DIGEST February 2022

Anywhere access to abortion is less than ideal―which is basically everywhere―or anywhere it is under attack by right-wing extremists (looking at you, Texas, Mississippi, Poland…), being able to manage one’s own abortion with pills is an important part of the solution. This is not only a political imperative, it’s also a practical one.

Want to know more? Here are some common questions and answers highlighted in a recent (November 2021) and groundbreaking article in The Lancet. (A special shout out to the brilliant and passionate researchers from Argentina, Nigeria, Indonesia, South Africa and at Ibis Reproductive Health in the US, who designed and conducted this study!). The study reviewed the experiences of over 1,000 pregnant women in Argentina and Nigeria, who used abortion pills outside the health system, but with the support and accompaniment of feminist community-based organizations. Examples of these groups include Socorristas, La revuelta colectiva feminista (Argentina) and GIWYN (Nigeria). The stages of pregnancy ranged from less than 7 weeks to 22 weeks of gestation. As the authors note in the article's introduction: “The self-managed abortion accompaniment model emerged as an area of autonomous health action and self-determination among feminist movements in response to the failure of the state to provide safe abortion care. This movement is characterized by activist-driven, community-based strategies to facilitate use of widely available medications outside clinical settings.”

Can pregnant women successfully terminate their pregnancies using abortion pills without medical supervision?

The answer is yes. Over 91% of the women in the study were able to manage their own abortion successfully (without surgical intervention for incomplete abortion); with similar results in Argentina and Nigeria. Pregnant women could take the pills according to instructions without any problems. They knew when they were pregnant, and when they no longer were. This was true whether the women used either of the two recommended regimens: misoprostol alone, or mifepristone followed by misoprostol.

Are abortion pills safe?

Yes, very safe in fact. The above-mentioned study found that only 20% of the women sought any kind of follow-up care. Most of them wanted to confirm they were no longer pregnant, while a few (2%) required vacuum aspiration or curettage of the uterus because of remaining embryonic/fetal tissue.Scientists have data on millions of doses of misoprostol and mifepristone used over several decades to induce abortion in various countries around the world, and the evidence is unambiguous in showing that these drugs are safe. Mifepristone has been in use since the 1980s. Penicillin and Viagra cause more complications than mifepristone does.

Misoprostol is included on the World Health Organization (WHO) Model List of Essential Medicines, because of its proven safety and efficacy for medical abortion (in combination with mifepristone), as well as for postpartum hemorrhage prevention, incomplete abortion/miscarriage management, and labor induction. So, we are not talking about dodgy medicines here.

Is there any medical reason pregnant persons should have to take the pills at a clinic, or in front of a healthcare worker?

No, there is not. Which is why telehealth is such a good match for abortion with pills: women can tell when they are pregnant, can use the pills competently, and know when to access follow-up care. During the early days of the COVID-19 pandemic, several countries (notably the UK, the federal government in the US…) temporarily allowed mifepristone to be dispensed via telehealth, and no problems ensued. As a result, the US Federal Drug Administration (FDA) recently and finally! lifted its politicized requirement that mifepristone be picked up only in person in hospitals or doctors’ offices. Mifepristone can now be bought at pharmacies or even mailed to patients. Unfortunately, the FDA did not remove the need for the prescribing doctor to have special certification, and added a requirementthat the pharmacies that will now dispense mifepristone also be certified. Two steps forward, one step back.

How far into pregnancy can abortion pills be used?

Formal clinical trials have previously shown that abortion pills work up to 84 days into pregnancy, i.e., 12 weeks. The above-mentioned study clearly shows that they are effective until much later in the pregnancy; with some of the women in the study terminating their pregnancy successfully at 22 weeks of gestation. This is nothing short of revolutionary.

Self-managed abortion has always been practiced. Regardless of the legal status of abortion, feminist solidarity networks have helped, and will continue to help pregnant persons access abortion, the way the Chicago-based Jane Collective helped American women before Roe v. Wade. But we now have a convenient, safe tool: abortion pills, which should be made widely available. Why should pregnant persons have to jump through unnecessary hoops to obtain and use these pills?

In this respect, I love the call to action of the US-based Liberate Abortion campaign: “We need more than legality. We need a world where abortion is affordable and available in all of our communities, when people need care, with the providers they choose, and in ways that people trust. We need abortion liberated, and we're working towards that vision together.”