One Thing the Failed Attempt to Ban the Abortion Pill Did

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One Big, Unintended Consequence of the Failed Attempt to Ban the Abortion Pill

The more anti-abortion activists attacked mifepristone ... the more women flocked to use it.

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One Thing the Failed Attempt to Ban the Abortion Pill Did​

The more anti-abortion activists attacked mifepristone, the more women flocked to use it.​

By Carrie N. Baker

June 18, 20245:45 AM

Photo illustration by Slate. Photos by Elisa Wells/Plan C/AFP via Getty Images and supremecourt.gov.



This is part of Opinionpalooza, Slate’s coverage of the major decisions from the Supreme Court this June. Alongside Amicus, we kicked things off this year by explaining How Originalism Ate the Law. The best way to support our work is by joining Slate Plus. (If you are already a member, consider a donation or merch!)

On Thursday, the Supreme Court dismissed a lawsuit, FDA v. Alliance for Hippocratic Medicine, that tried to restrict access to the abortion pill mifepristone based on false allegations that the medication was dangerous. The justices ruled that the plaintiffs—anti-abortion doctors and dentists who had never prescribed mifepristone and hadn’t treated women who had used the medication—did not have legal standing to bring the case. In a moment when the high court is understood to be highly politicized, the 9–0 ruling stood out as definitive, confirming the legality of the medication nationwide.


Although some evidence indicates that the case spread disinformation about the safety of abortion pills, the suit had unintended consequences. The demonization efforts have wound up being one giant publicity campaign for a medication that, for so many years, most women didn’t even know was an option.

“The SCOTUS case raised awareness of abortion pills and the pills-by-mail option,” said Elisa Wells, co-founder of Plan C, which maintains a website providing a comprehensive guide for obtaining abortion pills through telehealth, community networks, and online pill vendors in all 50 states. The case may have “also continued to spread the false perception that abortion pills are somehow dangerous or need extra regulation, which we know, from decades of research, is not true,” she said. But the ultimate effect might actually be quite positive for abortion access.

In 2023, while the mifepristone case garnered regular media coverage as it worked its way through the courts, the Plan C website received 2 million visits, doubling in the year after Roe v. Wade fell. On March 26, 2024, the day the Supreme Court heard oral arguments in the mifepristone case, the website experienced a 50 percent increase in traffic, reported Plan C co-founder Amy Merrill. The same day, lawyers counseling people on the Repro Legal Helpline saw a 70 percent increase in inquiries about abortion pills.

A central legal question in the case was whether the Food and Drug Administration had had enough evidence when it approved mifepristone in 2000, then expanded access to the medication in 2016 and 2021. In widespread media coverage of the case, anti-abortion advocates and lawyers loudly proclaimed that abortion pills are dangerous, and abortion supporters argued that they are safe—even safer than Tylenol. Despite the comparatively equal declarations on each side, the suit brought substantial attention to the voluminous scientific research demonstrating the safety of abortion pills; the New York Times published a list of more than 100 such studies. Public scrutiny of abortion pill research in fact led academic publisher Sage to retract three published studies written by anti-abortion advocates—two of which had been cited in court filings in the mifepristone case—because of a “lack of scientific rigor.”

News articles repeatedly reported that over 5 million women have safely used mifepristone in the U.S. since the FDA’s approval of the medication and that across the world, many more millions have safely used mifepristone in the 96 countries that have approved it for abortion use.

Meanwhile, the country’s abortion pill use and telehealth with pills by mail climbed. A decade ago, less than a third of abortions in the United States were done with medications and telehealth abortion was not allowed by the FDA. Today, two-thirds of abortions are done with medications, and 1 in 5 are done through telehealth, with pills delivered by mail.

Telehealth abortion became widely available for the first time after the FDA permanently lifted the requirement, in December 2021, that medical providers dispense mifepristone directly to patients. This change spurred the proliferation of virtual abortion clinics, which used mail-order pharmacies to dispense the medication. It was in response to this increase in availability that anti-abortion activists filed the lawsuit to ban mifepristone in November 2022. Then, the following month, the FDA for the first time began allowing brick-and-mortar pharmacies to dispense abortion pills.

Despite the Supreme Court overturning Roe v. Wade and 14 states banning abortion, the number of abortions in 2023 rose significantly over previous years. There were 1,037,190 clinician-supported abortions in the U.S. in 2023, the highest rate since 2012 and an 11 percent increase since 2020, according to the Guttmacher Institute.

The Guttmacher number is even likely to be an undercount—it does not include new telehealth services operating in six states with telehealth-provider shield laws that allow clinicians to mail abortion pills to women living in states that have banned abortion. Shield-state providers are now serving approximately 10,000 women a month, with demand steadily increasing.nanza for the very drug it sought to ban.

 

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The Guttmacher count also does not include abortions obtained outside the medical system, including through community networks providing free abortion pills to patients in states that have banned online pill vendors. Community networks estimate they have provided abortion pills to over 40,000 since Dobbs. Many more have obtained abortion pills from online vendors. The Plan C website lists 24 vetted online vendors offering abortion pills for as little as $28 with three-to-five-day delivery to all 50 states.

Although some women want in-clinic procedural abortions, an increasing number prefer to use abortion pills in the privacy of their homes, surrounded by a supportive partner or friends. Research shows that women choose telehealth abortion because of the privacy, convenience, and affordability of this option. Many telehealth providers require only completion of an online medical screening form, which patients can do on their computers or phones, at their convenience. And the cost of telehealth abortion is much less than in-clinic abortion. (In-clinic medication abortion generally costs between $500 and $700, while telehealth abortion costs much less. Telehealth abortion provider Aid Access, for example, charges a sliding-scale fee up to $150 with two-to-five-day delivery in all 50 states.)

In-clinic care also takes longer than telehealth care, extending the time patients will experience the negative side effects of early pregnancy, including nausea. In-person care also requires women to take time off from work, obtain and pay for child care, travel long distances to brick-and-mortar clinics, pass through judgmental and sometimes violent anti-abortion protesters, and pay hundreds of dollars to pick up pills. For some, clinic-based care is unaffordable or travel is impossible. Telehealth abortion and pills by mail provide prompt, private, and convenient service to meet patients’ time-sensitive need for care.

Many states now have multiple telehealth abortion providers competing for growing demand. For example, Virginia has 12, Massachusetts has 15, and California has 19. Plan C’s website maintains a full list of options for obtaining abortion pills by state. Four online clinics located in supportive states offer telehealth abortion to people living in states that have banned clinicians within their borders from providing the service. As a result, telehealth abortion is available to people in all 50 states.

Meanwhile, new creative ideas for accessing and using abortion pills have proliferated, such as missed-period pills—using mifepristone and misoprostol in the days after a missed period without confirming pregnancy—and advance-provision abortion pills, which allow patients to have these medications on hand if they need them. The latter option is particularly important for women living in states restricting health care providers from prescribing these medications.

What is perhaps the most interesting is that even as anti-abortion activists try, unsuccessfully, to scare people away from the pill, they have been successful in taking attention off the real problem: the overregulation of mifepristone by the FDA, which still places medically unnecessary and unjust barriers in the way of increased access.

As I document in a recent article and in more detail in my forthcoming book Abortion Pills: US History and Politics, anti-abortion politicians and threats of violence pressured the agency to be overly cautious when it first approved mifepristone back in 2000, placing the medication under unusual and medically unnecessary restrictions. FDA officials hoped to loosen these restrictions after a few years of safe use, but the Bush administration blocked those efforts.

Not until the waning days of the Obama administration did the FDA finally begin to relax some of the mifepristone restrictions. In 2016 the agency began to allow a wider range of medical providers to dispense the medication and changed the label to extend the recommended time for using mifepristone from seven to 10 weeks of pregnancy. Meanwhile, the World Health Organization recommends mifepristone and misoprostol for elective abortion through 12 weeks of pregnancy.

It took the COVID-19 pandemic, a lawsuit filed by the American College of Obstetricians and Gynecologists and reproductive rights advocates, and, later, the Biden administration to finally get the FDA to remove the medically unnecessary in-person dispensing requirement and open the door to telehealth provision of abortion pills and pharmacy dispensing of the medication. Problematically, the FDA still requires doctors to become certified in order to prescribe or dispense mifepristone, which has discouraged a wider range of providers—including primary care clinicians—from prescribing the medication. The agency also demands that pharmacies be certified to dispense mifepristone. There is no medical justification for these certification requirements: On the contrary, new research shows that abortion pills can be made safely available over the counter.

Anti-abortion politics have in fact prevented the development of mifepristone for other uses. Research shows that the medication is extremely effective in treating fibroids with fewer side effects than other treatments, but researchers could not find industry backers to support clinical trials because drug companies feared anti-abortion boycotts. Studies have also shown that mifepristone could be promising for the treatment of endometriosis and postpartum depression, as well as for contraception. Just recently, European researchers began clinical trials of mifepristone as a once-a-week contraceptive.

Abortion pills are now widely accessible, both inside and outside the medical system, in all 50 states. Not everyone knows about them yet, and many women are still traveling unnecessarily to pick up abortion medications in faraway states. But the Supreme Court mifepristone case played a critical role in raising awareness about abortion pills—a silver lining of an otherwise terrible case. The anti-abortion strategy boomeranged: The more they cried wolf about mifepristone, the more women learned about the medication and became confident that it was safe to use. The lawsuit has proved to be a public relations bo

 

[Dameon Farrow]

This is a losing battle for the right. You can be against abortion but short of locking somebody in a basement against their will you can't stop a woman from getting one. The vast majority of females don't get them and don't want them. Be content with that.

Not everybody wants children.

Not everybody needs children.

All the running to the courts and Bible waving won't change that.