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27 March 2024

The fight for abortion pills

In the US, UK and around the world, the backlash against safe, at-home abortion medication is growing.

By Sarah Manavis

When British mother Carla Foster was sentenced to more than two years in prison last June, for terminating a pregnancy after the legal time limit during lockdown, the media largely told a story of sadness and public outrage. This woman was trapped at her home in dire circumstances, perhaps frightened of attending a clinic (a legal requirement under the Abortion Act until Covid-19). She is a mother of three. Did this really happen in England? Explanatory articles clarifying that, actually, the rules were stricter in the UK than you might think went viral. Foster had ended her pregnancy via an at-home abortion pill: she believed herself to be 28 weeks pregnant but told a doctor during an online consult that she was within the legal limit of ten weeks. Eventually, a month after her sentencing, following widespread backlash, her prison term was reduced to 14 months, and then suspended. One of the judges said Foster’s case called for “compassion, not punishment”.

But many were furious to see Foster’s sentence softened – to even see her gain any sympathy at all. Her use of pills drew ire not just from loud and proud pro-life campaigners but from many social media users and media commentators who professed themselves to be on the fence on the abortion issue. They argued that she should have been forced to go see a physician in person, even during the pandemic, and that no abortion should be able to happen via the post. Some maintained that the force of the law should apply to those who provide this type of medication. Details that Foster took these pills when she was actually between 32 and 34 weeks pregnant only exacerbated these punitive responses.

Foster’s case is just a small part in a wider global movement against abortion pills – a medical intervention that saves women travel costs, discomfort and indignity. This issue re-emerged again yesterday (25 March) in the US Supreme Court, when justices heard oral arguments about whether to limit access to one of the country’s most commonly used abortion pills, mifepristone – even in states where abortion remains legal. The case is being heard after a three-judge panel in the US Court of Appeals court voted in favour of limiting distribution of the drug and preventing it being sent through the post.

The case could see the legal limit for taking the pills drop from ten weeks to seven, and could remove the ability for them to be prescribed by a medical professional who isn’t a doctor. It could also, crucially, remove the right for women to be sent pills without having to attend an in-person appointment. The case comes just two years after the Roe vs Wade Supreme Court decision, which effectively legalised abortion in the US, was overturned in the Dobbs vs Jackson Women’s Health Organization ruling. Since then, abortion pills have been a lifeline for women living in rural areas as well as in states with stricter abortion laws, with many Democrat states passing “shield laws” that allow the pills to be shipped over state borders while protecting clinics’ and doctors’ identities, and preventing them from being prosecuted.

Abortion pills have become a lightning rod in the abortion debate. Such medication has risen in popularity in the past few years, in part due to the pandemic but also as a result of shrinking abortion access. More than 60 per cent of US abortions last year were carried out using mifepristone. The backlash has been swift: around the world, aggressive campaigns have emerged that hope to force women out of their homes and into clinics if they want to end their pregnancy (of course, in the US, some clinics oblige pregnant people to listen to the foetus’s heartbeat). And despite studies proving the tablets are overwhelmingly safe – even more so than many common prescription drugs, such as Viagra or penicillin – they have been the subject of fear mongering, driving a concern over its other health impacts even among people who are pro-choice.

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But the fury these pills trigger in pro-life campaigners seems to be about more than the simple fact that they are another safe way to have an abortion. Giving a woman total agency over her body – the ability to end a pregnancy from her own home, with total privacy – is especially threatening to their cause. At-home abortion pills offer a way to terminate a pregnancy that is at odds with how campaigns describe abortion, even in some pro-choice ones: that abortions must be upsetting, traumatic, painful experiences for women, or “the hardest thing they ever had to do”. The pills undermine the idea that abortions must involve surgical intervention, spectacle, shame and expense. They provide an option that is straightforward and can be used from the comfort of home.

The Supreme Court’s decision likely won’t come until the summer, and may end up simply maintaining the status quo on US abortion rights (in the Dobbs ruling, several of the conservative judges implied they wanted any further rulings on abortion to be made at state level). But it isn’t the only case they’ll hear on this issue: there is another scheduled soon on whether emergency-room physicians can terminate pregnancies in certain circumstances, such as life-threatening ones, even in states where abortion is banned.

The trajectory, whatever the outcome, is disheartening. But we can find a glimmer of hope in the liberation, safety and dignity these pills provide women around the world. We must vociferously defend that access.

[See also: Among Conservatives, the mood has never been so grim]

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