Pills Are Keeping Abortion (Partly) Accessible

8,000 women a month take abortion pills in restrictive states. The question is: Who gets them, and who doesn't?

Photo by Aiden Frazier on Unsplash

It is no exaggeration to say that abortion-inducing medications have changed the face of clandestine and self-managed abortion. In the Bad Old Days before Roe v. Wade broadly legalized the procedure in the United States, abortion options were limited, and typically involved visiting a doctor or a clandestine provider for a furtive procedure, usually without anesthesia. Lucky women saw real doctors, many of whom risked their careers to help the desperate. Many unlucky ones saw freelancers of varying degrees of training, some of whom were simply greedy and happy to take advantage of women with no other options, and didn’t know what they were doing. Many women were badly injured. Some died. And every single woman who sought out an illegal abortion did so understanding that the risks were substantial, and heard the same message from the state: What you are doing is criminal, and you should be ashamed.

That same message is still broadcast by states that ban abortion. But the danger of seeking out a procedure has been ramped way down thanks to incredibly safe, very cheap abortion-inducing drugs.

Abortion procedures are generally overwhelmingly safe when performed by trained providers, and are many times safer than childbirth. Criminalization, though, tends to drive the procedure underground, which elevates risk. For decades now, though, abortion pills have radically decreased abortion-related injuries and deaths in nations where the procedure is limited or banned. The decrease in injury and death rates has tracked with the availability of these pills, dropping significantly in places like Latin America where abortion is broadly outlawed but pills ubiquitous, and being slower to drop in much of sub-Saharan Africa, where abortion is also often banned but lower rates of development and larger rural populations means that pills are harder for pregnant women to get. Now that abortion is banned across much of the south and middle of the United States, huge numbers of American women are relying on abortion pills, too, in places where the procedure is legal and in places where it’s not.

According to a recent study, some 8,000 women a month use abortion pills in states that criminalize or tightly restrict the procedure. Many of these pills are prescribed via telemedicine from states in which abortion remains legal, and specifically from liberal states with shield laws in place that (so far) protect providers from legal consequences.

Abortion rights remain broadly supported by the American public, including in conservative states, and by many Republicans. Roughly twice as many Americans support abortion’s legality as oppose it. Majorities of Americans across all racial groups say abortion should be legal, as do a majority of Americans of every educational level. The only religious group that seems a majority opposing abortion rights is white Evangelicals; even most Catholics say abortion should be legally permitted. And very, very few Americans — just 8% — adopt the anti-abortion movement’s view that the procedure should be outlawed in all cases.

Few issues in the US are both this broadly supported and routinely characterized as “contentious.”

But the Republican Party and the anti-abortion movement don’t actually care what Americans, including more than 40% of their own voters, think on this issue; they want to ban the procedure no matter what.

Thanks to abortion pills, the bans haven’t worked for thousands of pregnant women.

But for many others, they have. And those are the stories that so often go untold.

For each of the 8,000 women who are able to get abortion pills each month in abortion-restrictive states, there are others — I don’t know how many — who are pregnant and do not want to be, but don’t know what to do. Abortion pills are not evenly distributed among women in abortion-hostile states; instead, they are most likely to go to the women who are connected and sophisticated enough to seek them out. Women with higher levels of education, who are native English speakers, who live in slightly more liberal communities, who are fully-grown adults, who are not under the thumb of an abusive partner or controlling parents, who have the money for an internet connection and a telehealth appointment — these are the women who are more likely to get abortion pills. The women who don’t speak English as well, who are immigrants, who are isolated, who may not be women at all but rather teenage girls, who are under the control of a man or another authority figure at home, who struggle with substance use disorders, whose lives are chaotic — these are the women who may desperately need abortions, but for whom bans are a high enough bar to force them to carry a pregnancy to term.

It is a long-documented reality that unintended pregnancies are much more common among low-income women, and that unplanned births are part of the constellation of factors that keep women poor. Adding children one cannot afford, or one is not emotionally or financially ready to raise, keeps women struggling (it keeps men struggling, too). More affluent women are less likely to get pregnant unintentionally, but are then more likely to terminate those unintended pregnancies. This is part of what keeps them on the path to financial and personal stability.

Abortion bans stigmatize all women, and they make women suffer across the lines of race, education, and class. But they also cleave open existing inequalities more dramatically than just about any other political policy. They create circumstances under which the women who have the fewest resources and opportunities are also the most likely to be forced into childbearing. And the children of those women — those they were forced to have, or those they had before and after — do markedly worse than the children of women who were able to plan their families. These inequalities don’t just manifest in women’s bodies; they become the roots of intergenerational poverty, abuse, and struggle.

It’s not just “this group of particularly vulnerable women has the least access to safe abortion,” although it is that, too. It’s that abortion bans help to create an underclass of women in conservative states. They take existing inequalities and magnify them — not just now, but on down for generations.

xx Jill