The Promise and Peril of Abortion Pills
Pills put abortion rights into women's hands. But don't underestimate the anti-abortion movement's desire to criminalize those, too.
More than a decade ago, I was reporting in Brazil about the country’s strict abortion ban. I interviewed a doctor who had been excommunicated from the Catholic Church for providing an abortion to a nine-year-old rape victim — he was threatened and protested, and the girl herself had to be smuggled past vicious anti-abortion protesters to even get into the hospital. I talked to a young woman who, pregnant and desperate, told doctors she had been raped so that she could get a safe and legal abortion. While Brazil criminalizes abortion, the state also forced its will women who chose to have babies — for example, by forcing women into C-sections under threat of criminal penalty — and allowing for the widespread abuse of birthing women. “It's part of Catholic culture that this experience of childbirth should come with humiliation,” one doctor told me.
The abortion rights legal landscape, like the landscape for reproductive rights more broadly, was pretty abysmal. But some one million women were still having abortions in Brazil every year. And they were doing so largely thanks to abortion pills.
This is true all over the world where abortion is banned. I’ve reported many times on the proliferation of abortion pills, which women manage to get on far-flung Indonesian islands, in conservative pockets of Pakistan, in Bangladeshi refugee camps, in rural Kenyan villages. Abortion pills have been legal in parts of Europe since the late 1980s. In Latin America, where abortion was long criminalized across most of the continent, women began noticing that the ulcer medicine Cytotec came in interesting packaging, with a little symbol of a pregnant woman with a red line drawn over her and a strongly-worded warning not to take while pregnant. Well. Lots of women began turning up at pharmacies complaining of ulcers.
Nothing has changed abortion access as profoundly as abortion pills, which in the US are typically a combination of mifepristone and misoprostol, and in places where abortion is banned are often misoprostol alone. Before misoprostol, abortion in countries where the procedure was outlawed mostly looked like it did in America’s pre-Roe days: The wealthiest and most well-connected women might be able to travel overseas to end a pregnancy; others might be lucky enough to find a kind and well-trained albeit illegal provider; but many went to scammers and dangerous charlatans, or tried to take mattes into their own hands. In America, the symbol of abortion’s Bad Old Days is the coat hanger. In sub-Saharan Africa, where I’ve reported for many years on abortion access, it might be the sharp stick.
Predictably, this killed a lot of women. Some 70,000 women were dying every year from unsafe abortions, almost entirely in countries where the procedure was outlawed. Five million more were seriously injured year after year after year. And each year, roughly 220,000 children were left motherless. As you might imagine, unsafe abortion was one of the top drivers of maternal mortality worldwide.
Today, deaths from unsafe abortion number closer to 29,000, a nearly 60 percent decrease from 2009. This is still horrific, and these deaths would be near zero if all women worldwide had legal access to safe abortion care. But cutting unsafe abortion deaths by more than half is a huge achievement. It’s worth noting that the global maternal mortality rate has decreased by 40 percent from 2000. In other words, unsafe abortions decreased at a much faster pace, in a shorter period of time, than pregnancy-related deaths generally. Something about abortion changed.
