“Pills have become the frontline of the battle for abortion access,” writes professor and Ms. contributor editor Carrie N. Baker in her new book—the first to offer a comprehensive history of abortion pills in the United States.
In Abortion Pills: US History and Politics, professor and journalist Carrie N. Baker tells an enraging story about the decades-long struggle to bring abortion pills—mifepristone and misoprostol—to the U.S. of A. Her study highlights a stunning array of legislative gambits as well as an enormous number of players: feminist reproductive health activists, public health professionals, state and federal lawmakers, the Food and Drug Administration, doctors and abortion opponents—all of them hellbent on either expanding or curtailing abortion access.
The story involves an astonishing number of twists, turns, backtracking and forward motion that began in the 1960s when a collaboration between doctors in France and the U.S. began studying female hormones. Their goal was to create a drug to alter the chemical balance so that the body would reject a pregnancy. They succeeded and eventually created an “unpregnancy pill,” initially called RU-486, that was 95.5 percent effective if taken during the first seven weeks of pregnancy. After clinical trials on 20,000 women worldwide, drug manufacturer Roussel Uclaf applied to the French government for permission to market the drug. Approval was granted in 1988.
Twelve years later, the U.S. followed suit.
According to Baker, although American scientists had begun studying RU486 decades earlier, it took until 2000 for the FDA to finally sanction its use. Since then, pill efficacy has remained contentious. The upshot is that while abortion pills are safely and effectively used in 96 countries, conservative lawmakers and policy-setters in the U.S. continue to be leery about making medication abortion available domestically. Despite this, Baker reports that since the 2022 Dobbs decision, pill use has skyrocketed, with 63 percent of all U.S. abortions completed with pills obtained from formal reproductive health providers: brick-and-mortar or online clinics or telemedicine services.
This statistic, of course, ignores the many people who obtain pills through Internet sources or informal networks.
In fact, Baker writes, relatively easy access to the drugs has prompted antiabortion lawmakers and grassroots activists to step up their opposition to them. Publicity campaigns have dubbed the pills “chemical abortion,” and the Heritage Foundation’s Mandate for Leadership—better known as Project 2025—promises to work to make it a crime to send pills through the mail by resurrecting the long-dormant Comstock Act, an “anti-obscenity” law from 1873 to do so.
The right has aligned with law enforcement in states where abortion is highly restricted or illegal, leading to the arrest and prosecution of a handful of pill users—most of them young, poor and of color—who acquired the pills unlawfully.
Similarly, legal machinations over mifepristone, such as the rightwing Alliance for Hippocratic Medicine’s case before the Supreme Court to challenge the FDA’s approval of the drug, has led medical researchers to investigate the effectiveness of misoprostol alone. Their findings are clear and consistent: A one-drug regimen is 88 percent effective, with users experiencing few complications or adverse reactions.
Nonetheless, taking both medications remains the gold standard for self-managed abortion, and a host of groups are working overtime to get these drugs into the hands of those who need them; they’re also providing counseling and other support services to users.
They do this, Baker reports, despite the legal risks that come with aiding and abetting abortion provision in many parts of the country.
Nonetheless, while the Alliance’s case was unsuccessful, the constant wrangling over the drugs has taken a toll on the reproductive justice community, disappointing feminists who’ve long dreamed of making mifepristone and misoprostol widely accessible and affordable.
“Abortion pills are a long way from over the counter,” she writes, “or even behind the counter. They’ve only just arrived at pharmacies—or at least certified pharmacies in states without abortion bans. We do not yet have a combined product as exists in many countries. In the United States, clinicians still have to give patients two prescriptions—one for mifepristone and one for misoprostol. And while telemedicine is making the medications available for around $150, most medical providers still charge on average $550 in medication abortion services in-clinic.”
That said, Baker’s conclusion is unequivocal. Legal precarity notwithstanding, “advocates have made safe abortion much more widely available than before Roe—and in some respects even during Roe. … Pills have become the frontline of the battle for abortion access.”
That this frontline is fraught is a given. But groups like Plan C, Aid Access, Just the Pill, Red State Access and WeSaveUs, among others, know that the calculated risk they’re taking is worth it. For the moment, they’re doing all they can to keep abortion accessible, available and safe. Their bold acts are an inspiration.
Abortion Pills: US History and Politics, by Carrie N. Baker, Amherst College Press, 376 pages, $79.99 hardcover, $26.99 paperback. AVAILABLE OPEN ACCESS ON: Dec. 3, 2024.
