The approval of medication abortion care—20 years ago on Monday—was supposed to usher in a new era of abortion access in this country, to lessen the political and cultural stigma of abortion, to end the vitriol, quiet the noise, and give women an important new option to end an early pregnancy. This vision has yet to be realized.
Instead, with the passing of Justice Ruth Bader Ginsburg and the vacancy on the Supreme Court, the constitutional right to abortion is under greater threat than ever before.
To walk into an abortion clinic in the 1990’s often meant facing a gauntlet of protestors heckling, pushing and jostling to block a woman’s path (and unfortunately still does). The anti-abortion movement had waged a decades-long campaign of protest and even occasional terror against clinics, medical staff and the patients who sought care. From arson, bombings and even assassinations of doctors, clinics were under siege.
The 1994 passage of the Federal Freedom of Access to Clinic Entrances (FACE) law made these blockades a crime. Yet, as providers and advocates will attest, the harassment has not gone away. The barriers that were once physical and in-person now come in the form of cyber-attacks, email threats and social media persecution. Beyond these, in state after state there are legislative attempts to ban and push abortion care out of reach.
The story of how medication abortion care got approved bears re-examining today as it is both relevant and also offers a framework for confronting the ongoing, ever-escalating threats not only to legal abortion but to family planning as well.
Beginning in the late 1980s, a diverse group of advocates, scientists, reproductive health clinicians and medical professionals worked together to promote a range of technologies intended to help women control their fertility and protect themselves from sexually transmitted diseases such as the AIDS virus. Our group looked to culture shifts and advancements in health and science, such as in France where medication abortion was developed.
The long, tortuous road to approval included Republican administrations cutting funding for family planning organizations both in this country and internationally, the FDA classifying medication abortion care (RU-486) as a banned drug that resulted in halting research and barring manufacturers from selling pills in the U.S., and the continued threats and harassment of anti-abortion forces.
It was no wonder that no major U.S. pharmaceutical company would dare pursue medication abortion care. It wasn’t until 1994 that the French company that held the patent relinquished it to a non-profit organization that later partnered with a small domestic enterprise willing to take on the product. One by one, the many hurdles were surmounted—and FDA approval was achieved.
Almost everywhere else in the world, medication abortion care is now the standard of care to end an early pregnancy. In developing countries where unsafe abortion was a leading cause of maternal mortality and morbidity, countless lives of women have been spared. Public attitudes both in the U.S. and elsewhere overwhelmingly support medication abortion. Healthcare providers support it and offer it to women.
As political attacks on abortion and all reproductive health care persist, and in some parts of the country intensify, the origins of advocacy for medication abortion care in the U.S. can serve as a framework for the path forward. The work of activists and experts model the crucial nature of science-based advocacy and coalition-building to protect and expand reproductive health care today.
The COVID-19 pandemic and its harsh strain on the medical system have made the need for telehealth and other innovative approaches to health care more critical than ever. These must be applied to abortion services. While there are no longer as many human bodies blocking entrance to clinics, there are governors shutting down health clinics and, count them, over 400 state laws and restrictions in the past nine years conspiring to do the same.
Advocates must once again demand policy changes to ensure everyone can receive medication abortion care when and how they need it. This time the fight is not to have the medication approved, but for women to have medication abortion prescribed by their health care provider and then be able to receive their medications in the way that makes the most sense for them, whether that is at a health center, their local pharmacy or delivered to their home.
We who were early advocates of medication abortion care believed that women must be able to control their lives and destinies. Two decades later, this work remains as relevant and necessary as ever.