Global evidence on medical abortion shows how the US can protect reproductive rights

As the U.S. Supreme Court weighs whether to overturn Roe v. Wade, the next battle in reproductive rights is already heating up: access to abortion pills. 

Republican-controlled state legislatures, buoyed by the court’s leaked draft opinion, are rushing to pass a swathe of new laws that aim to criminalize what would otherwise be a lifeline — the distribution of abortion pills. There are already several states that have proposed or enacted laws banning “pills by mail.” In Texas, a recent law went into effect that also makes the provision of abortion pills after seven weeks of pregnancy a felony.

Options for women in a post-Roe world will be drastically different from those available pre-1973, thanks to medication abortion pills. 

It all began against the backdrop of restrictive abortion policies across Latin America in the 1980s, as women in Brazil started spreading the word about a pill invented to treat gastric ulcers that could also be used to end a pregnancy. Women who wanted abortions began to converge in droves on their local pharmacies to access the new drug, misoprostol. Today, misoprostol is taken as part of a two-step method for safely ending early pregnancy. The other pill, mifepristone, did not become available in the U.S. until 2000, because like with so many other advancements in abortion care, misinformation created unfounded concerns about its safety. 

The early pioneers in Brazil paved the way for women across the world, helping them to access abortion from the comfort, privacy and safety of their own homes. In the decades since, medication abortion has been proven to be one of the safest and most effective ways to end a pregnancy, accounting for more than half of all abortions in the United States.   

It was this data on the successful use of abortion pills along with a global medical consensus, including The World Health Organization’s (WHO) recommendation for the use of at-home abortion pills, that led to the U.S. Food and Drug Administration (FDA) decision to permanently allow abortion pills by mail.    

Despite the FDA’s decision and the increasing evidence supporting medication abortion since the 1980s, 19 states will seek to further restrict American women’s access to abortion by introducing legislation to stop these safe and necessary drugs from being shipped by mail.  

Medication abortion is not new. And during the pandemic, the evidence to support the safe self-management of medication abortion has only strengthened. With women’s access to reproductive health care affected by lockdowns and travel restrictions, several countries decided to support telemedicine and abortion-at-home to enable women to continue accessing abortion care. This included the UK, which changed its abortion regulations in March 2020 to allow early medication abortion at home via telemedicine.

In Nepal, the government introduced interim guidelines allowing women to access medication abortion at home. Nepal is a country which knows all too well the tragedy of maternal deaths. Before abortion was legalized in Nepal in 2002, over half of its maternal deaths were attributable to unsafe abortion — a number which has now dropped by a staggering 72 percent thanks to the steps it has taken to expand access to both abortion and contraception. 

Evidence shows that with the right support and information, the self-management of abortion is not only safe, more convenient and affordable for women, but often the preferred form of care when offered. A peer-reviewed study by MSI’s UK program revealed that at-home abortion care was the preferred choice of care during the pandemic for 83 percent of its clients. In addition, two-thirds shared that they would choose medication abortion at home again, even if COVID-19 were no longer an issue.  

Abortion has come a long way in the four decades that have passed since activists in Brazil changed the face of abortion access. The availability of medical abortion drugs has been pivotal in expanding reproductive rights across the globe. We urge lawmakers in the U.S. to listen to the global evidence on medical abortion and ensure that women can access this vital service.  

Amanda Seller is president of MSI United States, non-profit organization based in Washington, D.C., supporting MSI Reproductive Choices’ family planning services across 37 countries, providing reproductive health care including contraception, safe abortion and post-abortion care.