The Abortion Pill Is 22 Years Old. Its Rebirth is Stunning.
by Valerie Morales
For economic reasons both my parents receive their medications through the mail. When the idea was first presented to them they were skeptical. They were used to hand holding by a pharmacist and didn’t quite believe there was a simpler way of pill delivery until month after month their pills arrived on time.
Arlene who lives next door wasn’t as hesitant, in fact, she was blasé. She ordered abortion pills through telehealth and received them the same way my mother received her blood pressure medication. In a manilla envelope. Left by the mailman on her porch atop her Vanity Fair magazine. Nearly stepped on by her dog Venus. The clinic she would have gone to for an abortion- she was seven weeks pregnant- was shut down because of Covid. Since Arlene overused the internet to buy groceries, chat with a doctor, stream movies, FaceTime and watch make-up videos on YouTube, and since she routinely posted on social media sensational bits of gossip, she thought nothing of ordering the abortion pill. She was of the generation that had entitlement and options.
When Arlene opened her package at the kitchen table, she felt emancipated and empowered. The package of pills conceptualized her reality despite the politicians whose aim was to deny her the right to an abortion, preferring her trauma, poverty, and oppression. However, abortion was now a fire they no longer had the gasoline to stoke because it was out of their hands and frankly Arlene’s body was none of their business.
The abortion pill matters because 90% of United States counties don’t have an abortion clinic. And even if they did, getting an appointment would take weeks. Paying for an abortion can use up the entirety of a monthly check. And then there’s that stupid video you are forced to watch that changes no one’s mind.
Abortion pills are a combination of two drugs. Mifepristone or “mife” and misoprostol or “miso” are taken days apart and cause uterine miscarriage. Mife used to be called RU-486 (or its slang nickname RU-Going to Raise This Mf Baby If I Keep It?) and was approved in 2000 by the Food and Drug Administration. It’s new name is the abortion pill or Mifeprex. It is safe up to 10 weeks of pregnancy and poses less risk than Viagra or even acetaminophen. For women who live in states that enslave women’s wombs- like Louisiana which wants to put women in jail who have an abortion, the pills provide a lifeline.
The online delivery service of abortion pills is doing brisk business costing $600.00 at its high mark but usually around $200.00. Mife and miso are no longer a new kind of thing. They’ve been around longer than smartphones and Dancing With the Stars and texting and have finally matured, in large part because of what the FDA did because of the pandemic.
The FDA permanently erased the restriction of having to get a prescription at a health facility. These days 54% of abortions are performed by medication. You aren’t getting in your car. You aren’t sitting in traffic. You aren’t signing in at the clinic office front desk. You don’t have to do something with your hair or have someone mind your kids. And you aren’t waiting for your name to be called. It’s a short walk to the mailbox.
The introduction and acceptance of telehealth has, by design, created a cohort of advocates and women in control of their own health in a way that was impossible when Roe v Wade was litigated. 49 years after the landmark decision, I get texts from my provider twice a month, encouraging me to use their telehealth app if I need physical or mental assistance. Social media and blog articles provide information about treatment, wellness, exercise, symptoms, and abortion access; it furthers women’s independence as we partner with our providers to be in control of our own health without male interference.
Plan C is an online information site about medication abortion. Its co-founder and codirector Elisa Wells sees medication abortion as transforming how abortions are performed. She said, “We see medication abortion as being a potentially transformative and disruptive technology in the face of these unjust laws that are being passed.”
I have my own story about a deadly abortion. When I was a pre-teen, a coworker of my mother, a Cuban immigrant named Omi was being sexually assaulted by her boss and eventually wound up pregnant. She stayed with us for a brief amount of time before she had an abortion. She died because she chose an abortionist she could afford, a neighborhood butcher so to speak. In more modern times all Omi would have had to do was go online and order pills overseas or from a local provider.
The abortion pill is uterine chemistry. Mifepristone is taken first. It blocks progesterone, a vivacious hormone for a healthy pregnancy. Misoprostol is then taken to do the heavy abortion lifting. It cleans the uterus spectacularly. Cramping. And then the bleeding starts like a miscarriage. Both pills are taken one after the other and are successful 99.6% of the time at nine weeks of pregnancy or less.
While it’s not a coat hanger in a dark room, the abortion pill isn’t perfect either. Did the user take it correctly? Was it shipped in enough time? What happens if taken after ten weeks? There are women who have pre-existing health challenges, are they then at risk? These are questions that providers can answer that aren’t available when you order the pills from international pharmacies. While online delivery may explain (via pamphlet) that the usual two-day expulsion process sometimes, for some women, lasts almost a week, much longer than a clinical experience, it doesn’t soothe the nerves of the anxious. Prolonged excessive bleeding is a warning sign. And yet, more women die in labor than they die from having an abortion.
(There are online providers that allow you to order the pills in advance of a pregnancy sort of like ordering a Covid test for you to stock up just in case.)
In her cover story for the Atlantic “The Abortion Underground” Jennifer Bruder told a horrific story about a mother who ordered the pills for her daughter who was sixteen and pregnant. The daughter experienced severe stomach pains and was rushed to the hospital. When the mother told the treating physician about the pills, she was arrested for giving medical advice and was sentenced to nine to eighteen months in prison. Her daughter wasn’t harmed.
Women who live in conservatively backward states (most of which were slaves states as well) their elected officials are playing catch up and are drafting rigid pieces of legislation to stop women from, 1. traveling to a different state, 2. ordering abortion pills via telehealth, 3. sending it to a friend’s address, and 4. having that friend mail it to her. It feels offensive, the GOP’s hypocrisy about abortion once you mold it neatly next to their lust for war, the death penalty, and guns. They are seemingly fine with gender intolerance and racial wounds but are up in arms about AK-47’s being banned and pregnant women exercising their options.
So far, 116 bills have been introduced to limit medication abortions. The proof is in the pudding. Republicans aren’t going for leniency, not in perception, not in the nuts and bolts of policy. The physical act of mailing pills is banned in Arizona, Arkansas, and Texas. Waiting for similar bans while legislation moves through the courts are Montana, Oklahoma, and South Dakota. 19 states say no to accessing pills through telehealth. 33 states require only licensed physicians to administer the pill.
South Dakota enacted a law to make women go to the clinic four times before they could get a medication abortion but it was blocked by the courts. Texas prohibits medication abortion after seven weeks despite the FDA’s rule of ten weeks. All self-managed abortions are illegal in Nevada, South Carolina, and Oklahoma.
It’s illegal to prescribe abortion pills via telehealth to a patient who lives in a state where telehealth abortion pills are banned. Physicians could lose their licenses. The loophole is this: a woman can travel to a different state, one where abortion pills aren’t restricted, order the pills there, and then go back to where she lives. This method erases the weeks-long delay at abortion clinics.
Many online medication abortion sites are seeing up to 2,000 unique visitors a day, four times as many as before Texas began rolling their sexist ball down a bumpy hill and before the Alito draft and before GOP representatives were proud to tell their daughters: enjoy being raped. Entrepreneurs see an opportunity to buy pills online and sell them in states that are restricting women because prohibition creates a buyers market.
Kristan Hawkins who is president of Students for Life said “We really have to be making our case to the American people why these [medication] abortions are just as equally as gruesome as a late-term abortion.”
Gruesome? I disagree.
Being forced to endure a pregnancy because a white man said so, a white man who knows nothing about my life, circumstance, or uterus, that is gruesome. Flinging a child into poverty because the state criminalizes the uterus and has cut aid to poor women and children, that is gruesome. Dying in childbirth because I couldn’t have an abortion eight months earlier is fucking gruesome. Not being an equal partner in my own health because politicians hate female power, female bodies, and female independence, that is gruesome. Racism is gruesome. Sexism is gruesome.
Abortion is a medical procedure.
The FDA is working on a plan to certify pharmacies that want to administer medication abortion, as long as they adhere to a set of rigid rules. While a new (Republican) president can reverse everything, including making the abortion pill illegal by changing the head of the FDA, the GOP cannot stop the internet.
