Outlook • Perspective

The next normal: The future of medication abortion is at home

By Abigail R. A. Aiken
Abigail R.A. Aiken is an associate professor at the LBJ School of Public Affairs, University of Texas at Austin.
October 29, 2021 at 9:00 a.m. EDT

We’ve all spent the past year thinking about the “return to normalcy” in the wake of the pandemic. But our world’s always changing, even outside of the moments that seem obviously exceptional. Sometimes that change takes the form of some dramatic, unforeseen rupture; often, it happens more subtly. What aspects of the imagined, far-off future might soon become part of our ordinary present? We’re asking policy experts, historians, scientists, economists and creators about the ways they think that society will shift next — transformations that once may have seemed inconceivable, but now seem possible. — Sophia Nguyen

This has been the worst legislative year for U.S. abortion rights on record. More restrictions have been passed in 2021 than in any year since Roe v. Wade. In the most extreme case, Texas banned abortions after six weeks of pregnancy. The Supreme Court may be poised to overturn Roe. Yet despite moves by some states to make abortions harder to obtain from a clinic, an increasing number of people are using abortion pills at home.

Medication abortion, which involves two pills taken 24 hours apart to terminate pregnancies up to 10 weeks, is one of the simplest and safest procedures in all of medicine. The pills cause bleeding and cramping. Afterward, a simple pregnancy test can confirm that the pills have worked. But for many in the United States, accessing these pills is an obstacle course, thanks to a rash of state-level restrictions blocking clinic access. With no federal and little state funding available, the price tag of $300 to $800 often falls on the individual.

Ironically, it is exactly these restrictions that have sparked innovation in where and how people access the medication. When laws prohibit in-clinic access, people often take matters into their own hands and self-manage their abortions outside of formal health care settings. Indeed, some people prefer self-management; it offers convenience, privacy and an alternative for some who may distrust the formal health care system. A 2020 study suggests that approximately 7 percent of U.S. women have attempted a self-managed abortion — in any form, including pills — in their lifetime.

Though the historical record indicates that people in North America have managed their own abortions for centuries, evidence also suggests that self-managed abortion using pills has been on the rise in recent years. In 2018, an Amsterdam-based doctor launched Aid Access, the first online telemedicine service to provide self-managed medication abortion to people living in the United States. The service operates entirely outside of the formal health care system and outside of Food and Drug Administration regulations, which ban mifepristone imports. Aid Access serves people in all 50 states, providing mifepristone and misoprostol up to 10 weeks of pregnancy for home use. People make a donation of around $110 and fill out an online consultation form, which is reviewed by a doctor, and then medications are mailed to their home. A help desk is available for information and support. Testifying to the scale of demand, the service has received 57,506 requests during its first two years of operation.

{snip}

By Abigail Aiken
Abigail R.A. Aiken is an associate professor at the LBJ School of Public Affairs, University of Texas at Austin. Twitter https://twitter.com/ProjectSANAteam