How Abortion Pills Upend the Politics and Practice of Abortion

By | January 12, 2018

NEW YORK, January 12 (C-Fam) Since the dawn of the abortion movement, activists insisted that abortion should be solely the concern of a woman and her doctor.  But as the method of abortion worldwide has shifted from surgery to medication, abortion advocates are increasingly regarding the doctor as unnecessary—and, in some cases, counterproductive.

“The classic framework of abortion rights advocacy, where safe equals legal and illegal means unsafe, is turned on its head by self-managed medical abortion,” according to representatives of a Dutch organization that provides abortion pills to women in countries where the practice is illegal. “Ironically, in legally restrictive settings medical abortion is currently more under women’s control than in settings where medical abortion is used within the official healthcare system,” they said.

The remarks appeared in a special issue of the journal Contraception focusing on medical abortion, with its political position exemplified by a lead editorial by Marge Berer, the head of a UK-based abortion advocacy group.

Countries long regarded as having progressive laws on abortion are increasingly drawing criticism by the same feminist groups that used to praise them.  Decades of effort to house abortion firmly within national health care systems, as in the UK, have ensured that it is subject to the same bureaucratic and regulatory hurdles as any other procedure.  One article surveyed women who sought illegal abortion drugs in Great Britain, despite the presence of legal services.  The most commonly cited reasons for this were the delays that have become widespread within the overloaded health system.

In 2000, Berer published an editorial in the Bulletin of the World Health Organization (WHO), where she argued, “[m]aking abortion legal is an essential prerequisite to making it safe.”  In 2017, her position had shifted from one of legalization to complete decriminalization, or the removal of any legal regulation whatsoever: “What makes abortion safe is simple and irrefutable—when it is available on the woman’s request and universally affordable and accessible.”

Affordability and access to abortion—regardless of the law—requires widespread availability of the drugs needed to perform it: misoprostol either alone or in combination with mifepristone.  Both drugs were added to the WHO’s essential medicines list in 2005, but with the caveat “where permitted by national law and where culturally acceptable.”  An article on abortion by misoprostol in the francophone African countries Benin and Burkina Faso noted that the drug had been added to their national essential medicines lists in 2013 and 2014, respectively.  The authors credited this with its increased availability, while noting that the addition was “for other reproductive health indications, not induced abortion.”

Various authors in the special issue explored the prospect of first-trimester abortions becoming entirely medical rather than surgical.  Some expressed concern that this trend could lead to even fewer providers being trained to perform surgical abortions—even as existing shortages of providers increase due to stigma and conscientious objection.

Just as medication abortion has changed the international discussion of “safety,” it has also challenged the concept of “providers,” by placing women themselves increasingly in the role of both patient and abortionist.  In her summary editorial, Berer admits that medical abortion is “not problem free or perfect,” but blames women’s adverse experiences on anti-abortion laws and beliefs: “This is not the fault of the pills, though the pills are often blamed.”