that Guardian writer Jessica Valenti spoke to argued that part of the declining abortion rate in the United States is likely attributable to the growing interest in abortion pills obtained illegally. It’s hard to see how it could be otherwise. Birth rates went down alongside the abortion rate. While the reasons behind that are complex—fertility in general is down, clearly, likely because of improved contraception use—the lack of a corresponding surge in the birth rate where legal abortion is increasingly hard to get suggests at least some women are taking matters into their own hands.
While a trollish part of my personality enjoys watching the women of the world thwart the efforts of the forced birth brigade, overall this trend is not a happy-making one. While there have been efforts to get safe and legal help to women who need the pill as an alternative to a clinic-based abortion, anti-choice legislators shut it down pretty quickly with all sorts of state bans on telemedicine abortions. (Though hooray to the Iowa Supreme Court for protecting the women of your state!) There are, of course, all sorts of very reasonable concerns that women don’t know what kind of pills they’re getting or how to take them, and while Women on Web and other activists are trying to get that information out there, gaps remain.
Just as concerning, the invisibility of the pills themselves cause a problem. Anti-choicers know for a fact that some percentage of women—though who knows how many?—that show up at emergency rooms with incomplete miscarriages took an undetectable abortion pill. Of course they’re going to be interested in digging a few up and making examples out of them, in a futile effort to scare other women off doing it. But since there’s no way to tell, the method for picking whodunit, at least in some places like El Salvador, appears to be by assuming, often without any evidence, that anyone young, poor, or single is a likely candidate and just tossing her in jail.
As the cases of Purvi Patel or Kenlissia Jones demonstrate, anti-choice law enforcement in the United States cannot wait to do the same here. Oh, they’re just dipping their toes in, picking a couple of cases where they can cobble together actual evidence of pill-taking, and going after women whose pregnancies ended fairly late in the process. And, as abortion isn’t technically illegal, they’re having to resort to creative interpretations of the law—such as accusing women of murder—in order to justify these arrests. But it’s not unreasonable to think that the suspicion and efforts to weed out the abortion pill users will increase.
Still, as the effort in Poland suggests, the abortion pill revolution is here. And it’s driven not by pharmaceutical companies, but by women doing what they’ve always done: Taking charge of their fertility in any way they can, and getting creative in the face of opposition.